Question for Physicians

[Clio]

I have a question....

But I'm not sure how to ask it.

Yesterday the orthopedic surgeon I saw regarding my knees told me that he can't explain it, but the bones in my legs are producing "bloody marrow" and they shouldn't be. He also told me that my knees were in much better condition than the X-Rays of November had indicated.

But he seemed to regard the production of "bloody marrow" as a good thing, even telling me that "old people's bones" aren't supposed to be able to do that. And that since my bones are doing that, he's not sure he wants to do surgery, he'd like to have me makes some changes to my footwear, my exercise routine, and pain meds and watch the situation for a while.

I'm feeling a tad , cautiously and a little .

Any ideas?

[benherndon]

Hello, Clio!

As people age there is a gradual lessening of the amount of 'bone marrow' that is making red blood cells. However, it never, or seldom ever gets to 'zero' except in rare instances and or extreme age. There are diseases of the bone marrow----some malignant and some benign. I'll assume you don't have either of those. As for your age of being in the '40s' I would say you probably have lots of bone marrow producing healthy cells.

What were the reasons and/or symptoms for which you were visiting the orthopod? That might help us understand his comment pro or con regarding 'bloody marrow'----because normally and in healthy persons most marrow is 'bloody' except in the quite small bones. Spine, pelvis, skull, long bones is where most blood is made. With aging I would suspect the long bones would decrease their blood making earlier than spine or pelvis, and the like.

I must be missing something here.....sorry!

I was not an orthopedic surgeon but a gen'l surgeon---however, all of us docs have been around 'bones' for a long time. The term "bloody marrow" has not been, in my nearly 50 yrs of practice, a common term used by orthopedists. Maybe its its a 'new' term younger generation.....Hmmm!

Elaborate a little, please, on the reasons you were visiting the orthopod and what he might have done IF you didn't have the 'bloody marrow' "problem" he spoke to.

Ben

[Clio]

Hi Dr. Ben!

I'll be glad to. For the last two years, I've been hobbling around on crutches after having been told I have degenerative bone disease in one knee, mediscal tears, cysts, and the beginnings of osteoporosis based on numerous X-Rays and MRI's.

In mid-November, I went to see the orthopedic surgeon (after visiting two others the previous year who could hold out no hope at all for me), and he took some additional X-Rays. Looking at those films it was clear, and he showed it to me, exactly where the damage was, how severe, and surgery was clearly indicated.

He scheduled some additional MRI's for me, which I completed in December. Yesterday, was my followup with him to schedule surgery, the only question remaining to be answered was supposed to be arthroscopic or total replacement.

I've been praying for healing for 18 months, but ever since November, I've been REALLY praying, because I have severe issues with anesthesia. Nearly died once already, and it turned a one day stay into a 6 day stay that time.

Well, when we were looking at the films of the MRI, he was stumped. He said the films of the MRI don't show the same level of degeneration that the X-Rays in November did. He also pointed out red splotches all over my bones surrounding my knees, and identified it as "bloody marrow" as did the radiologist who initially read my MRI. He specifically assured me that what we were seeing was not any kind of cancerous or benign change, but was the level of "bloody marrow" one would expect to see in the long bones of a 20 year old... not a 43 year old with a documented history of bone and joint degeneration.

He told me that there was more cartilage present in my knee than can be accounted for from the X-Rays in November, that my cysts appear to be shrinking, and the mediscal tears also appear to have healed or are in the process of healing themselves.

The whole time looking quite puzzled, and commenting that "it just doesn't make any sense".

I just smiled and told him I've been praying for healing for some time because I really didn't want to have surgery.

Anyway, we've decided to make some minor lifestyle changes, diet changes, and footwear changes and to assess the situation again in 6 months or so.

So... Comments?

Clio

[Nan]

Clio, while I qualify as a physician, this issue is out of my area of practice. What Dr Ben says makes a lot of sense, and any further comment from me would be superfluous. But I will pray for healing for your knees, if that is the will of God.

[Clio]

Thanks, Nan. I kinda had the impression you are an OB-GYN... right? So I'm hoping Dr. Ben will drop back in soon.

His explanation does make a lot of sense.

Clio

[benherndon]

Clio, let us see the reports of the x-rays and MRIs. You can get copies, surely, by asking for them to put into your own files---which you should keeping routinely anyhow.

I know some orthopods here I could ask questions of.

Ben

[Clio]

I can do that. I'm not too worried about it, actually. He didn't seem to think it was a problem, just... a head-scratcher. He's the third doc I've seen and prior to the MRI's said the issues were pretty much what the others had said... just that he was certain he could do something about it.

He said that there wasn't justification for surgery now, because there just wasn't enough damage, as had initially appeared on the X-rays.

Thanks though... I'll see if I can't get the reports and I'll scan them and email them to you.

I'll probably not have them till next week, but I can get them.

Clio

[Pockey]

Becareful, she might sue you.

jk! <img src="/ubbtreads/images/graemlins/wink.gif" alt="" />

[Clio]

Not funny Sid.

I've had plenty of provocation to sue someone, several someone's actually, but I don't believe in lawsuits.

Not a nice way to kid.

[benherndon]

Its OK, Clio. I'm OK if you are! If not too much, let us see the x-ray and MRI reports, if you still wish to pursue finding out whatever 'bloody marrow' means. I'm curious, too.

I only discuss...I do not diagnose or treat people via emails!

Ben

[Pockey]

</font><blockquote><font class="small">Quote:</font><hr />

Clio said:

Not funny Sid.

I've had plenty of provocation to sue someone, several someone's actually, but I don't believe in lawsuits.

Not a nice way to kid.

<hr /></blockquote><font class="post">

Sorry about that Clio.

It wasn't directed at you, just really bad medical humor.

[Clio]

Quote:

---

Sid said:

Quote:

---

Clio said:

Not funny Sid.

I've had plenty of provocation to sue someone, several someone's actually, but I don't believe in lawsuits.

Not a nice way to kid.

---

Sorry about that Clio.

It wasn't directed at you, just really bad medical humor.

---

Thank you Sid. I may be a tad too sensitive to medical humour, but having watched my husband for the last two years.... well...

If I were going to sue, I would have done so when the hospital gave him 3 of the 5 medicines that he's highly allergic to, even though his allergies were all over his chart.

I would have sued when some arrogant little nurse came in and tried to take the IV out of his last viable vein after we were told to not let ANYONE touch it, or they would have to go in through his chest because his arms (thus no pic line was possible) were all used up and he was diabetic and they couldn't use his feet. I had to throw her bodily out of his room he was so agitated. I made the mistake of going downstairs to grab a sandwich.

The BEST recommendation I can give to ANYONE with a loved one in the hospital for something serious, where they are going to be heavily sedated, surgery is involved, or who has drug allergies, is DON'T LEAVE THEM THERE ALONE.

ASK what meds they are administering and why. ASK what the side effects could be, why they chose this med or that med, and if it will conflict with any other of their meds.

If the patient seems agitated every time the nurse comes in, find out why, and GET A NEW NURSE IF NECESSARY. It's your RIGHT to ask for a new nurse.

It's about the patient, not the nurse's ability to hold her job. It may just be a personality conflict, but it's still your right to ask for a new nurse.

DON'T let them quote hospital "policy" at you if you want to stay and they want you out. During shift change, agree to shut the door, so as not to invade other patient privacy, and then abide quietly in your loved one's room so they CAN do shift change.

You CAN sleep in intensive care if necessary. They will bring you a chair with an extendable footstool.

NO ONE will be as vigilant for your loved one as you will. The doc's and nurses are overworked, quite often, and mistakes do happen. It's important to agressively manage your own, or your loved one's health care if they are unable to do so for themselves.

Mike would be dead now, if I had not done so.

Clio

[Jeannieb43]

I totally agree, Clio.

My DH, a physician himself, always said that in today's medical climate, a hospital patient MUST have an advocate with him/her at all times -- to do just what you listed: ask questions, watch what's going on, and summon help yourself in an emergency if the nurse doesn't answer the light. Hospitals are way too short-staffed. The advocate need not be medically trained, just a person who's there, physically, all the time.

During my DH's long last illness, my daughter and son-in-law took time off work and came and spelled me at his hospital bedside. He never wanted to be left alone, and for most of the time, he was not.

Recently I was visiting another friend in the hospital and just out of curiosity asked the nurse why he was being given a certain IV medication [i'd read the name off the bag she had just inserted with his other IV]. She hastily looked to verify the name of the med I'd mentioned, and immediately removed that medication from his IV. She admitted she'd mixed up two different antibiotics by laying them both on the counter at the same time, while they were being prepared -- picked up the one meant for a different patient by accident! She thanked me for asking! No harm was done because it was caught immediately. But it pays to ask questions! The patient has a legal right to know everything he's being given -- actually he has a legal right also to refuse any treatment, including shots or pills.

[Clio]

One of the nurses actually told my husband not to be a baby. They knew what they were doing and he didn't need to know.

Sheesh.

That prompted my stubborn DH to wait till she left the room, pull out his OWN IV's, put on his street clothes and call me from the street corner outside the hospital.

With a femoral artery opening for an angiogram less than 6 hours old.

That was the one and only time he was alone in a hospital... and he was alone because they had life-flighted him to another hospital 300+ miles away. I convinced him over the phone to go back to ICU by telling him he didn't have to take any meds, or do anything they asked, but he had to be where I could find him when I got there. If I didn't get there before his sleep study, he should go to his sleep study, and I would come see him before they had him go to sleep.

I got there, demanded his meds list, found three on there that they were giving him that he was highly allergic to, and went upstairs to the sleep lab to reassure him.

I could have owned that hospital. Chose not to.

Clio

[Morning Glory]

Clio,

I am apalled that a nurse would tell a patient that!! I "prided" myself on being very sensitive to patients varying needs and educating them on what I was doing for them and why. Not always easy, but the only way to ensure that they got what they needed and understood what was going on.

In fact, just last week a patient asked why he needed to have home therapy as he had had it for his other joint last year, and knew the exercises. I explained that we all forget details, and it would be a to his benefit to have the professional make sure that he was doing the exercises correctly. That is all he needed to hear to be convinced.

It was when I was "threatened" with working 12 hour shifts and greater patient loads that I said enough. If I don't have the appropriate time with my patients to do the care and teaching that they deserve and need, then in my opinion it is not safe for me to be in that situation. So, I am not. It scares me to see the way things are done now!!

I completely agree that someone needs to be with you in the hospital if you are going to be sedated and not able to make decisions for yourself. There are ways to be informed regarding what is going on with your patient without being a "problem" for the staff. I really hated caring for a patient whose loved ones would not let me do my work. Those were the patients that didn't get the care and attention that they deserved because of intrusive relatives. There are ways to NOT be that kind of relative!!

From what you say, I don't get the impression that you are "one of those," Clio. Your hubby is SOOOOO fortunate to have you!! Keep on being the advocate that you are now.

MG

[Clio]

Thanks MG!

I don't think I'm one of those either... My hubby the patient is though. All the nurses in the ICU here know us, and greet us on the street, and stop by to visit for a few when we make our run to ICU.

The ICU nurses in Anchorage know us also, and they always rearrange their loads so Mike gets his favorite nurses. They know to keep that arrogant little... well... I could hear her at the nurses station and she was talking how Mike must not like women... away from me, and from Mike.

The nurses on the telemetry floor at Anchorage know us well too. They come by and visit even if we're in ICU.

LOL! First name basis with all the emergency medical staff in the two largest cities in Alaska... and the EMT's know the way to our house... This last time, one of the guys got out of the ambulance saying, "Chief, you should have listened to me. This is my fourth trip to this house. You wouldn't have taken that wrong turn."

But Jesus is on the move. He has granted Mike gentle withdrawals from the addiction to fentanyl. Not once has he thrown up, no hot and cold sweats, no heart palpitations or chest pain. He feels dreadful, but no trips to ER.

I'm cautiously optimistic for how the rest of the week is gonna go.

Clio

[Gregory Matthews]

I am tagging on here, and making some general comments:

a) One can certainly request that other health-care providers by the ones giving care to a patient. I serve on a hospital ethics committee. We once removed a MD from the care of a pt. due to essentally personality reasons. A pt. does have a right to refuse care to include care from a specific person. However, we also sometimes tell patients, and family members, that a refusal of care from a specific person means that we will be unable to provide them with care, they will need to go elsewhere, and we will attempt to help them get that care elsewhere.

We may chose to allow familiy members to remain in the room while we are giving care. But, we have the right to refuse to allow such.

c) We may provide family members with clinical information about the care of a patient (e.g. medications), but we have the right to refuse to do such.

d) A Federal law, commonly known as HIPPA, prohibits us from providing certain information to people other than the patient. In such cases we will not do so, and it is up to the patient to share that information if the pt. wishes to do so.

e) When a family member inappropriately demands to remain in the room, to recieve confidential information, or otherwise acts inappropriately, we provide that family member with a police escort to a place where they can calm down. Normally the family member does, and it is a rere occurance when we either have to issue a citation to appear in court, or to arrest them. But, when required, we will remove them from the hospital in handcuffs, and take them to a place where they will not longer cause our staff a problem. E.g. we do not allow family members to physically assult staff, other family members, visistors, or patients.

By the way, I have seen all of the above. Fortunately, the vast majority of the time, a simple police escort to a "quiet room" followed by a calm discussion of the issues is all that is needed.

[Naomi]

</font><blockquote><font class="small">Quote:</font><hr />

Gregory Matthews said:

I am tagging on here, and making some general comments:

a) One can certainly request that other health-care providers by the ones giving care to a patient. I serve on a hospital ethics committee. ............ A pt. does have a right to refuse care to include care from a specific person. ..........

<hr /></blockquote><font class="post">

<img src="/ubbtreads/images/graemlins/129933-offtopic2.gif" alt="" /> and tagging on. A few years ago after a serious stroke I found much personal stress developed by attempting to communicate with health care personnel who spoke very heavily accented English.

When I asked for someone else to care for me I was treated with much resentment by ALL hospital staff.

I was refused PT treatment because the staff were from another country and their English "was not up to my standards". The neurologist assigned to me removed himself and they had no one "available" to take my case. The cardiologist followed suit.

Side Note: In spite of receiving limited treatment I worked hard on my own physical therapy and prayed a great deal. Today few people would know that I had been completely disabled for over 6 months. God is good, all the time.

What is so interesting is that my personal physician is from South America. I am patient #18 and have been seeing him since 1988.

Under most conditions attempting to understand someone's broken English is not a problem to me. However, at that time, it was a serious issue. I was working hard to comprehend even the most basic of activities and actions.

As I visit others who are hospitalized, I have noticed that the trend for more and more heavily accented people appears to be increasing.

I suppose my point in all of this is that things do not always work as designed. When you are disabled and have no one who can be with you all the time or a lot of the time (I am amazed that so many people have that type of attention) you should carefully choose your battles ... and carefully (tactfully) ask your questions.

OK, I'll stop ... <img src="/ubbtreads/images/graemlins/focus.gif" alt="" />

[Clio]

And in most cases, that may be appropriate. But when the patient becomes so agitated due to the care provider's callousness, and downright WRONG care, and has demanded family member's presence for reassurance.... and been denied it, then there's a huge problem.

Had she continued on her course of action, instead of an IV, they would have opened up my husband's chest and gone in that way.

I hold durable power of attorney for all my husband's medical needs and care, and if he's going to get any treatment except in extreme medical necessity, they're going through me first. Period. There is nothing confidential they would discuss with him that they shouldn't be discussing with ME first and allowing me to present the information to Mike along with options, consequences, and implications.

He would be dead due to nurse's and doctor's errors caused by sloppy notes in the chart and failing to read the chart several times over in the last few years. Had they tried a police escort on me, I'd've owned the hospital. And that little nurse and the prescribing doc's individually.

I'm not unreasonable, and neither is my husband. But I'm not going to allow over-work and arrogance to kill him either.

When I stay with Mike in his room, it's to protect him, but it's also to make sure that he's cooperative with his health care staff, kept calm to ensure he CAN be cooperative, and to reassure him because when he's heavily sedated, it doesn't matter who you are, mine is the voice he responds to... period.

I generally put it to them this way. "you can have an easy shift with my husband.... or not. Your choice. You let me do most of his care with the exception of administering meds and taking vitals, and you both will have pleasant, easy shifts. You don't and you start trying to run me out of his room and he's going to get apprehensive."

They take one look at my 6'4" 50" around the chest with a 38" waist husband and even sick they generally decide they'd rather not have him be apprehensive. Especially when he looks around and starts demanding where I am because he can't see me.

Didn't used to be an issue, he was willing to trust them, until we'd had so many problems with medical staff he won't even sleep in a hospital room without me in there with him.

You want a calm, non-agitated patient? Then you want me in there running interference for you. A police escort for me, will get you Mike pulling IV's out of his own arms, getting dressed, and leaving. Regardless of his condition at the time because if they're escorting me out, then to his way of thinking, they've got something to hide.

Fortunately, most of the medical staff know us well enough now, to not try such foolish stunts.

And I am experienced enough and medically savvy enough to know when to get out of the way. But I prep Mike for that, so he's calm and cooperative and not afraid.

Clio

[Clio]

Naomi,

After I bodily threw that nurse out of his room, because her mere presence had him totally agitated after I had spent over an hour calming him down through his drug haze, she sat at the nurses station and said loud enough for me to hear "He must hate women, I don't know what's wrong with him."

I walked over to the nurses station and asked her, "Did he tell you not to remove his IV?"

She very icily said "Yes, but I know what I'm doing."

I picked up his chart that was sitting in front of her and pointed to the big red letters two inches high across the front that said: DO NOT REMOVE OR CHANGE IV. Then I told her, "You caused so much agitation in my husband that even still sedated from surgery, with an open femoral artery, he was attempting to get out of bed, dressed and get away from you. This is not about you, it's about him, and getting him well. You refused to listen to him, you refused to listen to me, and you didn't read his chart. He doesn't hate women, he just has an aversion to having his chest opened up needlessly. I can hear you when you talk at the nurses station and so can he."

Had I not been there, I do not doubt that something like what happened to you would have attempted to happen to Mike.

I'm so sorry you had such a bad experience Naomi. Unfortunately, it's more common than not.

Clio

[Naomi]

Clio,

I am so glad that you were there for Mike.

I don't know what the stats are now but a few years ago, more people died in hospitals, due to errors by the care giver, each year than all of the people killed in Viet Nam.

Now I am in no way saying that we do not have a lot of very good, competent, compassionate care givers in our hospitals.

Sadly, like everything else, it's the bad ones who get the press.

I am very thankful for the overworked, overtired, loving dedicated nurses and Drs who are there when we need them.

Naomi

[Clio]

Quote:

---

Naomi said:

I am very thankful for the overworked, overtired, loving dedicated nurses and Drs who are there when we need them.

Naomi

---

You know what? So am I. They are awesome. But unfortunately, there are now enough of the other kind, and I do think some of it relates to the overworked, overtired adjectives, that it's no longer possible to "trust" that they know what they're doing.

The staff at the hospital here in town have been wonderful. We've not had any problems here, after the first time. And they recognized right away that he was calmer and more cooperative when they used me as a resource in his care.

We've only had two problems out of 4 trips to Anchorage, but that's a 50% error rate, and both could have had catastrophic consequences.

A good nurse or physician is worth more than can ever be paid to them, and the other kind... well... I dunno. Too close to the negatives for me to comment.

Thankfully Jesus is more than sufficient.

Clio

[bevin]

Quote:

---

they would have to go in through his chest because his arms

---

Clio, by this phrase I suspect that they were telling you that they would have to do a "central line"

http://www.pedisurg.com/PtEduc/Central_Venous_Access.htm

http://www.emedicine.com/radio/topic859.htm

Quote:

---

He doesn't hate women, he just has an aversion to having his chest opened up needlessly.

---

These lines are usually inserted without opening up the patient's chest.

Your experience was horrible - and I am fully supportive of your actions. I just thought this detail should be cleared up.

/Bevin

[Clio]

Hmmm... It's been more than a year now, but I do recall that they specifically said they would "open" his chest.

Could be though. It was a rather "exciting" day. Mike can be rather stubborn when he's scared, and the combination of what happened on top of still being pretty groggy from anesthesia...had him nearly beside himself.

But a "central line" also sounds right too.

Could be, bevin. Could very well be. We've also had a pic line installed, and that was bad enough, and they told us it was preferable to a central line. But that was a different trip to Anchorage.

Clio

[Clio]

Heh.

Mike isn't a coward. BUT when he's medicated up, he recognizes that he's not sure what they're doing and can't make informed decisions.

So... apprehensive is probably a better word, and it can escalate to fear if he doesn't have me running interference for him, because he knows even on his best day, he needs some help interpreting medical-speak.

Trust. It's about trust. And he trusts me, and doesn't trust most medical staff.

Just wanted ya'll to be clear I don't consider him a "fearful" person. But, well... when you're really sick, the kind of sick where physicians see you and stop, and come in and say, "Wow! I didn't expect you to still be alive! You're doing great!" apprehension and fear can take on a whole new meaning.

Clio