The last couple of days have been HELL for me again. I need to vent!
Not only was I recently told by my treating specialist surgeon that a bone infection (chronic osteomyelitis) is suspected in my [limb joint],which would explain a series of 7 failed major surgeries, night sweats, some fever on and off, general malaise, ongoing severe pain in the [limb], suspicious looking recent MRI and, now also the development of an acutely painful, red and swollen finger in the hand (which may or may not be a case of an infection that has spread from the [limb joint] to the finger).
What is chronic osteomyelitis?
Chronic osteomyelitis is an established bone infection that has been present for a period of months or even years. It is often seen in individuals that have sustained open (contaminated) fractures, undergone multiple orthopedic procedures or had chronic wounds.
Draining wounds that fail to heal or intermittently reopen are suspicious for the presence of an underlying chronic bone infection. Additional signs and symptoms of osetomyelitis include local pain, redness, swelling and bony instability.
A series of lab and imaging tests are available to help your physician make a diagnosis. X-rays, MRI scan and a nuclear bone scan may be requested. Blood work may be draw to look for evidence of immune activity and inflammation (WBC, ESR, C-reactive protein).
The most accurate method of verifying the presence of chronic osteomyelitis is a bone biopsy.
Chronic osteomyelits is difficult to cure but can often be successfully controlled.
The cornerstones of treatment include complete excision of unhealthy bone, well-vascularized soft tissue coverage and administration of culture specific antibiotics.
The treatment of chronic osteomyelitis includes meticulous debridement (surgical removal) of all infected bone and scar tissue. Multiple trips to the operating room are generally necessary to fully cleanse the wound prior to any reconstruction. Antibiotic beads are frequently left in the wound between cleanings where they release a high concentration of antibiotic locally,etc etc.
WorkCover INCOMPETENCE exposed
My surgeon requests diagnostic tests, which are submitted to Workcover
My treating orthopedic surgeon started of (after the recent suspicious MRI) with a request for extensive blood tests, which I had done. The tests showed a few abnormalities including a raised infection/inflammation marker and severe Vitamin D deficiency.
Next, my treating surgeon requested a Technetium bone scan. This nuclear medicine whole body bone scan is used in evaluations of various bone related pathology, such as bone infection, for bone pain, stress fracture, nonmalignant bone lesions, or the spread of cancer to the bone.
Because my bone scan (see picture) was positive, but because a bone scan cannot really differentiate between infection and inflammation (i.e. such as severe oestoarthritis), my surgeon requested I also undergo a Gallium body scan. In infections, the gallium scan is used to look for chronic infections.
Unfortunately at the time that my surgeon prescribed the Gallium body scan for the [limb] infection, my finger also had become red, hot and swollen and looked infected, so my surgeon also added onto his radiology referral form an x-ray for that hand.
After the Gallium scan I am to take a trip to the operating room and have bone biopsies taken in the hope to find the bug that is causing the infection, so we can start treatment with the right antibiotics before replacing the entire joint.
My case manager denies me the Gallium scan and the taxi transport to attend the test
I forwarded the radiology referral form to my case manager from hell sometime last week.
My stupid case manager told me that the request needed to be “reviewed” and that she would let me know of the outcome.
I explained to her that the Gallium scan is a standard test which is done after a positive bone scan when a chronic bone infection is suspected and that I did not see why the request would need to be ‘reviewed’. I stressed the fact that a bone infection is a very serious matter and that delaying any investigation and or treatment will come at a great cost, not only for me,but also for the workcover insurance, because the longer you have the bone infection, the harder it is to treat, the more bone needs to be cut out, the more maimed I will be, the more impaired I will be and the more the workcover insurance will have to pay.
Right… On Friday evening, at 16:45 (COB), this stupid case manager refuses to pay for the Gallium scan and for the taxi transport to attend the scanning. Note that I was to have the Gallium injected on Monday (today – and I did) and the scan itself 48 hours later (on Wednesday).
She writes in her email of Friday (COB) that she had spoken to my surgeon who had told her that my finger has nothing to do with my workcover injury and that therefore the x-ray of the HAND (to see if there is an infection) and a Gallium scan of the BODY (to look for a chronic bone infection in the shoulder (site of work injury/body) will not be paid for nor the taxi to those appointments.
So, here is an UNEDUCATED, NON-MEDICALLY trained stupid case manager making decisions on her own based on twisted information, forced opinion, plain stupidity or to just delay my treatment(s). I mean how fu***ng stupid do you have to be not to be able to differentiate between a plain x-ray of a “reddened and tender” partially amputated finger (10 years ago) and which indeed has nothing to do with the work-related injury (UNLESS of course it is a case of spread bone infection from the [original injury limb] to that finger OR it a case of advanced RSD/CRPS (which I have in that arm following original work-injury) which causes in its end stages inflammation in distal joints which lead to deformities). If none of those 2 things are responsible for the “reddened and tender” finger, of course I will happily accept liability for the cheap x-ray which I had done last week already! And my case manager fully knows that I had the x-ray done already before she sent me that stupid email on Friday evening.
How fu***ng stupid must you be to even think that:
- a simple, cheap x-ray of a hand would take two (2) DAYS!?
- that anyone would prescribe a nuclear radioactive Gallium body scan scan/or a complex white blood-cell labelled scan for a stupid “reddened and tender” finger? Come-on!
Can this absurd, dump case manager NOT read or what: what does it say on the referral form? Two tests. An xray and a Gallium scan, and two (2) reasons of which the reason for the Gallium body scan (or WCC scan) is “multiple R shoulder surgeries, with known infection 6 years ago ,ongoing pain (in shoulder etc), ? chronic infection”
Perhaps my surgeon should have put each test on a separate form because obviously these non-educated mere clerks cannot differentiate between an x-ray and a nuclear medicine test for two different reasons.
So, this idiot (case manager) left me FURIOUS over the weekend and stranded. I went to see my GP over the weekend who told me NOT to DELAY the Gallium scan at any cost. So I had the displeasure to catch public transport (which is really not advised on doctors orders because of the way things are -very fragile), as I did not get my taxi.
So off I went this early morning, bus, tram, train and had the Gallium injection. In 48 hours time (Wednesday)I have to go back to the hospital for the scan itself because it takes 48 hours for the radioactive gallium to get to your (infected) bones.
I have written several emails to this stupid woman and cc’d to my surgeon and hope to be able rectify the issue asap. Otherwise I’m in for a case at the ACCS again…and I am tired and exhausted and just sick of having to fight all the time for what I am legally entitled to!
Interestingly the stupid, vindictive case manager from hell has been hiding all morning – I have not heard from her – whilst she tends to overwhelm me with harassing emails on a daily basis.
I really believe that Case Managers should be mandatory trained healthcare professionals in the first instance, i.e. hold a nursing degree or something similar. They make decisions everyday about OUR health care and treatments, on their OWN and don’t even understand what a doctor writes. This is so so scary, especially when you suffer from something severe and potentially life-threatening, like an infection or an unstable spine. Yet those donkeys have no fu***ng clue and play GOD. “I, who is uneducated, illiterate, non-medically trained, and I,who have never even seen you, decide what treatment I will approve and what not”.
Grr… I am ENRAGED!
Another recent example of my donkey’s behaviour was that “after she had spoken with my specialist orthopedic surgeon” she needed an “objective” assessment by an IME. Well donkey sent me to an 86 year old general orthopedic surgeon – I kid you not. One of donkey’s questions to the IME was what type of surgery (number eight) I should have. Well, first of all donkey must have “forgotten” that I had been sent to the Medical Panel by her colleague donkey 2 weeks earlier. You can only send someone for a permanent impairment assessment/rating when the injury is considered “stable”, which means, yes, that I signed a very legal document with my solicitor stating that it is my wish not to have further surgery for the foreseeable future given that I had undergone 7 failed massive procedures with many many complications. So, for an injury to be considered stable you are not allowed to have further surgery in the “foreseeable future”. At that time, we did not know yet that I may have chronic osteomyelitis (we only realised this at the last stage of the Panel 3 weeks later and the Panel rightly suspended the impairment assessment because of “injury not stable”).
The 86 year old IME, who never ever operated on this sort of injuries in his whole life by the way, was of the very old-fashioned opinion that I should have procedure X done (massive surgery). This procedure X has been abandoned about 20 years ago because it causes a hell of complications and is irreversible. They may in very very rare occasions perform this procedure on very old people (75+) to help alleviate pain. Isn’t that shocking? In addition the procedure involves bone-union (growing of bones together). Now consider that I have most likely osteomyelitis (if not, severe osteoarthritis) and consider, most importantly, that I have very severe Vitamin D deficiency, which includes lack of calcium and phosphate. This means that my body is totally unable to grow bone or heal a fracture… do you know what I mean? Jeezus. ..oh boy, oh boy!
The worst part undoubtedly is that I am medically trained with 20+ years experience and I know too much for my own good and so I see all these things and “opinions” and lie awake at night worried sick about my fellow workcover victims, who may not even be aware that they are misinformed, mislead or given the wrong treatment(s).