Whose Case Is It Anyway?

Well, now I know why the doctors I've been seeing about my spine haven't been giving me advice on how to manage my problems.  Seems that the neurologist now considers herself to be operating solely in an advisory capacity to the neurosurgeon, but she didn't mention that to me.  Also the surgeon moved his practice from Providence St. Vincent Hospital to Legacy Meridian Hospital (different health systems and provider networks, of course), and that's the first I've heard of that, also.  So it looks like I've fallen through the cracks.  Time will tell, we've got messages in to the surgeon's new office asking what my status really is.

Oh, and quite by accident, this won't affect my health insurance situation.  If I were staying on COBRA it would, since that coverage makes Providence a preferred provider network; anything done at Legacy costs me an extra 20% of the invoiced amount (which has been a problem because the neurologist is at Legacy Meridian).  But as of the beginning of this month my COBRA coverage has expired (thanks, Congress), and I'm going on the Oregon Medical Insurance Pool.  Coverage won't lapse, but I have to wait for the paperwork to be done and my coverage info sent to me before I can get it to the providers.  I believe the OMIP coverage will be the same for both providers (at least I hope it will; Providence is more convenient for a lot of things, and I like the hospital itself better).

It's interesting to compare this situation with the therapy Eva is getting for breast cancer prophylaxis.  There is a single person who is her case worker whose job it is to coordinate therapies and doctors, and to make sure that she knows what's going on, and that everyone is singing from the same page of the score.  And all the health professionals go to great lengths to keep it that way.  I think everybody should have a case worker, for all health concerns.  I did a rough back of the envelope calculation: Eva's caseworker says she's carrying 300 active cases; for everybody to get one (and assuming an entire family gets the same caseworker, which makes sense to me) means we'd need considerably fewer than a million caseworkers nationwide.  I bet we could train that many of the currently-unemployed to do the job in less than a year.

Medical Status

The kids have gone home, the dogs have settled down, and I've gotten a few of the medical tests and consultations out of the way, so things have slowed down a bit. The consensus of my doctors at this point is that surgery is probably not indicated now; instead we're going to investigate having a neural stimulator implanted in my spine. This works very much like the TENS unit I'm currently using, except that instead of electrodes pasted to the skin, it uses wires and a small control unit implanted next to the spine. The first step is a temporary implant, to test whether the stimulation will actually help; before committing to that I have to get a psychological exam to make sure I'm not a fruitcake who won't react properly to the current. That's scheduled for 2 weeks from now.

Now if Congress would just get off its collective thumb and pass the COBRA subsidy extension, I may get back $5 or $6000 that I've already overpaid for health insurance before I have to change my coverage from COBRA to the Oregon Health Plan, and then to whatever they're going to call the Health Reform Act post-COBRA coverage (can't tell the insurers without a score card). Then we can figure out who's going to cover the implant procedure.

Bionic Me

The other day my back doctor told me I should be using braces on my feet; the pain in my knees I was complaining about was because my gait was bad, and the knees were being stressed in ways they aren't accustomed to.  This was actually good news: I had been afraid that several decades of jogging before the nerve compression that caused the gait problem had wrecked my knees.  Needing braces isn't a new thing for me; I've got one for my right foot that I got before my back surgery last year, so I only need to get one made for my left foot.

But the doctor's prescription started me thinking about how many orthotics, prostthetics, enhancements, and replacement parts we get as we get older.  I'm in my early 60s, and I've already got plastic lenses in both eyes and powerful signal-processing hearing aids in both ears.  And most days I paste electrodes to my back and plug them into an electrical stimulator that I hang on my belt; it's called a TENS (Transcutaneous Electrical Neural Stimulator) unit, and its job is to block the pain in my legs that actually comes from the nerves that were compressed.  Part of that back surgery was a spinal fusion; if I'd had that 10 years ago when the doctors first suggested it, I'd have a titanium rod in my spine, with stainless steel screws to hold it in place.  But in the 9 years I waited, the state of the art in spinal fusion advanced to using bone grafts instead of hardware; result: I can go through a metal detector without it freaking out.

I may not even be near average in the replacement sweepstakes: I know several people not much older than me who have had both knees and both hips replaced with metal parts.  And as we grow older, not only does our need for replacements grow, so does medical science's ability to provide them.  I fully expect that by the time I need to replace my hearing aids (5 to 10 years from now, I hope), implants much more advanced than the cochlear implants available today will be able to restore hearing to many people who get by with hearing aids that barely do the job.

So where does it stop?  How much can you replace before you're not a biological homo sapiens any more, but some sort of homo ex machina?  My own opinion is that there may not be any change that retains the ability to think and speak and empathize with others that can take away humanity.  It's worth thinking, though,  about the cautionary tales that have been written about the subject.  The best and most thought-provoking I can think of are the "Moderan" stories of David Bunch.  Bunch wasn't telling simple horror stories out of a Luddite abhorrence of technology.  The people he described used the techology to express some of the ideals of the period of the 1960s and '70s; ideals like conforming to the expectations of others even in private matters,  competing with everyone else for your place in society, and considering the acquisition of wealth and power the most imprtant goal in life.  Of course our modern society finds these ideals abhorrent: no one would think them appropropriate today.  Oh, wait...