cross-posted at Daily Kos and MyDD
I am a healthy woman in my late 30s who rarely sees a doctor outside of regularly scheduled checkups. I have had two uncomplicated pregnancies followed by easy, midwife-assisted births.
Most years we pay far more in premiums for our family’s health insurance than our medical care would cost if we paid for everything out of pocket.
Not this year. Yesterday I returned home after spending seven days and six nights in the hospital. It might have been a lot worse if I were uninsured.
We’ve had one illness after another go through our house this winter. My husband has battled sinusitis, bronchitis, and walking pneumonia, while my sons and I all came down with strep throat, along with various other minor colds.
On Friday, February 15, I felt my left ear close up in the mid-afternoon. I soon realized that I was getting an ear infection, the first I’d had in approximately 30 years. I asked my husband to pick up some homeopathic ear drops (oil infused with garlic and other herbs) after he came home from work, and I got out the ibuprofen.
We try to avoid using antibiotics in our family, and the medical community has swung away from automatically recommending antibiotics for ear infections, because so many resolve within a couple of days on their own. The idea now is to use other methods to reduce the pain while waiting for your body to fight the infection.
By Friday evening I was miserable. The ear drops and ibuprofen did nothing to reduce the pain. Sitting upright was no more comfortable than lying down. I had no idea how I was going to make it through the night, but in the early hours of Saturday morning my eardrum ruptured. That released the pressure from the fluid building up in my ears and brought the pain level way down.
Saturday I called someone I know whose husband is a retired ear, nose and throat doctor. Her husband confirmed that many ear infections are viral, and it was prudent for me to wait it out. I used ibuprofen to control my fever and used tissues to wick out the fluid that was seeping out of my ear.
Sunday morning I noticed a slightly sore spot just below my right knee, on the outside part of my leg (around the top of the outer shin bone). I thought I slept funny, perhaps because of the ear infection. I also had a sore spot in my upper left arm, which I figured was from getting whacked by my two-year-old.
By Sunday afternoon I no longer had full mobility in my right knee. I take Pilates twice a week, so I called my teacher. I told him I couldn’t think of how I would have injured my knee, since all I’d been doing was lying around getting over an ear infection. He said it was possible to strain a tendon by sleeping in an awkward position, and we’d need to keep an eye on it.
Sunday evening I started limping heavily, and Monday morning I could hardly put any weight on my right leg at all. I briefly considered toughing it out, but decided to make an appointment with our regular doctor, an internist. He was fully booked, but I got in with a nurse practitioner who called in my doctor when she saw my knee.
At that point it was painful and swollen, but not red or hot.
A blood test revealed a high white cell count, and my ear was still draining fluid, so they prescribed an antibiotic for my ear infection. I got the prescription filled right away and started taking the oral antibiotics around noon on Monday.
The big concern was that I might have a blood clot developing. The doctor and nurse were skeptical, given the location of the swelling. On the other hand, I had been lying around all weekend. Other possibilities included tendonitis, which didn’t seem to fit, or some kind of inflammatory auto-immune reaction related to my ear infection.
Because I have health insurance, I spent all of Monday afternoon getting these possibilities checked out. First, to the imaging department for x-rays of my leg in various positions. Then, off to the vascular center, where a nurse used a doppler (ultrasound) to check for blood clots in my legs. Then, to a different imaging center where I had x-rays standing up and an MRI of my right knee.
Without insurance, these diagnostics would have been prohibitively expensive. I would likely have stayed home, hoping my leg got less sore soon.
I went home Monday with no answers and an appointment to see an orthopedic doctor first thing Tuesday morning to get his interpretation of the MRI.
Monday night was miserable for me. I was told to take a double dose of ibuprofen to help with inflammation, but even so my leg was killing me. I still had a low-grade fever, which shot up whenever the ibuprofen was wearing off. My right calf started to get red and hot.
That was when I should have gone to the hospital, but I didn’t realize it at the time.
Tuesday morning my neighbor drove me to my 8:45 appointment with the orthopod. By this time I was sure the swelling in my leg was an infection. The sore spot in my arm was getting worse too, and I couldn’t see any bruise there, even though I bruise easily if I’ve been bumped.
It was 10:15 before the doctor came in to look at my leg. A huge area around, above and below my knee was swollen, red and hot. He immediately said I would need to go to the hospital for intravenous antibiotics, and excused himself to go call my doctor. I remember thinking it was a bad sign that he left the room instead of calling my doctor right in front of me.
My neighbors were tied up, and it took a while for my husband to get our kids in the car and out to the suburban office to pick me up. He then took me downtown to my internist’s office, where I waited for a while until the hospital room was ready. Then I waited a while longer until they got an IV going. The infectious disease doctor put me on three heavy-duty IV antibiotics while we waited for the results from culturing my blood and the fluid seeping out of my ear.
Meanwhile, she ordered more x-rays and a CT-scan of my leg.
Late Tuesday afternoon, I got the diagnosis: cellulitis, a bacterial infection in the soft tissues of my lower leg. She thought the sore spot in my arm was probably part of the same process, but less advanced. The good news was that the CT-scan didn’t reveal any abcesses that would have required surgical draining or any air pocket suggestive of necrotizing fasciitis (flesh-eating bacteria).
Normally cellulitis would start from a cut or open wound in my leg, but in my case the skin was unbroken, so the assumption was that the bacteria infecting my ear had entered my bloodstream (a septic infection) and somehow taken root in my leg.
Thursday the infectious disease doctor told me that they had cultured strep A from my ear. They couldn’t grow anything in my blood, probably because those oral antibiotics I started taking on Monday stopped the strep from further multiplying in my bloodstream. I am very fortunate that the bacteria did not take hold in any vital organs, which could have been life-threatening, or bones or joints, which could have been debilitating in the long-term. They switched my IV antibiotics to ones even better-suited to fighting strep A.
My white cell count came down a little bit every day. On Friday, three days after I was admitted to the hospital, my fever finally came down for most of the day. The excruciating pain in my leg started to improve on Saturday and Sunday, and I was able to slowly reduce my pain medication. On Monday, my seventh day in the hospital, the infectious disease doctor felt it was safe to send me home on oral antibiotics and ibuprofen for the remaining pain and inflammation.
I can’t even imagine how costly my hospital stay will be. My husband and I pay through the nose for a family health insurance plan through Blue Cross and Blue Shield. We can afford this in part because we have no rent or mortgage payment (I inherited my family’s home). We have a ten percent co-pay and are hoping that the insurance company doesn’t try to deny coverage for any major costs associated with my strep infection.
Mostly we are relieved that I survived this infection without any lasting damage to joints or organs.
I asked various medical staff during the past week how my care might have been different if I’d been uninsured. The consensus was that an uninsured person who showed up at the emergency room with a leg looking like mine would have been admitted for the same kind of care. As one doctor said, “hospitals take it on the chin” quite often in caring for patients who lack insurance or any ability to pay. (I have no doubt that an uninsured patient would have been sent home sooner I was, though.)
The infectious disease doctor declined to speculate about how my blood infection might have developed if I hadn’t made that doctor’s appointment on Monday and started taking oral antibiotics. She agreed that it was very fortunate that only my leg and arm seemed to be affected by bacteria spreading from my middle ear.
Thanks to anyone who reads this long personal diary. I am more determined than ever before to fight for universal health care coverage in this country. My scary experience could have become a life-threatening emergency if I had hunkered down at home in an effort to avoid an expensive doctor’s visit.