Thursday, November 29, 2012

Adventures in Health Care - My Liver

I hope that this topic does not become a regular feature here at RR.  At my age, anything is possible however.

Back in September of 2010, while vacationing in Provincetown, I had an annoying discomfort just below my right ribcage.   I had experienced this before and the discomfort always went away within a few days and wouldn't recur for months.  Out of sight out of mind, so to speak.  When it wasn't bothering me, I didn't give it a thought.

This was all pretty much according to my philosophy: if you wait a while, generally three months, the pain or ache or whatever goes away.   Like when I threw that rock out of the garden one day and my right shoulder kind of went "crunch".  I don't know if it was a sprain, or what, because I never got it looked at.  For a while I had to bring my left hand to the assistance of my right arm - just to hang my bathrobe on a hook.  I waited three months.  It got a little better, but not much.  I waited another three months.  It would get a bit better, then worse.  Well, it took about two years more and it's as good as new.  OK, so the three month rule doesn't always apply.

So with the pain in my side, I figured.

During my yearly physical back in November, 2011, the doc asked if there was anything that I was concerned about.  I started to say, "No, nothing."  But then I figured, what the hell, I'll tell her.  Well I mentioned three things.  One was an infection that started with a hangnail on my left middle finger;  the second was the discomfort under my rib cage and the third was a sinus problem.

Well, I guess the doc now had something to do.  She prescribed an anti-biotic for the finger and made referrals for the ache in my side and sinus problem.  So began my adventure in health care.  I  am fortunate that my complaints were minor in comparison to people with real health issues.

To make two long stories short, the hang nail was finally cured around July or August of this year 2012 after three courses of two different antibiotics and a surgical lancing which was not done by my primary care physician, but by a surgeon and which came with a hefty bill to the insurance company.  I could have done it myself with a new single edge razor.  So, even with medical care, my hang nail took about nine months to cure.  My fingernail still has scars from the infection.

The sinus problem was dealt with by an Ear-Nose-Throat Doc and Flo-nase.  Knowing that my insurance is crap, I had verified several times that the Doc accepted my insurance and even had the receptionist write that on my co-pay receipt.  Turned out, the receptionist called me at home later to say I could not come back for a follow-up visit because they did not, in fact, take my insurance at that office.  Good thing the sinus problem cleared up with the flo-nase.

The third story - the pain in my right side, began with blood work and a referral for ultrasound of my gall bladder.  The gall bladder was OK, and the blood tests were good except one showed an auto-immune antibody for smooth muscle - the liver - which might indicate that my body was attacking my liver, or so I understood.

So Primary Doc sends me for a MRI and to a rheumatologist because they deal with auto-immune diseases.  The MRI showed an enlarged liver.

It took a couple of months to get an appointment with the rheumatologist.  The rheumatologist said "I don't know why you were referred to me, you need to see a hepatologist - a liver specialist."  But I still had to pay my co-pay for the rheumatologist, of course.

That referral to the liver doctor took another three weeks.  I had more blood tests.  More co-pays and something called "co-insurance".  The hepatologist said, "Much ado about nothing, but I want to do some more blood tests."  By the time the blood tests came back, I was experiencing a discomfort lower in the right side of my abdomen and my checkbook.  I was thinking I'd developed a hernia because one day when I had bent over it felt like my innards had turned inside out.

About four weeks later the hepatologist said the blood test were normal, except for high triglycerides, which I've always had.  I was assured that I probably did not have a hernia, but that I should have a liver biopsy.

That took about another four weeks to schedule.  I had to have more blood tests and co-pays first.

So today, a year after I told my Doc that I had some discomfort in the area below my right ribcage, I had a liver biopsy.

I would not recommend having one, just for fun.

The hepatologist was very good, explained everything during the procedure and was very accurate and precise.  I tried to relax during the procedure by pretending to be One With The Universe.  After the somewhat painful local anesthesia, the actual needle insertion was instantaneous and hardly felt. But there was an immediate pain as soon as the needle had done its job, like being punched in the gut.

It made me think how painful it must be to be shot with a bullet or stabbed in the gut with a knife.  And how there is way too much violence on TV.  And how people should not do such things to others.  I was on a minimal dose of pain medication.

The recovery required two hours laying on my right side to prevent internal bleeding.  I had a good dose of  IV pain medication that was very nice, but I couldn't help wondering if the insurance would cover it.  I had peed at 8 AM.  The procedure and first two hours in recovery brought me to 12 noon.  They were dripping a quart of saline by IV into my vein during that time and if you don't think I had to pee by 10:30 AM, you'd be wrong.  The nurse brought in the "urinal".

Leon says that the moon and stars must align for me to pee in a public place.  There was no way my faucet would open while laying on my side, especially with all the hustle and bustle just beyond the curtain and the nurse waiting for a result.  I can't pee under duress, like if someone is waiting to use the urinal I'm trying to use at the Pennsylvania rest area after three hours on the road -  even with a bladder ready to burst.

I tried four different times between 10:30 and noon.  Finally at noon I was allowed to sit upright and I scooched off the bed, against orders, to pee standing up - the way nature intended.  Then I begged for a blueberry muffin and orange juice.  I was wondering if that would be added to the bill for charges the insurance would not cover: Blueberry muffin, $15.98, Orange juice, $9.47.

So now I must wait a week or two for the biopsy results.  And for the hospital bill for what the insurance didn't pay.  That will be a whole different adventure.

P.S. Leon took pictures of me in the recovery room on his phone, but it is an old phone, not at all smart, and we need to figure out how to download the photos to the computer.  So no pics on this post for  now.  Maybe tomorrow, if I don't look like a 64 year old who's just had a liver biopsy.

UPDATE: Results of the biopsy showed only a fatty liver - something like fois gras before being paté.
I should eat a low-fat, low-calorie diet and lose weight.  That was it.  I guess that means little or no cheese or dairy, not bacon or sausage, little or no pasta or bread and definitely no cookies (yeah, right) no occasional glass of wine or beer.  Una cena senza vino (pasta, pane, biscotti, gelato, formaggio) e come una giornata senza sole.


  1. Interesting adventure. Hopefully the tests will tell you what is going on.

    That said - I don't look forward to that aspect of getting old.

  2. You are aware that 60 is the new 40. Provided of course that you live to 60. "Old" is now the "O" word which is politically incorrect like the "F" word and the "N" word.

  3. Hang in there Frank I'm going through the same thing with my kidneys. I have to get blood drawn and the go for an MRA (Magnetic resonance angiography) where they send you through this coffin-like machine. I've had it before and almost lost it after being in there for 40 mins.
    I don't know what Medicare will cover this time either. It's the only insurance I have plus I'm still paying off my last hospital stay this past summer.
    Oh the joys of old decrepitude!

  4. Sorry you had to go through that ordeal, sounds to me like the problem is definitely a deficiency in the checkbook lobe. Once the docs figure that out, they will kick your ass out the door and tell you to man up and quit wasting their time.

    I speak from experience. Good luck with all that.

  5. Sorry to hear about that, there are many people who face issues related to liver, consulting with a physician for checkups can help to diagnose and treat the problem.



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