The tweets (messages on twitter) was so popular last time, I did it again for the follow up laser ablation surgery done on the back of my legs for varicose veins. You can catch the first installment here if you missed it.  And once again, I went through the trouble of reverse flowing the tweets so they go in order as you read down. For the record, I saw Dr. Roger Bonau at The Surgical Clinic in Nashville.

The discomfort this time may be a little bit more apparent from the posts. But the post op has been better. Luck of the draw, I guess.

The award for best tweet to me during the surgery comes from good friend and health care law blogger, Bob Coffield (catch his tweets @bobcoffield on twitter):

@robert_hendrick another twitter use. Monitor real time malpractice. Going to start including tweet requests in discovery

@bobcoffield doc found no humor in tweets in discovery. I did though.

@Robert_Hendrick did you tell him that I am on the defense side?

Enjoy!

Live from surgery part 2. Tweeting my surgery starting around 9am

Sooo. Valium $2.63 last time. $2.29 this time at same kroger. Must be on sale. Purely for research. Going drug free.

Uh oh. The staff at the doc’s office is following me on twitter now.

Getting quick ultrasound on previous surgery spot. Healing nicely.

Smearing betadine on my legs now. COLD.

Waiting for the rock star doc to show for surg. Country music playing in operating room. I love Nashville.

Doc walked in “what the hell are we listening to?”

First stick. No big deal. Still feel the flush and warmth in my body. Nerves.

Man I’m sweating. Stress of recent days ha heightened my apprehension over this. Doc in canulating (trying to get needle in vein)

Dr. Bonau says of the canulating “This is a bit tortuous.” Mmmmhmmmm.

Doc jinxed us when he said “this will be easier than first one.” Getting more lydocaine right now.

Wondering where the health content 08 tweets are. Not seeing any.

@dian_luffman the adrenaline rush has abated. Still on leg #1. Searching…searching…searching

Left leg canulated. FINALLY! Going for other leg and planning to laser both at one time.

@bobcoffield thanks for the distraction.

Doc is giving me his entire educational background. Been at tulane, NY, sloan kettering, st thomas, vandy…

No more pain than the first time. Far more tedious. “Worst is over.”

Firing up the laser…

Lydocaine going in around laser site. Flattens the vein a bit by putting pressure protectsthe vein from the heat.

Ooooooooow. Bad stick. Bad bad stick. Ow ow ow ow ow

Taste of burnt blood in the back of my throat from laser

Right leg hurt like shit up in the hammy. Left leg done and no pain at all.

Oh so glad to be done. Cleanup to ensue. More COLD stuff on my legs to clean.

So doc goes in at calf. Runs catheter up leg about 12″ and then lasers 12″ of vein shut.

Only getting compression wrap on calves. w00t! No behind the knee wrap.

@bobcoffield doc found no humor in tweets in discovery. I did though.

And done. Thanks to everyone!

8 hours after the surgery, the lydocaine has worn off.

Ah. Now I’m getting the feeling of little bee stings up the back of my left leg. This is fun (sarcasm noted).

First off, thanks for all of the concern and support from so many people over the past few days WRT my surgery. It seems I’m telling people things and repeating myself and I hate to bore anyone, so I’m putting this together to give folks the details and use my own experience as a personal example of why change:healthcare does what it does.

Why change:healthcare Does What It Does:

The business end of things…My doc will bill my insurer somewhere around $6,124. However, the allowed amount with my insurer is $2,904. Per the FANTASTIC staff at Dr. Bonau’s office, “double check with [insurer] to be sure and I don’t even know if they will tell you an exact number but you can try… The procedure codes are 36478/36479″

They also pointed me to the insurer’s financial counselor complete with the phone number.

Had I been uninsured, the amount would have been $6,124. On a different insurance, the cost would most assuredly been something OTHER THAN $2,904. And had my surgery not been Medically Necessary, and I had simply done self-pay without submitting a claim, I may have been expected to pay $6,124. Keep your eye on the peanut, now which shell is it under?

change:healthcare helps people sort through all of that.

My Status:

I’m doing well. 48 hours out of surgery the wrap is off, I have to wear a support sleeve on the leg, but I got on my bicycle on the stand in my home office. Rode for an hour at a moderate pace on an easy gear. Felt great to move again. Doing well.

So well in fact that I failed to take the prescribed ibuprofen today (day 2 post surgery). Should have taken some on waking up at 6 AM. After lunch, I started to feel it a bit, and finally got the anti-inflammatory into my system at around 2PM (Kids, do NOT try this at home).

The Procedure:

The procedure I had is called laser ablation or a phlebectomy. It beats the living crap out of the other option which is the traditional vein stripping I had done 25 years ago (I describe the traditional method below).

With laser ablation, they do a local anesthesia and then they insert a catheter into the leg near the vein. they run a fiber optic cable into the vein and use a laser to cauterize the vein closed. I literally stood up from the procedure and walked out the door. The other method would have left me bed ridden for several days and as much as 6 weeks from any significant physical activity (Boooooooooo).

The degree of discomfort during the procedure was less than that of getting some ink. Post-op, the discomfort is minimal and far less than the discomfort that I used to live with on a day to day basis. I did not realize how much pain I was living with day in and day out.

History:

I have a long-running history of varicose veins. My first surgery was at age 16 on both legs. Had a second surgery at 18 on the right leg. That would have been 1983-85 time frame. There was no ultrasound in those days to see what was going on inside, so they did what they thought was best, but in fact it turned out to create future problems. So here I am today some 25 years later dealing with it again.

I went to Doctor N., Head of Vascular Surgery at a large academic hospital which shall remain nameless. I told him the procedure I wanted - laser ablation. He told me the veins were not big enough and that the method would be the traditional vein stripping.

In vein stripping, they put you under general anesthesia and make numerous small (1-2 inch) incisions all down your legs, tie off the veins at those spots, cut them and pull them out. Bad news. Long recovery times (6 weeks) and severe bruising of the legs all along the path of the veins. That’s what Doc N. wanted to do to me. I declined.

A good friend of mine I ride bikes with had the same condition and recommended Dr. Bonau instead. My buddy told me that he did not realize how much pain he was living with until after surgery. Pre and post, the relief is hard to believe. I am ever so grateful to my fellow cyclist.

Had a bit of outpatient surgery done on my legs today. Laser ablation on my legs to eliminate varicose veins. Basically they numb the site, locate the vein using ultrasound, insert a fiber optic cable and cauterize the veins closed at the faulty junction. I was awake and on no drugs for the whole procedure. Opted out of the Valium to calm my nerves. And I “tweeted” (used twitter) the entire experience in real-time. Some of those who follow me suggested I post the tweets. So here they are. For the twitter-savvy, the order is in chron order - went thru the trouble so it would read from top to bottom.

Alrighty now. Get ready for live tweets from surgery. Getting laser ablation on my legs this am.

Got some great paper shorts. Then they french cut them up the side. Gr8!

Pre-op ultrasound.

I’ve got 10mg valium just in case I get nervous. So far no drugs.

Betadine on the legs. Damn this room is cold.

Ah, the joys of medicine. All dignity is sacrificed

Enter the rockstar…erm…doc

Oh crap. The ultrasound is running thru a laptop running windows platform.

To clarify. Having laser ablation to remove varicose veins.

First stick. Little bit o lidocaine. No biggee. Laser in.

2 lasers in top part of left leg. Little bit of sting not bad. Getting a tattoo is worse.

Doc explaining procedure and pointing out what’s going on on the screen.

Looking at ultrasound, doc says,”That’s the sheath and this is the laser” blown up to several times actual size this looks painful. But its not.

Lydocain and sodium bi-carb going in around site for laser. Provides better contact and numbs. Extreme laser heat next.

Head down to make vein smaller. First shot of laser stings a bit. Getting more numbing med.

Getting a bit of a burning taste in the back of my throat. Normal perdoc. No pain now from laser.

2 veins down. 2 to go. 1 lower left leg. 1 lower right leg. Top left leg done.

FYI there will not be pix of this one. Will bring cam next time. Back of the legs in a couple of weeks.

“Lower leg harder to anethesize” yeah thanks doc. Noticing that.

And lasering the lower left. Much quicker set up.

Dr. Bonau rocks! Gr8 sense of humor about all of this. He’s not sure what twitter is but he’s indulging me.

Feels like a bad windows program – searching…searching…searching. Looking for something on left leg. Left is all in back so will get it in 2 weeks. Done.

Now its time for cleanup. Wiping down the betadine from my freshly shaved legs. Maybe I’ll b faster on the bike now.

@bobcoffield @matt_mueller @georgesibble and others. Thanks for all of the support. @caparks. Thanks for the ride.

Leg wrapped tight. Stays bandaged for 48 hrs. No bath. Hmmmm.

Kroger pharmacy - healthcare consumer shout of the day! They have $4 generics but 3x 10mg valium generic only $2.63.

@jenmccabegorman I’m sure its even cheaper in the netherlands.

@bobcoffield had this done at ages 16 and 18. Now at 41. Have watched options evolve. Laser ablation is best imho.

@georgesibble Yep. Normal routine. Movement is good for circulation in lower leg. No heavy lifting. Ibuprofen o’ plenty.

Transparency: Dr. Bonau has performed this surgery 2500 times. 2 cases w complications. Both successfully resolved.

Ran across this neat concept that has started here in Nashville as an offshoot of St. Thomas Hospital. The idea is that those who are in need of prescriptions but are unable to afford them should still have access. The Dispensary of Hope accomplishes this by partnering with pharma to collect unused samples and drugs as they near the end of their shelf-life. Instead of allowing these drugs to run to their end and not be utilized, they distribute them out to the less fortunate. It’s a noble cause and one well worth taking a look at.

The proof of our book is in and people have already started to latch onto the free downloadable PDF version at My Healthcare Is Killing Me.

Seems like we might have struck a bit of a nerve.

Thanks so much to Bob Coffield for the shout out on the book. Can’t wait to catch up with him at Health 2.0 in just a few weeks. Bob is a master of Twitter. If you don’t know him, he’s @bobcoffield.

We’ll probably catch a lot of hell from Steven Krein at OrganizedWisdom for not calling it change:healthcare, but we’re working on that as another title and hope to have it out before November .

And many thanks to the others like Frank Hone and “Why Healthcare Matters” and Zane Safrit who have started to pick up on the book.

Saw this post on the DailyKos that just so perfectly illustrates the state of our healthcare system.

Jollygreen does a great job of breaking down his costs and pointing out how the hospitals have increased their chargemasters in an effort to drive up their reimbursement. To top it off, the hospitals are pushing through as many people as they want simply processing transaction with no regard for things in context such as sending the bill for an ultrasound along with the bill for the other services associated with the miscarriage of that child one week later.

This just underscores again what poor business people most healthcare companies are.

Their approach to smaller reimbursements is simply to increase the billing amount. The approach to dealing with them is to simply low-ball them. Go ahead. Call up the hospital billing office and ask for a discount. They did not feel bad about simply raising the price with no rationale as to the amount. You should not feel bad about not using any rational reason for the lower amount you want to pay.

So with the high cost of energy and that subsequently driving the cost of many things including delivering goods and services, it is small wonder that healthcare is starting to see people cut back.

I’ve seen a good number of articles already on people allowing their insurance coverage to lapse. They are forgoing the premium cost in an effort to save money. That’s a big short-term gamble. It’s a HUGE long-term gamble. Chances are, if someone drops their coverage, they won’t see a need to pick it back up until, well, they really need it. And then it’s too late.

And people are starting to cut back in other ways, too. In the face of efforts by employers to implement wellness programs and disease management programs, people are starting to act counter to that arguably wise practice. A recent WSJ post documents how Americans have begun to forgo those screenings and well care visits. that’s like not putting a new roof on a house until the rain water coming in has rotted out the floors from the leaks.

There are lesser ways to cut healthcare costs. Find a lower cost provider of the service you require (sorry for the shameless self-promo, but it’s what we do). Find a provider closer to you, so you don’t incur the fuel costs (again, sorry for the shameless self-promo, but…). Shop your prescription prices (um, sorry…). Just get engaged with your health and be aware instead of being passive. After all, it is your health, and if you don’t have your health, what do you really have anyway?

People find it hard to believe that healthcare is far more like used car sales than well…even used car sales.

So here comes another article on it from Kiplinger’s on how negotiable those pesky healthcare bills can be. This one talks about  a nearly 70% discount on the hospital bill.

“The doctors said he’s comin’, but you’ gotta pay in cash”

-The Eagles

We’ve enjoyed a bit of a free ride for the past several decades when it comes to healthcare. Employers and the government have picked up much of the tab. But now we are starting to pay the price literally. Increasingly we are asked to pay for medical services. Locally, The Tennessean just featured a piece on a doc who is going to charge his patients $1,500 annually to maintain access to him. We had best get used to it.

I have nightmares of other businesses becoming like our current healthcare system. In these night terrors, I go to buy groceries, pay a $20 co-pay and then get the bill 30-45 days later, can’t understand what it is I got, have already consumed the product and am expected to pay far more than I would ever have dreamed it might cost.

Predictable costs in healthcare will have to become more the norm. Concierge healthcare is becoming more popular. Just ask Jay Parkinson, M.D. who has had a concierge practice in NYC and is starting Hello Health. He uses REAL docs, not nurse practitioners like the retail based clinics (RBCs), but like the RBCs, Hello Health has [gasp] transparent pricing. You will actually know what you are paying at the time of service. Novel concept.

It’s a different way of thinking and doing business on the healthcare front, but it has tremendous merit.

Our unfettered access to the healthcare system has taken much of the responsibility for our health off of our hands.  As partial proof of that, we can point to our obesity epidemic, overprescribing of drugs for any small ailment and overuse of the system (even I have kids who go to the doc at every sign of a sniffle, and then feel silly for being asked what I’ve done to treat it - I noticed it and brought them to the doc). Not only have we stopped being responsible for the cost, but we’ve also stoped being responsible as a society for understanding and managing our health. I’m guilty.

Now we are paying the price.

Kudos to the Nashville Business Journal Health Affairs Editor-in-Chief Susan Dentzer for her insightful comments on many issues surrounding healthcare at the recent Nashville Healthcare Council gathering.

The attention grabbing headline of her corresponding article about the potential for healthcare to be the next sub-prime mortgage crisis rings true though I’m not sure it can all be pinned on HSAs as she does in her article.

Compare the two industries and beyond the similarities in dollars paid out, there are some disturbing lessons begging to be learned.

Housing runs in the hundreds of thousands of dollars for a family. Healthcare has the potential to do the exact same.

Mortgages can easily hit $1200 per month in expense. And at $1200-1400/month for family healthcare coverage, average healthcare premium costs alone are comparable to the size of a mortgage note for many families.

And houses have to be maintained. You need a new roof or air conditioning (that’s where I’m living right now). Those are not small expenses running $5K-$10K per instance. Under all too common circumstances, a major illness can generate bills into the tens and hundreds of thousands of dollars beyond premium.

The financial implications of healthcare are clear. They are equal to if not greater than housing expenses for most Americans. But that’s where many of the the similarities end. And this is where it starts to get worrisome. It is potentially far worse than the mortgage crisis.

With housing, you can see it, feel it, touch it. Now ask yourself if you know what tests your doctor ran that last time you saw them.

With housing you decide when to buy. You decide what the right size house is and the best schools. Healthcare is often times unplanned or in a best case scenario, that pregnancy might give you 7-8 months forewarning, but the cancer did not nor did the broken leg (don’t tell me you were planning on breaking your leg unless of course you had a ski trip planned).

In buying a home, you do your research. Find out what other people are paying. Compare features. Ever tried to find out the price of a strep throat test? Pretty basic, but we’ve tried it, and it’s all across the board. For that hip replacement surgery, did your doc ask if you wanted a plastic of a titanium hip, or did he put in what your insurance would cover or simply what he was trained on and what he knows?

With housing you get all sorts of disclosure information about costs. In fact law requires it. Pardon the uncontrolled laughter, but do you have any idea what you are going to be charged walking into your doctor or the ER? There is no pricetag on healthcare for the most part. Cost transparency does NOT exist and what you pay and what someone else pays for the exact same service can vary dramatically.

In buying a home, you budget for it. It’s a big expense. You don’t go outside of your means and say “Damn it all, that’s what I want and by gosh I’m going to get it even if it’s five times what I can afford.” (OK so those days only recently ended in housing). In healthcare, other than premiums, do you have a budget? Are you on a plan with a deductible? Do you have a co-insurance that saddles you with 10 or 20% of the costs incurred? That can be an unbudgeted $500 or even $10 thousand dollars or more.

Which leads to the terms. For a home, you set up terms. You pay out over 30 years or so. Truth in lending requires them to show you how much you will actually pay out in interest, etc. over the 30 years (try to avoid passing out when you see that one by the way). In home-buying, you set up terms that you are (at least theoretically) able to meet with your income. Healthcare is potentially a home-sized expense. And it generally runs its course within 60-90 days. Not a lot of time for an expense that is potentially the size of your home.

So if you default on your home loan, they repossess it. That’s the pledged asset because on debts that size, no one is going to give you the money for the purchase without securing an asset. Healthcare is really different. They can’t make you take back that nasty gall bladder or break your leg again (though the collections tactics they use sometimes border on that). There is no asset pledged against the expense. Hospital wants the money? You don’t have it. their option is to try to force you to liquidate your assets - like your home. The one you lost in the mortgage crisis?

Does healthcare have the potential to be the next sub-prime mortgage crisis?

No, it has far more potential.