A very enjoyable five days in hospital.

toglhot

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I was admitted to Hospital on 25 July 2022 for hip replacement surgery, fixing the bung first surgery, it was a big operation, three hours, the surgeon saying there was a lot of damage. By 6:30 that night the surgery was completed and I was transferred to a ward and medications started. By morning I was extremely nauseous only managing to eat a couple of mouthfuls of food for breakfast, a few hours later I started vomiting. I assumed this nauseousness was due to the anaesthetic, advised the nurse and anti nausea medications were given. Over the next three days I could not eat due to extreme nauseousness, but continued vomiting.. By PM hours on the third day my stomach was empty, however I was still extremely nauseous and although my stomach was empty but I was now dry reaching. I noticed the nauseousness got worse after each antibiotic. At this point I asked for a change in antibiotic as it was obviously what was making me sick. The on call Doctor refused to change the antibiotic and advised the staff to continue with the current antibiotic. At this point I refused any further anti biotic treatment.

The next morning, my surgeon, attended at which point I advised him I had stopped the antibiotic medication and would be discharging that morning to seek appropriate treatment. I also advised him that going without food and vomiting continuously was not sustainable. The surgeon asked why I hadn’t advised him of this earlier. At the time I had no answer, however, in retrospect, I would ask ‘why haven’t you checked the nurses notes, if no one is reading the nurse’s notes, why do they bother taking them?’. Nevertheless, the surgeon then changed the antibiotic to a less aggressive one and I started feeling better, by the afternoon of the fourth day I was finally able to take in a few mouthfuls of food and discharged the following morning, although still very nauseous.

Diabetic control.

On admittance I advised all that I would be self administering diabetic control in the form of insulin. For the first couple of meals there were no problems, glycaemic level post operatively was in the vicinity of 20 mmol/L ((normal being between 4-6) which I had gradually started to decrease, carefully as I was not able to eat. Glycaemic level would go down to around 12/14 mmol/L, then rise again. When my glycaemic level rose to around 22mmol/L I ask for 15 units of insulin. However, at this time the nurse decided to consult the on call Doctor who advised insulin was to be withheld until I had eaten.

Experience over 23 years has told me that I should not eat with levels in excess of 20. Experience also told me that my glycaemic level would peak one hour after eating and that insulin has no effect on me until around 45-60 minutes after intake. So, had I eaten one sandwich, managed to keep it down, and injected the appropriate insulin dose immediately, my glycaemic level would have peaked in one hour to over 30 mmol/L before starting to decline. At high 30s, low 40s a diabetic can become comatose.

I demanded to see the Doctor and he eventually attended. A heated discussion ensued and he left advising the nurse to allow me 6 units of insulin. This was clearly no where near enough, it lowered my glycaemic level to 18 after a couple of hours and then it started to rise again. Not long after the Diabetic specialist attended and another heated discussion ensued. Eventually he left giving my diabetic control back to me. Over the next 12 hours or so, without food I managed to get my glycaemic level down to 7.5 mmol/L, however it kept rising so my level wavered between 8-14 for the remainder of my stay.

Many things affect glycaemic control post operatively: Medications, bodily stressors, mental stressors, anaesthetics and so on. Further, every diabetic is different, what effects one diabetic doesn’t necessarily affect another in the same way. I was diagnosed with slowly evolving type 1 diabetes 23 years ago and have been controlling it since then. 23 years experience has taught me how different foods affect my glycaemic levels, how activity affects my glycaemic levels, how different amounts and types of insulin affect my glycaemic control. Timing, insulin dosage, food intake and activity levels have to be taken into account when treating diabetes. I manage my diabetes by counting carbs and rely on experience gained over 23 years on how much insulin to inject for a given carb intake, taking intended activity levels into account.

To date I have been very successful, my HbA1c levels have been in the high sixes for a number of years, I no longer see a diabetic specialist and my GP is more than happy with my diabetic control.

I was made aware of the hospital’s diabetic protocols, however, those protocols clearly were not working and the on call Doctor ignored that fact, as well as the effect the antibiotics were having, but refused to change antibiotics even though they were having a negative effect on me.

Every hospital has a responsibility to provide their patients with a safe, appropriate, responsible and sensible level of treatment during their stay. Withholding necessary medications from a patient is in no way safe, and causing a patient to become ill during their stay without taking appropriate steps to resolve the problem is in no way responsible or sensible. The cornerstone of a patient/medical professional relationship, in my view, is for the medical professional to listen to the patient, without listening, there can be no understanding of the patient’s needs.

A very enjoyable stay that was, I came home 4kgs lighter.


[TH1]
 
Brother @toglhot, I am glad to read your words after this ordeal. You and I do need to meet at a pub someday to discuss your meaning of "enjoyable" though.
And the internet is full of less invasive means to lose weight, just sayin...
Your heated moments make me wonder if the medical staff there got the degrees from Facebook.
I'm glad you are home and thankful you kept your spirits up despite the evil that affronted you.
 
Wow lot of red flags there. Obviously I’m state side so our practice is going to be different, but I would go as far as saying I’m offended as a medical professional by the lack of direction and compassion provided by your caregivers.

At both ends of the spectrum, post op ABX and DM treatment, the ball was dropped. ABX prophylaxis is obviously important after orthopedic surgeries of your nature and while I would expect some level of post residual sedation side effect, continuous nausea and vomiting by a patient, especially one with glycemic control issues raises a big concern in my mind. The ABX should have been slowed or discontinued until a physician could be consulted regarding it’s efficiency in this particular case. Obviously a large part of the healing process is nutrition and they threw that right out the window.

No sick days for type 1 as the saying goes, but if they’re not going to regulate glucose properly then that’s a null and void point. All hospitals have sliding scales and glycemic control measures as dictated by the physician caring for the patient, but that should certainly take into account the patients wishes and knowledge base, especially if they have well controlled glucose levels. It reminds me of the ICU new grad who went to deliver insulin into my type 1 sister after forgetting to administer her tube feeding, she was NPO at the time, we caught him and called him out, he wanted to continue as it was MD orders and we told him we would physically restrain him if he tried as she was 32mg/dL. We told him to get the manager right the fuck now and it was at this point he realized he was dealing with a nurse practitioner, an ER nurse, and a paramedic as family members. The hospital ended up eating that entire 30 day hospital stay in fear of us suing the ever loving fuck out of them. Which to be fair, dumbass could have killed her, thank the lord we know our shit and we were there from day one observing.

There’s a lot of great medical staff out there but with that being said the current situation has thrown a lot of dumbasses in the mix. Be safe out there and never be afraid to be your own advocate.
 
I've been admitted to hospital for quite a few procedures over the last 10 years, every time there have been problems with the hospital objecting to me controlling my own diabetic condition, Sometimes the staff are somewhat happy to oblige, sometimes not so happy to oblige, but always there is conflict.

Obviously, there is history behind my demands to treat my own diabetic condition, that being dissatisfaction with hospital protocols and having levels in excess of 20mmol/L. By and large nurses are usually OK, but on call Doctors and hospital specialists are a different matter.
When I first told my GP of these problems, his response 'it's common sense a diabetic would be better placed to treat their own insulin requirements than someone who doesn't know them from a bar of soap'.

This time around, the anaesthetist was more than happy with my decision, the surgeon not so much. One wonders why these learned men and women masquerading as medical professionals don't undergo a course on common sense before being issued with their licence to practice medicine.
 
I've had very similar experiences with hospitals (allegedly not-for-profit included), their attending staff, et al, in our insanely mercantile skewed, "3rd Party Payor" system. If one is not an informed and strong advocate for one's own care, well, you're screwed!
 
You are lucky that you survived your "enjoyable" hospital stay.....

tim
 
We have public and private hospitals in Oz. Private hospitals are far better run and staffed by better trained personnel.

Public hospital staff are govt funded whereas private hospitals are funded by patients.

For minor ailments we generally see a GP who usually works from a privately run medical practice. If you don't have private health insurance, you either pay the bill yourself or go to the hospital emergency in a public hospital, sit down for a few hours and eventually a Doctor will see you.

We pay a Medicare levy as part of our tax which funds medical treatment in public hospitals. If we see a GP locally, Medicare only covers around 40 percent of the cost.

We can use either public or private hospitals. It costs you nothing in a public hospital, but could cost a bomb in private hospitals as health funds only cover about 30 + - percent of the bill, depending on the procedure.

Health insurance costs a bomb and increases every year, we pay $112 per fortnight just for the wife. Being a veteran with accepted health conditions, I have a Department of Veteran's Affairs Gold Card which covers me for all conditions, so I pay nothing!

If you want your hip replaced under the public system it's about a 10 year wait, but is free. If you have private health insurance or are covered by a DVA Gold Card, there is no waiting time. Hip replacements cost around $10k, if you have private health insurance they pay around $4k, leaving you with $6k to pay.

More and more people are pulling out of private health funds due to costs, and relying on the public system instead.

I've probably missed a few elements, but in essence, our health system is a shambles, third world country stuff.

Now if you think this sounds complicated, don't delve into our tax system.

Now, can someone explain the American system.
 
Good to hear from you again after having that procedure. Been sending out prayers and will continue to do so for recovery.
Welcome back!
 
We have public and private hospitals in Oz. Private hospitals are far better run and staffed by better trained personnel.

Public hospital staff are govt funded whereas private hospitals are funded by patients.

For minor ailments we generally see a GP who usually works from a privately run medical practice. If you don't have private health insurance, you either pay the bill yourself or go to the hospital emergency in a public hospital, sit down for a few hours and eventually a Doctor will see you.

We pay a Medicare levy as part of our tax which funds medical treatment in public hospitals. If we see a GP locally, Medicare only covers around 40 percent of the cost.

We can use either public or private hospitals. It costs you nothing in a public hospital, but could cost a bomb in private hospitals as health funds only cover about 30 + - percent of the bill, depending on the procedure.

Health insurance costs a bomb and increases every year, we pay $112 per fortnight just for the wife. Being a veteran with accepted health conditions, I have a Department of Veteran's Affairs Gold Card which covers me for all conditions, so I pay nothing!

If you want your hip replaced under the public system it's about a 10 year wait, but is free. If you have private health insurance or are covered by a DVA Gold Card, there is no waiting time. Hip replacements cost around $10k, if you have private health insurance they pay around $4k, leaving you with $6k to pay.

More and more people are pulling out of private health funds due to costs, and relying on the public system instead.

I've probably missed a few elements, but in essence, our health system is a shambles, third world country stuff.

Now if you think this sounds complicated, don't delve into our tax system.

Now, can someone explain the American system.
I only hit the laugh icon because of how absurd coverage is here in the US. The way my own coverage works, I call the insurance and ask permission to have a procedure. If they say no, that is not normal, I am out of luck. It is the same with medications, they constantly say "Non-formulary" for your treatment. BS, if my doctor prescribes a medication, it is formulary for my condition. I despise dealing with insurance.
 
Now, can someone explain the American system.
Oh, well, fair question that. I could try to.....it will take several "mini-rants" perhaps over some time. I don't claim I'll get it all in.

Let's start with our wonderful pharmaceutical industry - and they have produced many wonder drugs and eased suffering in the entire world and that part is due to the scientists and the budgetary power to fund their research. Ah, but there is a slimy underbelly that crawls along with that altruism; the financial engineers, lawyers and lobbyists have devised a truly diabolic business model for operating the pharmacy.

Enter the payors - insurance co.'s - and the "Formulary" that Boog speaks of. The formulary is a product of yet another seemingly altruistic player in the game: the (PBM) Pharmacy Benefit Manager. So, the PBM's job is to allegedly reduce drug costs for the payors (not patients) by negotiating deals with the pharma manufacturers. An oversimplification of how that works in practice is this; The PBM's say to Pharma give my client insurer a good price and we'll include your pill exclusively in the formulary. Oh, wait, if you jack-up the listed Retail Price of your pill let's say quadruple the current price then we list it for half that on the formulary, the insured pays a co-pay based on that, the insurance company pays you the difference and you rebate half of that to us, the PBM, for our good work. That's how we get $600 EpiPens. Everybody's happy.

As a little aside: there are only two countries in the entire world that permit advertisements for prescription medicines - the United States of America and New Zealand. Pity, nobody else gets bombarded with those lovely ads.

As Grandpappy said: "follow the money".
 
Google "best healthcare in the world" and the US does not fall in the top ten. Australia does. There's a strong argument that Americans are the sickest people in the world. Wherever you are, you have to be your own advocate. The American system leaves much to be desired. Yeah, follow the money for sure. If the treatment isn't profitable, you can't have it!

@toglhot, I hope when it's all said and done, you have a very positive outcome on all counts.
 
I've been admitted to hospital for quite a few procedures over the last 10 years, every time there have been problems with the hospital objecting to me controlling my own diabetic condition, Sometimes the staff are somewhat happy to oblige, sometimes not so happy to oblige, but always there is conflict.

Obviously, there is history behind my demands to treat my own diabetic condition, that being dissatisfaction with hospital protocols and having levels in excess of 20mmol/L. By and large nurses are usually OK, but on call Doctors and hospital specialists are a different matter.
When I first told my GP of these problems, his response 'it's common sense a diabetic would be better placed to treat their own insulin requirements than someone who doesn't know them from a bar of soap'.

This time around, the anaesthetist was more than happy with my decision, the surgeon not so much. One wonders why these learned men and women masquerading as medical professionals don't undergo a course on common sense before being issued with their licence to practice medicine.
Two words, giant ego's, the Dr's, that is.
 
Google "best healthcare in the world" and the US does not fall in the top ten. Australia does. There's a strong argument that Americans are the sickest people in the world. Wherever you are, you have to be your own advocate. The American system leaves much to be desired. Yeah, follow the money for sure. If the treatment isn't profitable, you can't have it!

@toglhot, I hope when it's all said and done, you have a very positive outcome on all counts.
A large part of Americans not being healthy is lifestyle, mainly obesity and all of carnage it brings, rather than access to medical care or quality of medical care. Food, especially high fat, high carb food is very tasty and very cheap, and so many of us (myself included) have difficulty resisting it. I'm 63 and I have met people in their 40's who cannot cook anything, much less tell you what is "healthy food". I don't have a clue what we do about it, but you could make health care "free" and it wouldn't make any difference.
 
A large part of Americans not being healthy is lifestyle, mainly obesity and all of carnage it brings, rather than access to medical care or quality of medical care. Food, especially high fat, high carb food is very tasty and very cheap, and so many of us (myself included) have difficulty resisting it. I'm 63 and I have met people in their 40's who cannot cook anything, much less tell you what is "healthy food". I don't have a clue what we do about it, but you could make health care "free" a
You have to figure out for yourself what "healthy" is. It's my opinion that the food industry will happily kill you for a buck. The government's food pyramid is a fraud. The food industry is at odds with the medical industry, or are they?
As for me, I'm on a high fat diet. (No processed fat) I eat plenty of red meat. I consider processed food to be poison and avoid it as such. I took control three years ago and at 63, I never felt better. I quickly went from a jacket size 48 to a 42 and all the fat that went with it. We had a health thread going for a while, but it's really another thing we can all disagree on. I know what's working for me. I probably should give my wife access to this forum in case I suddenly drop dead, so y'all might know I was wrong. As for now, we're both doing CrossFit together.
 
You have to figure out for yourself what "healthy" is. It's my opinion that the food industry will happily kill you for a buck. The government's food pyramid is a fraud. The food industry is at odds with the medical industry, or are they?
As for me, I'm on a high fat diet. (No processed fat) I eat plenty of red meat. I consider processed food to be poison and avoid it as such. I took control three years ago and at 63, I never felt better. I quickly went from a jacket size 48 to a 42 and all the fat that went with it. We had a health thread going for a while, but it's really another thing we can all disagree on. I know what's working for me. I probably should give my wife access to this forum in case I suddenly drop dead, so y'all might know I was wrong. As for now, we're both doing CrossFit together.
Good for you! I agree with you. We all have to figure out what works for us, but high profit processed foods are bad period.
 
So, no one can explain the American health system?
From reading, I gather if you don't have health insurance, you don't get treatment???
 
Google "best healthcare in the world" and the US does not fall in the top ten. Australia does. There's a strong argument that Americans are the sickest people in the world. Wherever you are, you have to be your own advocate. The American system leaves much to be desired. Yeah, follow the money for sure. If the treatment isn't profitable, you can't have it!

@toglhot, I hope when it's all said and done, you have a very positive outcome on all counts.
Australia is in the top 10, I'll be buggered, doesn't say much for the rest???
10 years wait for a hip replacement. Two year wait to see a specialist. Ambulances sitting in the parking lot housing patients inside because there are no beds in the hospital.
In Adelaide our city hospital couldn't cope, so the premier shut it down and built a new hospital with fewer beds, smart thinking. The new hospital does have the important bits though: a piano player and a couple of atriums. What else matters.
 
To quote my accountant long ago.
If you think you understand it now, then I'm not explaining.
Sounds like our tax system. Our tax accountants can't explain it!

We also have an obesity epidemic, but I can't say anymore otherwise the wise one will jump in and label it intolerant and judgemental.
 
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