Wednesday, August 29, 2018

15,000 miles with a hole in my foot

The hole in my foot is kicking my ass. Ever since we started full-timing the hole in my foot has been a constant companion. At it's largest about the size of a quarter, at it's smallest about the size of a pinhead. Never healed from the surgery in October 2016. It has kept me out of the water in the Florida Keys and off my motorcycle. It prevents me from walking any distance. The hole in my foot is a diabetic ulcer.

Our idea when we started this journey was to motorcycle, kayak, fish, hike, sail and explore, posting photos and videos of the things we discovered. Instead we have experienced setbacks, some gear related but most hole-in-the-fucking-foot related. I say we because when I'm laid up Shawna has to pick up the slack. I can't walk the dog, get groceries, shoot video, or take still photos.

Most recently I noticed an infection in my foot while we where in Maine. Quick trip to the ER, some indifferent attention and off to New Hampshire for a month. Infection returns, off to the ER again. This time x-rays, blood work, and IV antibiotics. Enough is enough, time to get this taken care of. We decided our best bet for treatment was a state with Kaiser Medical, where my coverage is reciprocal. We chose Colorado, we have friends here and good motorcycle riding in the Rockies, because I expected some antibiotics and some basic wound treatment, and expected to be out exploring again quickly. Instead, the new doc took one look at it and hospitalized me.

I'm going to jump in here folks because Lance is struggling to finish this post. The bottom line: we're probably looking at another round of foot surgery. I'll spare you the photos. I tallied it up the other day and came up with 12 surgeries/overnight hospital stays in the 18 years we've been together... so we're pros at this point. In any case we've certainly covered the "in sickness" part of our contract. Now we need to take a break from our tour and focus on the "in health" part, whatever that turns out to mean, be it surgery or something else, be it here or back in California or somewhere else. We'll know more after the cast comes off next week and after another round of meetings with the surgeon.

We have learned some things about the traveling lifestyle and healthcare.

Kaiser has a "traveler" phone number. They are generally helpful but not always on the same page.  We have received contradictory advice on subsequent phone calls, and have found our best course of action is to keep calling until we get the answer we need. Perhaps this is because the rules are flexible, or because the staff is not trained consistently, or perhaps the phone staff is empowered to make allowance decisions based on the dire needs of the individual patient on the fly. I don't know but we rarely get the same answer two phone calls in a row.

When you are at a hospital that is out of your service range (ie New Hampshire or Maine where there is no Kaiser), do not give them your payment up front - tell them "bill me". In New Hampshire the IV antibiotics services they asked us to pay up front for ended up being covered by our plan as part of the emergency program, and so the $1400 x 2 they wanted us to pay upon admittance as a "cash patient price" at the hospital became $290 copay total to us in the long run, after Kaiser paid their portion and disallowed most of the rest of it. We paid the bill promptly when it did arrive, and got an early payment discount, bringing that payment down to $262 total, a significant savings over the original quote.

You need an ambassador. At Denver Colorado's St. Joseph Hospital there were two Kaiser Internal Medicine doctors there assigned to Lance. Their job is to coordinate Kaiser's allowances with the St. Joseph staff's plans for Lance's care, and even though it's not a Kaiser hospital they work onsite there wearing a Kaiser badge on their labcoats. They were able to smooth many of the bumps for us.

Home Health Care is a problem in a tiny house, but not for the reasons you'd think. The Case Management team from the hospital kept throwing roadblocks at us because they just couldn't wrap their heads around the concept of follow up visits for Lance in our 272 square foot space. In the long run I ended up driving him around for follow-up care instead which is fine (it's a good thing we hung onto the car). In reality, recovery is turning out to be easier in our tiny house because most everything he needs at home is at his fingertips, and even when I'm working at my computer I'm still peripherally aware of everything that's going on and can reach it quickly if he can't reach it himself. The end result is that he does a lot less hopping around than he did in previous casts in our home when I was out of earshot in another room or outside.

The Foot

In the meantime we'll take drives out to see the beautiful Denver area and more of the Rockies when Lance is feeling up to it now and then between appointments. We're also using this downtime for some vehicle maintenance - we found a Yamaha shop willing to take on the random electrical gremlins haunting Lance's bike since North Carolina. The silver lining is that we'll get some unexpected bonus time with very good friends that recently moved to the Denver suburbs.

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