Elders Being Green
INTERESTING STUFF – 15 February 2014

Crabby Old Lady and the Medical Establishment

Throughout her life, Crabby Old Lady's relationship with the world of medicine has been sporadic and she is only half kidding when she says that's what has kept her remarkably healthy through her life because doctors always find something wrong.

It's similar to the world looking like a nail if you are a hammer; if you are a physician, every patient needs treatment.

Since she moved to Oregon in 2010, Crabby's closest connection to the professional health community has been an annual flu shot from a pharmacist. Oh, and her yearly eye exam.

Now and then she reminded herself that she was getting on in years and ought to find a primary care physician so to have a baseline of medical records for comparison if something goes wrong in the future.

Good idea but not as easy as you would think.

Only a few medical schools in the U.S. require short courses – about six weeks – in geriatrics for non-specialists so ideally, Crabby wanted a geriatrician, someone with a lot of education and practical knowledge about old people's health.

That idea did not work out well. When, in her online research, she located a few and called their offices, Crabby was told they were not taking new patients. More than once, she was given that information after being asked what kind of insurance she has – Medicare, of course.

(Crabby is not saying there is a connection between insurance and physician availability but it does leave her wondering what kind of insurance a geriatrician's office would expect most people who need a geriatrician to have.)

After a few such discouraging telephone conversations, Crabby would set aside her search for a future day and did not often return to it.

Moving on.

In January, eight years after the initial diagnosis of cataracts, Crabby's doctor said she was ready for surgery and before she could say howdydoo, she was being evaluated in an eye surgeon's office.

But wait. No surgery without a recent physical examination. Uh-oh. No primary care physician in Crabby's life.

Armed with a recommendation from the surgeon's office, Crabby got lucky that day and within an hour was undergoing a general examination, blood and heart tests, etc. with an internist in the building next door.

So in a period of about three hours, in addition to her established eye doctor, Crabby had acquired an eye surgeon and a primary care physician – a collection that, in 21st century business jargon (it IS business these days), could be referred to as her personal healthcare management team.

Oh, but she was not nearly finished yet.

Crabby Old Lady doesn't remember much about her bout of flu in January. She lost about 10 days of her life and when she awoke clear-headed again, her right foot didn't work properly.

Before she goes any further, let Crabby explain something that won't be a surprise to anyone who has read this far: Crabby's theory of healthcare is that if it is not a broken bone or an artery gushing blood, give whatever is wrong some time and it will probably take care of itself.

Although Crabby does not recommend this conduct for others, her personal experience is that most of the time it works. It did not with her foot.

Step. Flop. Step. Flop. Step. Flop. Crabby could not lower the sole of her foot to the ground in a normal way; it just dropped to the ground (flop) on its own after her heel touched down.

A virtual walk around the web revealed that it was probably something called peroneal neuropathy and after a visit to Crabby's new primary care physician, she was in the office of a neurologist who was sticking electrified needles into her foot and leg.

Yup. Peroneal neuropathy caused, in Crabby's case, probably by crossing her legs - “don't ever do that again in your whole life,” said the neurologist. It's a common condition, he continued, and in Crabby's case treatment will return the foot to normal or near normal function but it will take months of physical therapy.

So Crabby Old Lady, who began 2014 with only an eye doctor, now has a personal healthcare management team consisting of that eye doctor, an eye surgeon (temporary), a primary, a neurologist and a physical therapist. She can't wait to see what's next.

Although there is some comfort now in having a primary care physician – someone to call when something goes wrong in the future - perhaps you can see Crabby's point: get involved with the medical establishment and they multiply like bunnies.

At The Elder Storytelling Place today, Chlele Gummer: My Dandy Brandy


I have that same problem here. The only reason I was able to keep my primary care doc is because I have a medicare advantage plan also. She doesn't take Medicare. Many now don't.

I love reading your column. However, your past (lack of) experience with the health care establishment is one aspect of your writing that always seemed quite out-of-sync with the experiences of most old people I know. Most of my friends have various ailments, have had a couple of real scares, and are on close terms with doctors.

Happy Valentine's Day dear Ronni.

PS: Crabby and my inner self Miss Rose agree on this doctor thing.

Agree on the doctor thing; don't see 'em unless you have to and you'll do fine. Or at least that's what I hope and practice.

But also: eventually most of us will be in some kind of "managed care." That is, we'll enter the system through a primary care doc and get seen by specialists on referral. The system (insurance company or non-profit or Medicare contractor) will make its money by its efficiency at keeping us well and needing few services. Something like this is probably the only way to squeeze waste out of medical costs.

And when it works -- when your ailments are pretty standard -- it is a wonderful system. (By sheer luck, I'm in the Kaiser system which is the prototype.) But people are going to feel constrained by changes in this and, shall I say, "crabby."

I am glad your foot will mend with time and therapy. I am thankful that I am able to get doctors with my coverage, but I do know what you mean. I feel like I am in a web of them. One refers to another and that one reports to the primary who refers to another and on and on it seems. I like that your theory worked for you for so long. I say seeking medical care is a personal choice as to if and when. Thank-you for sharing some of your experiences.

On your next trip in make sure you get a CBC and A1C - have the Thyroid checked and also the diabetes situation evaluated.

You'll get to meet another raft of friendly physicians!

I have a primary care physician I like and rely on—It helps that she's a she. However, sometimes, during my annual exam, I don't tell her about some minor symptoms I've experienced because I don't want to be thrown into a whirlwind of new tests and doctors yielding no definitive result. And you're right, Crabby Old Lady, usually the symptoms subside on their own. As my Aunt Beulah used to say, "Sometimes the more you stir it, the more it stinks."

Crabby Old Lady has the same feelings about doctors as Cantankerous Old Codger (me). I told my doctor "If it's not broken, bleeding or dangling", I'm not going to the hospital. So far so good. And about the walking thing...
I was hospitalized and in bed for 2 months. When I tried to walk for the first time I had lost all of my ability to do so. Finally. after months of PT, it started to come back. Two years later I still need a cane to get around. I wish you good luck.

Better get used to those bunnies. At our age, they become increasingly important. We have less resistance to and ability to recover from aches and illnesses, as I learned this winter. An ordinary sinus infection had me down for two months. It seems I don't "bounce back" like I used to.

I have had more primary care doctors than I can remember. They either move away (2), give up their practice (2) or are no longer on my HMO plan. It's a royal pain as you should have a personal relationship with your primary care doctor; one who remembers you from visit to visit and one who will notice changes and what to test for.

I only see my primary care doctor when something serious goes wrong and he is not happy about that. Like you, Ronni, I try to avoid doctors like the plague, but they are a necessary evil and it is not always wise to ignore symptoms. I found this out when I had a diseased gall bladder and by ignoring the symptoms I nearly died. By the time it was so painful I could no longer put off getting medical attention I almost ended up with peritonitis.

I'm glad that physical therapy will restore your foot function to normal.

I am so in agreement with your outlook of not looking for things that might go wrong--

I have know people who are constantly proactive and are always having something done.

So far--I have been very lucky--

Crabby, I am sooo in your camp! Occasionally, just because I'm over seventy, I get a fit of hypochondria, but that too passes. I do love my primary care doc, who harasses me for a yearly test or two--though I'm hoping to talk him out of a mammogram, given the latest research. I always feel a little guilty--as if I will be struck down because I don't do the requisite number, whatever that is, of doctor visits.

Crabby, consider seeing a good podiatrist. Mine is excellent, conservative, and does not push surgery (I have ugly, protruding bunions that do not bother me). After a simple foot x-ray, he was quick to diagnose and relieve my severe ball of the foot nerve pain with a simple moleskin pad for the bottom of the foot where the pain was. The only negative, he is super busy.

And I agree with Ponce de Leon's good advice on the other stuff.

I agree completely. I feel the same way about medicine. Remember they are practicing physicians and they are practicing on you.

One thing leads to another. In my case, extraction of two teeth led to extreme gastritis which led to numerous expensive tests. It turns out that I simply can't take ibuprofen, the pill I was prescribed for pain after the extraction. It has taken me over six months and dozens of prescriptions to recover.

I heartily agree with Ronnie that one should avoid doctors as much as possible. I'd hate to think what it would cost me if I were a hypochondriac.

Ronni you mention that you are covered by Medicare but aren't we supposed to have a second carrier also?

Emily T...

I'm afraid I don't know what you are referring to.

Oh, wait. Are you talking about supplemental insurance (also called Medigap) that helps cover medical costs that original Medicare doesn't pay for?

If that is what you mean, it is offered by private insurance companies but no on is "supposed" to buy it. It's a good idea and people MAY buy it if they choose.

If that's not what you mean, you'll need to explain more.

Because I live in two places, I need two health care management teams. I found out the hard way that one should not be without an in with the medical community wherever one lives. Anyhoo, my main message is that if you have a condition for which you must take medication, do all in your power to stay abreast of news in this area. My bigee is my dicky heart...Educate yourself and always ask "Why?"

Watch the news for the word that NSAIDS are not without serious side effects.

Crabby, I hope your therapy works well and that you are soon back to normal.

Yes Ronni that's it Medigap...I like to know more about what Medigap would cover that's not covered by Medicare..
Emily T

Emily T...

You can research this online as well as I can. Just google something like "what does medigap cover."

PT always seems to take forever but - works. Hope your foot is fine in time for some Spring walks.

Sounds like "drop foot," which I also have had. PT goes fast if you do the exercises and also get professionally designed orthotics (which I wear in all of my shoes now). I have found that my foot problem affects my knees, hips, and back if I don't use my orthotics. If possible, you should see if you can find someone locally who makes them for athletes and dancers. That's what I did, and I was even able to continue ballroom dancing (of course that was in a much younger life.) Good luck.

Ah, the team that never plays together--our various doctors. I've called 3-4 doctors here in Portland looking for a private practice, something outside of OHSU. but each time I'm told they're sorry but they don't accept Medicare. I've found the medical care in Portland to be not so great, but then I was spoiled before I moved here. Gosh, not spoiled, medical care should be with someone who knows who you are.

Be afraid. Be very afraid. you have placed that foot on a slippery slope.

Yes, many doctors will not accept new patients who have Medicare. It took me five hours of calling doctors on Medicare's list, until I found one who take me as a new patient.

Bless you, Ronni!!! My team has about 7-8 doctors and another is waiting in the wings. I envy you.

Oh my gosh did I uncross my legs quickly as I read this! My theory of health management is pretty much exactly the same as yours. Did the eye thing a couple of years ago. Saw a GP for the first time in two years last summer. Need to see a dermatologist soon. We're in Florida and I'm a former blond.

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