Sunday, December 14, 2008

DBS SURGERY IN A MRSA-RIDDEN WORLD

Originally posted on 11/14/08

You might want to give some serious thought before you sign up for any surgery.

It's on the Internet. It’s on television and in the newspapers.

MRSA, pronounced Mersa, sounds innocuous, almost poetic. Don’t let the name fool you.

MRSA stands for Methicillin Resistant Staphalococcus Aureus, or: a staph infection that is resistant to most known antibiotics. As the title states, these little creeps are resistant to normal penicillin drugs that heretofore have been used to send them to the great beyond. Now they sit up on their haunches and laugh at the antibiotic as it courses through the body, thumbing their nose because they know they have a permanent home in the dark recesses of their host.

My husband, Ray, has Parkinson's Disease (PD). He's had it for almost ten years, but it has just recently turned ugly. The dyskinesia (involuntary movement), seen by thousands of viewers at they painfully watched Michael J. Fox in Washington, D.C. asking for help for this disease, is one of the ugly parts about PD.

When it got to the point that my husband couldn’t even sit without nearly jumping out of the chair, we knew it was time for some help.

Parkinson's is caused by the failure of a group of nerve cells in the brain to produce adequate amounts of a dopamine. Dopamine is necessary for smooth, coordinated movement and muscle relaxation. Some patients, therefore, have no control over arms, legs, neck and head, which seems to take on a life of their own as they jerk, lift, flail, and tremble.

We looked into a procedure called Deep Brain Stimulation (DBS). Holes are drilled into the top of the skull and then wires are forced down through the holes and into the brain to find a spot that irritates the cells, causing a disruption of the dyskinesia.

The surgery, if all goes well, stops the dyskinesia completely, and supposedly the patient is able to lead a fairly normal life. We promptly signed up for the procedure at Loma Linda University Medical Center in California, and on January of 2008, Ray underwent DBS. He has been relatively shake-free since then.

However, along with the installation of the wires into his brain to calm the dyskinesia (we were later to find out), a few nasty little bacteria known as Staphalococcus obviously took up squatting rights on the wires before his head wound was closed.

Being Snow-Birds, we left in June for Washington, six months after the surgery. At the end of the month I noticed a spot of blood in Ray's hair just above the ear (and right over a wire). We were referred to a UWMC neurosurgeon, who felt it was just a slight break in the skin with some inflammation, rather than an infection. He opened the wound, cleaned and closed it. Antibiotics were prescribed for four weeks.

Two months later the wound appeared to have a bulge under it, so off we went again to the doc, who basically did the same thing; opened it, cleaned it, closed it and put him on antibiotics again.

The third trip, a month later, caused the doctor to throw up his hands in exasperation and suspect something was amiss. He called in a prescription for a stronger antibiotic.

Two days later, after we'd flown back to California, the Washington surgeon called to say that the laboratory results showed Staph. Ray would now need to take a much stronger antibiotic, Zyvox, which he would call in to our pharmacy and Ray was to start immediately. He also strongly suggested we see the DBS surgeon in California as soon as possible.

Now, some infections can be licked pretty fast, but having a foreign object in the body is the ultimate to these little scum bags. With all the wires and plates that were inserted into my husband's head during the DBS procedure, it must have seemed like an "A" ride at Disneyland to these bugs. As the doc explained to me, the bugs like to latch onto those foreign objects.

It was now time for me to throw up my hands in exasperation. After spending over $200 on the antibiotics for those first two occurrences, I now had to toss them and get yet another.

Now the pharmacist was shocked. “You do know these are very expensive, don’t you?” he said as he typed in the prescription for insurance approval.

“Well, no, but what can we do? We have to have them.”

“Very well, but you must be in the “gap” with Medicare, right?”

“I have no idea. Why?”

“Because the prescription for six weeks is seven-thousand dollars!”

I chuckled as I dug through my purse for my husband’s Medicare card. Then I looked up as the words hit home. “Huh?”

The pharmacist was not smiling. “The bad news is you will owe three-thousand dollars. The good news is Medicare will pay four-thousand dollars.”

“You’re kidding me, right? How could an antibiotic cost that much.”

“I’m afraid I’m not kidding. That’s why I asked if you were in the 'gap' because I think Medicare would pay more if Ray had met his deductible.”

I struggled to come to grips with what he was telling me. “I can’t believe that. What do people do who have no insurance and need this drug?”

“I guess they do without,” he said. "But it doesn't always work. I have an elderly lady customer who has used this same drug and it didn’t work the first two times. She’s on her third go-round. So you have no guarantee with this.”

“OHMYGAWD! I don’t have three-thousand dollars to hand you right now.”

“Then my advice to you would be to have your doctor admit your husband to a hospital for the intravenous injections of this antibiotic. It would be much safer and cheaper because Medicare would pay.”

I digested this for a few minutes. “Well, we do have an appointment with the surgeon who did the DBS in five days. Could I just buy enough pills to get him by until we see the doctor and ask him to admit my husband?”

“That would be smart,” he said, turning back to his computer. He put nine pills in a little brown bottle, handed it off to the clerk, who smiled at me, and said, “Seven-hundred and eighty-three dollars please. Just run your credit card through the slot.”

“What? No! Please tell me you’ve made a mistake. Seven-hundred and eighty-three dollars for nine pills?”

“Yes Ma’am,” she said, repeating the amount as if I were deaf.”

“I heard you, dear. I just can’t believe it!“

Medicare’s rules for payment state that you must first be hospitalized for three days before you’re admitted to a nursing home.

The surgeon admitted my husband immediately and after three days Ray was admitted to a nursing home where he got his IV antibiotic therapy compliments of Medicare.

So, here we are, three weeks down and three weeks to go, of a very strong intravenous antibiotic, Vancomycin. We return to the surgeon on November 20th for the verdict.

But the jury still isn’t in on the MRSA. After all this, if those dirtballs are still hanging on, the whole works (hardware and wires) will have to be removed…otherwise their next stop is…the brain.

So, as I said, give it some serious thought before you undergo any elective surgery in a hospital. And, if you must have surgery, get discharged as fast as you can.

MRSA IS WAITING FOR YOU!

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1 comment:

Mike said...
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