Speak Out 4/10/16

The VA would not approve it

Speak Out:

The high cost of government-controlled health care can't be measured. I know this because my dad was a loyal patient of a Veterans' Administration hospital, and in my mind there is no question that had he not been, he could have had a better quality of life. I think his story needs to be told especially today when the government is seeking to completely control health care for ALL of us.

My dad had a host of health issues, chief among which were that he was an insulin dependent diabetic and he had atrial fibrillation. He was what doctors term a "brittle" diabetic, which means that his blood sugar was never really well controlled. For at least 25 years he had been on the same 70/30 Humulin mix, and it had never been effective. He regularly "bottomed out" in spite of being true to his prescribed diet. My mother became a diabetic and was put on Lantus and Novolog. She was taught how to use a sliding scale and "cover her carbs." These insulins worked wonderfully for her. I went to the VA and asked them to try Lantus and Novolog for my dad. My daughter, a nurse, also asked his doctor to change his insulin regimen. We were never able to get anywhere with that request, and although I can't prove it, I will always believe the doctor's refusal was due to the vast difference in cost between the two insulins.

Dad survived several strokes, each a result of being taken off his blood thinner for too long. The first stroke happened while he as in Saint Louis having eye surgery. The procedure could not be performed at his local facility, so he caught the VA transit that morning. At some point during the day (we aren't sure when) the stroke occurred. Apparently no one noticed. My mother was the first to recognize the obvious signs - the drawn face, slurred speech and confusion - when she picked him up that evening at 7 p.m., sitting outside the base hospital.

Another stroke occurred when I took Dad to the VA to be treated for flu symptoms. It was discovered he had a brown recluse bite on his back, which he didn't know about, and was admitted. During his time in the hospital he was taken off his blood thinner. He was released on Monday with instructions to see a civilian surgeon for consult for a possible gallbladder removal. He was not given any instructions about when to resume his blood thinner or what dosage, and until his surgical consult we did not know he wasn't taking it. He had a scope procedure on Wednesday, and the surgeon told him to start back on his Warfarin that night. Early the next morning I arrived to pick him and take him back to the hospital for a CT. I knew immediately he'd had a stroke. I put him in my car and drove him back to the civilian hospital where his scope had been done, which made more sense to me than taking him back to the VA. Later, I was very thankful for that decision. The hospitalist at that facility put Dad on Lantus and Novolog. It changed his life! His blood sugar never bottomed out again. It took him more than four months of therapy to regain the use of his right side. He continued to struggle with his speech and he lived in fear of having another stroke.

Dad was blind in one eye and his sight was not great in the other, a result of all those years when his blood sugar was out of control. My mother had done most of the driving, but she passed away in 2010 and I began taking my dad to doctor's appointments. He continued to have issues with his blood thinner, so he often had to visit the "Coumadin Clinic" at the VA. He didn't always tell me when he had these appointments, not wanting me to miss work to take him, because I was already taking him to his monthly eye appointments in Dexter. I worried about him driving himself, so I asked the VA doctor if we could use home monitoring for his INR tests. Many civilian doctors are prescribing home INR monitoring because the tests can be done weekly instead of monthly (or every other month), which is much better for the patient. Dad's doctor said the VA "would not approve it." I then asked if we could have a home health nurse draw the blood and bring it to the VA. This request was also refused, for the same reason, "the VA would not approve it." Instead the doctor elected to change Dad's blood thinner from Warfarin To Xarelto. Even that change did not happen immediately. The doctor told me he had to first "get approval" from the VA to prescribe the new medication. Why? My guess is cost.

The Xarelto was approved and worked very well. However, one day a purplish blister about the size of a quarter appeared on Dad's left side. When the doctor saw it, he said it was caused by the Xarelto and immediately took him off the medication. The doctor further instructed Dad that if the "blister" busted he could bleed to death. In spite of that dire prediction Dad was sent home and told to stay off his blood thinner for the next four days, then resume Warfarin. Given his history of strokes, I was worried, but the doctor had said the Xarelto remained in the system longer Warfarin, therefore requiring long enough to allow it to wear off before resuming the Warfarin. No tests of any kind were done on that day.

Dad began taking his Warfarin again on Friday. Six days later we found him in the floor. He'd had a stroke, which he ultimately did not survive. He was taken by ambulance to a civilian hospital, where I learned that the stroke had been caused by his being taken off Xarelto. The purplish blister was filled with clear fluid, not blood. It was not a hemotoma and would not have been cause to take him off his blood thinner.

I realize honest mistakes are made and other than taking my dad off the Xarelto, I honestly do not blame the doctor for my father's death. However, I do take issue with the system who employs him, because I look back over a long history of bad decisions that were made throughout his health care experience with the VA. I believe those decisions were based on cost.