That is a Very Interesting Rash!

April 6, 2011

This is a story of healthcare. After being employed by large or medium size corporations
for most of my professional life I was not prepared for the fact that instead
of paying anywhere from nothing to less than $100 per month for healthcare plus
dental coverage for me and my family, I was now expected to choke up around
$1,400 for the same. The stupidity of linking healthcare to full time
employment had not dawned on me until then. I could wax on about this injustice
for hours but it is not why I am writing.

Suffice it to say that I and my business partner are now ‘enjoying’ the coverage for our
health and dental needs supplied by a very large health insurance company. We
pay nearly $1000 per month as a corporation for the honor and privilege. Not to
mention the copay and prescription charges which bring our total financial commitment
to health to around $14,000 per year.  I am sure you can forgive or at least
understand any satirical tone you may detect.

Back in the fall of last year I decided to take full advantage of the dental coverage and
have a checkup. This procedure revealed that I would need some heavy duty work
on several teeth. In fact two adjacent teeth needed crowns, and there may be
other teeth needing attention. Two visits were required to accomplish the immediate
treatment. Just note that despite paying around $100 per month for the dental
part of the coverage my part of the bill still ended up at $1200. The first
part of the work involved attacking the old teeth with a small jackhammer until
they were worn down to stumps and gluing on temporary pieces. This went well
except for the excruciating muscle pain that later developed in my neck and
shoulder from straining in the chair for 90 minutes. More cash for my massage
therapist who got that discomfort to subside after two hour long sessions.

Apart from the weirdness of having alien lumps of ill-fitting plastic in my mouth all was
well. I returned some weeks later to have the permanent custom made crown glued
on. It went well. But over the next week I developed a painful sensitivity to
anything hot or cold around those teeth. It just got worse and worse.

I called my dentist. She was not available to see me anytime soon and but she arranged an
appointment with another of the team of dental surgeons who work at the clinic.
He took a look at the situation and said that a tooth next to the recently
crowned molars likely needed a root canal and with my permission he would begin
this procedure right away. How could I not agree? This also would take two
visits. Once again I was straining in the chair for some time as he drilled
into the tooth in question to remove the nerve and top it with another
temporary filling prior to the second visit when a permanent one would be
applied. The office would call me when an opening occurred. It was after the
Novocain wore off that the intense sensitivity to pressure in that tooth or in
the area around it began. The hot and cold sensitivity had gone only to be
replaced by this new problem.

I called the dentist who had done the work, left a message, and left the
same message with my original dentist. He was not available but my
original dentist called and surmised; and this is a careful choice of words;
that I perhaps had an infection in that tooth that was causing the pain.

She prescribed a course of Amoxicillin. She asked me if I had taken Amoxicillin
before and I said I was not sure but thought perhaps I had. At my age it is likely that I have taken
quite a few antibiotics. It was a Thursday when I picked up the antibiotic at
my local pharmacist and started to take the dose; 500mg three times a day for
seven days. It was Friday morning that I noticed a curious redness between the
fingers of my right hand. Suspecting a connection I stopped taking the drug,
and hoped that his would be the right thing to do. Over the weekend the redness
developed into a full and livid rash covering nearly half of my body. It began
to feel as if I had severe sunburn in random areas of flesh. On Monday I called
the dentist to ask for advice. She was not in that day. I left a message.

I did a little research on the internet and found that an allergic reaction to
Amoxicillin is not a trivial thing and can be very serious for some. With my
fingers swollen, blisters covering the back of my hands and red spots advancing
to new areas by the hour I was prepared to believe this. As my partner jokingly
remarked, “Why are you hiding two lobsters in your sleeves?”

Worrying that perhaps a dentist might not be the right person to address this
potentially dangerous allergic reaction I then called my regular MD. Or should
I say I started to call the system that prevents me from easily talking to my
doctor. Please remember that my dentist and doctor work for the same megalithic
organization in tow buildings perhaps four miles from each other. After a few
calls I got to speak with an advice nurse who expressed surprise that there was
no record of my Amoxicillin prescription in my file. Having experienced the
vagaries and disconnections of large corporate databases before I was not
surprised. I was advised to take Loratidine (an OTC antihistamine), use
Cortisone cream on the affected parts and call back the following day.

And upon the Tuesday morning it was obvious that a large part of my skin was covered with
red points and in some areas the points joined and had become inflamed patches.
My hands continued to imitate crustaceans. I renewed my telephonic dialogue with
the megalith. Three times I was told that an advice nurse would call me. By lunchtime
on Tuesday this had not happened. I called once more in a slightly feistier
mood. And somehow the person dealing with me this time; I got different people
every time I called; suggested that I could actually walk in to my regular
clinic and ask to be seen! I did not know this! Why?

Of course I leapt into my car and sped off to the clinic. And lo, I walked in and without
the usual copay; mirabile dictu; was directed to go to Gate #5
(the waiting areas remind me of the airport) and await a nurse.
As I was sitting there I decided to turn off my cell phone. As I
began I noticed that I had a message. It was from the advice nurse, finally,
who had called to inform me that my doctor has recommended something but I
would have to call the following number, choose option #1 and ask for team #2,
to get this message. I was about to do this when the doctor in question
actually appeared through the door of gate #5. She looked at me with some vague
recognition; we had met once before; but then turned toward the only other
person in the area and asked him if he was not in the wrong waiting area. She
then walked off sipping on a drink she was carrying.

I was almost laughing out loud when a nurse came out to summon me into the recesses of gate
#5. She took my vital signs and said that another nurse would come and discuss
my problem with me. Fine. And indeed an obviously competent nurse came into the
examination room, looked at the skin on my hands, ankles and chest, poked my
arm, and said, yes, you have an allergic reaction rash, but she would have to
speak to the same doctor who had just left via gate #5 to get an approval to
prescribe a steroid that would help me. This took more than a few minutes. But
lo, a prescription was made and I picked it up at the clinic pharmacy within
ten minutes.

It was as I got in the car that my cellphone told me I had a new message. Of course it was
from my original dentist expressing regret that I was going through this and
adding that she had prescribed a new antibiotic to fight the infection that she
surmised was still active. It might be but it certainly is not as painful as it
was at first.

In a message I left on her voice mail I declined to accept this course feeling that it might
be better to clear up one thing at a time and not risk complications. I might
have thought differently if the pain had not declined to slight and tolerable

It occurred to me as I am sure it will to you, dear reader, that it might be a swell idea
for the dentist and the doctor to share all my medical records so that either
of them would have a whole picture of me and not inadvertently prescribe
something deleterious to my health. Surely it cannot be beyond the resources of
the megalith to achieve such an obvious thing. Of course there will be issues
to overcome, but I do believe it to an obvious step. Building upon this they
might actually be able to discuss my health care holistically as if I was one
person and not two.

Believe me I have respect for all of the professionals involved in these events. What I
don’t have is faith in the system under which they labor and towards whose
profit margin, and quite possibly obscene executive salaries, I sadly choke up
nearly a thousand dollars per month.

Fortunately my rash will subside and I will be left with an interesting story, much like
the time when I was allowed to board the wrong plane, about which I will surely
relate another time. But it could have turned out badly for someone else with a
higher sensitivity to antibiotics.

Lastly, I did a little research on the steroid prescribed for me and noted with some
irony that it had several alarming side effects, not the least of which were
allergic reactions….Stay tuned.

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