My Faith Shaken in Canadian Medicine -So What Now?

Oh how I miss those days when your family physician, with his little black medical bag, came to your house when you were sick.  A doctor that got to know his patients and often looking after them throughout their lives.

These days there's a waiting list to even find a doctor accepting new patients.  I've had four doctors in about 5 years.  Family physicians are considered to be standing on the lowest rung of the medical ladder.  Higher pay and prestige lie further up.  Can't fault anyone who wishes to improve themselves but the revolving door reality leaves much to be desired for our healthcare system.

My shaken faith:

• When in my twenties, four doctors, five if you count an allergist, failed to diagnose my sporadic bouts of rapid heartbeat, profuse sweating, weak and shaky legs, tunnel vision, disorientation and asthma.  I believed I was about to experience an heart attack whenever a spontaneous episode would occur.  I was sedated with Ativan or Valium and given a asthmatic "puffer" for my breathing.  Now I was just sleepy or dopey when episodes occurred.  It wasn't until I read a newspaper article of others experiencing the same symptoms that I could put a name to my symptoms: Panic Attacks.  No doctor had used that term for my symptoms.  A family member gave me some Anafranil (Cloprolamine) and said "take this, it settles my stomach".  I had no stomach problems but at that point I was borderline suicidal and didn't care if I took someone else's prescription.  After only a day, it was as dramatic as the curtains being drawn open to let bright sunshine in on a dark and dusty room.  Symptoms were gone and I could discard the inhaler.  I remained on the Anafranil for several years; a chemical imbalance in my physiology I suspect.  My doctor at that time told me, "we know a lot more about that now."  Too late to have helped me.

• In mid-2000 I experienced a severe debilitating backache.  I had to hold onto walls as I inched from one place to another.  I left work and came home to crawl into bed.  I wanted to take a shower, but couldn't lift my leg up over the tub.  Oh how I wish I could have and prevented my infection.  I had yet to find another doctor, my most recent physician having left for more fertile ground.  I went to a walk-in clinic where I was prescribed a muscle relaxant, then went back to bed (no urine culture, which might have offered a better outcome).  How many days went by I cannot recall.  I woke up one morning and my legs would not move.  Taken by ambulance to the hospital, an MRI revealed I had a spinal cord abscess caused by the bacterium Staphylococcus aureus. Surgery followed and I came out of the ordeal as a paraplegic.  I can only speculate whether my outcome would have been different if I had my family doctor at that time.

• While in the hospital, recovering from my spinal infection, I lost hearing in one ear.  At least two doctors, one twice looked into my ear canal with the otolaryngoscope but couldn't seen anything amiss.  So that was that!  I couldn't hear but nothing was wrong.  Once discharged I saturated some cotton with hydrogen peroxide and stuffed it into my ear.  I removed so much "black junk" from my ear canal which doctors couldn't detect.  I could hear again.  My ear had picked up some sort of infection from some hospital fomite (inanimate vector) such as a pillow.

• The most recent episode which continued to shake my faith in the Canadian medical system is described in the three previous posts.  In April of 2022, I experienced severe spasms in my right leg which sprained to to such a degree that it would no longer support me in standing or transferring or more importantly, in stepping into our family vehicle as I had been doing for the previous fifteen years or so.

1. Doctor No. 1, who I found after a year's search after having moved back to my hometown.  He told me all I needed was rest - which was what I had been doing all winter up til this April episode.  I went home and rested.  I did recover to some degree but not to what I had pre-April, 2022.  The strength, stability and tautness did not return allowing me to get into our family vehicle.  My limited independence is now all but non-existent.  I have to rely on disability transport.
2. Doctor No. 2: Doctor No. 1 left after about a year and a half with no one taking over his practice.  He had left me with a years worth of repeat prescriptions which was about the time it took to find another doctor.  At the "meet-and-greet", I explained my April episode to the new physician.  He ordered an EMG [meaningless without a baseline to compare it to - a before and after to see what changed] and an MRI [something specific diagnosis in mind or just grasping?]  The EMG was scheduled for early the following year (2023) and just about that time I received and e-mail informing me that he was leaving his practice; he was handing his practice over to another doctor.  [The EMG result confirmed that I was a paraplegic and nothing more.  Waste of my time and the taxpayer's money.
   
3. Doctor No. 3: At the meet-and-greet, I was interviewed by, I assume, was a clinical assistant - prior to meeting the doctor, or so I thought.  No, that was it.  I've not met my new family physician yet though I've been to his office twice.  I did hear from him though,  When the previously ordered MRI result came in he phoned me with the result.  I had previously heard from the Osteopath? or Neurologist? or their clinical assistant? who gave me a summary of the MRI results:  I needed immediate surgery for a bone spur which was causing my spasms and I could continue to take my Gabapentin [nerve pain] and Baclofen [anti-spasmodic].  Huh, did you not read my chart to see that I'm a paraplegic and am on those two prescriptions for life [or miraculous biblical intervention].  Were they misreading my original injury for a new problem?  I discussed this with Doctor No. 3 by phone and he patiently listened but I don't recall him challenging my assumption.

 

And so after hanging up I'm left wondering: Do I really have a bone spur causing additional problems.  Do I need surgery?  Was I misdiagnosed?  Will I ever meet my new family physician or will all diagnoses and results be offered by phone?

At the time Doctor No.2 ordered the EMG and MRI he also sent me to a plastic surgeon regarding my finger contractures and to an orthopedic surgeon for torn tendons in my shoulders.  The plastic surgeon injected one finger with cortisone and ordered additional x-rays and ultrasounds.  After a half a year or more, I have not heard back from their clinic. nor my new family physician regarding the results - prognosis or possible treatment.

As for the torn tendons in my shoulders, I was examined by the Orthopedic surgeon and his assistants and told there was nothing they could do for me.  I asked therefore if I should just learn to live with the pain?  The doctor then asked me my age.  I told him.  He just smiled at me.  The only way I could interpret his countenance was that I was close to death anyways, so why bother...

The summer of 2023 has for me been the summer of medical tests.  Yet no issue has been resolved and there is nothing more on the horizon.  I guess it's up to me to raise my fists and beat on their doors to do more to find out what ails me.

I won't even get into how the Canadian medical system hastened my dad's death.  I've relayed it elsewhere in this blog.

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What Happened -Part 3

 A summation of the previous four posts:

Ever since my spinal cord injury some fifteen years ago, I was able to climb into our family van from my wheelchair for transportation to wherever I needed to go.  In fact I last did so in the last week of March of 2022 when I visited my out-of-town dentist.

Then, on April 6th & 7th of the following week, I experienced excruciatingly painful, explosive spasms which lasted all night till dawn with only a slight reprieve during the day before they resumed again the following night.

The spasms were so intense and devastating that I could no longer place my weight upon the leg for support during transferring.  I could lift my left leg upright and hold it taught; the right leg would sag and bounce when trying to do the same.

Here lies my frustration with the Canadian medical system:

I am now on my fourth family physician in five years.  I left my previous physician when I moved back to my home town.  Family physicians accepting new patients are rare in Ontario Canada - with some wait lists as long as five years.

Doctor No. 1 (2019-Summer 2022): Though some distance from home, I found a doctor accepting new patients.  I was with this doctor in April 2022 when my debilitating spasm event occurred.   He told my all I needed was rest but ordered an ultrasound to humour me.  I showed no abnormalities and the leg slowly did recover but not to pre-April capabilities.  I tried but could not raise my left leg while balanced on the wobbly right leg, high enough to step into the van.

Just when I was about to approach him again, I received a letter in the mail telling me he was closing his practice as there was no candidate willing to take it on.  I left my name with the clinic should events change and then the search was on again.

Doctor No. 2: (January 2022-May 2023) I received a call from the clinic that a new physician had arrived and was accepting patients.  I immediately signed up and shortly thereafter went to the meet-&-greet.  I explained my spasm event to the doctor during our initial meeting.  He ordered an EMG and an MRI [along with other tests unrelated to my spasms - trigger fingers, shoulder pain from torn tendon, etc.]  Whether do to the demand or Covid backlog, the tests were scheduled into the following year.  In May of 2023, some four months after establishing his practice, he decided to leave [for personal reasons].  There was another doctor at the same building but not with the same clinic who was willing to accept Doctor No. 2's patients.

Doctor No. 3 (June 2023-?): So I go to my third meet-&-greet for my fourth doctor in almost five years.  But I don't meet the doctor; I meet who I presume was a medical clinician for the doctor.  They listen to my gripes and take my notes [which will be scanned into their black hole, never to see the light of day again.  They suggest I meet with another doctor in the same office who manages pain.  When the time came to meet this pain doctor No.4, I meet with the same clinician.  So I have yet to meet my new doctor(s).

Results ordered by Doctor No. 3 began to come into his office. Negative results are not called but I finally did hear the voice of Doctor No. 3 when he called regarding the MRI. The hospital's neurology or orthopedic doctor's clinician had already contacted me regarding the MRI results, telling me that a bone "spur" was causing my spasms and that I needed immediate surgery. They continued by telling me that I should keep taking the bacolfen for spasms and gabapentin for nerve pain. That left me wondering if I really had a "spur" or whether they were misreading my original injury as something new. When Doctor No. 3 called, I explained my reasoning to him which he took in and didn't challenge.

The more I think about it, the more confused I become.  Was there something new and abnormal in that MRI?

I guess it's up to me to make another appointment and pound on the good doctor's door [or his clinician's] for I still am housebound and unable to get into your family vehicle.  Something suddenly happened to me in April of 2022 which robbed me of my ability to get into our family vehicle; the problem remains.  Though not solved, it appears Doctor No. 3 had dismissed my medical complaint and it's up to me to continue to raise a stink.  (Oh, you were serious about that issue?)

I remain housebound, having been off my property some thirteen times in the last seventeen months (since April 2022 to present) and all for medical or related appointments.  All trips were by public disability transit.

And so it goes....

Disability Transportation

 As mentioned in the previous post, since my massive spasm episode in April of 2022, I suddenly lost the ability to step into our family van for trips away from home.

As such, I have been off my property only 13 times in the last 17 months, as of September 1, 2023, and all trips were by the local disability transport, and all were for medical, or related (pharmacy flu/Covid) appointments.

I have not left my home for entertainment, to shop, meet friends or to enjoy a meal at a restaurant.  Nada! 

Local disability vehicle

There lies another problem.  Perhaps it's the staffing shortage - the employment lethargy which appears to have resulted from Covid.  People no longer wish to return to work after the pandemic viral slowdown or downsizing.  Perhaps it's the manner of the job.  Their paycheck perhaps not compensating sufficiently for their stressful work.

Though not highly skilled work, it does demand a compassionate, tolerant, flexible and even-tempered worker, whether a driver or dispatcher.  Clients may miss scheduled rides with routes and timetables constantly juggled and readjusted.  Clients can be in pain, can be surly, exhibit anger and frustration; they may require special attention, etc., etc.  How do the hire and retain competent staff?

The earliest the local company allows me to book a ride is seven days in advance.  I had a MRI scheduled in a year's time and was unconcerned about getting a ride to the hospital.  Perhaps I would have recovered sufficiently to be able to again step into our family vehicle.  So the week finally approached and in the early morning of the seventh day before my MRI, I attempted to book a ride to the hospital.  No luck.  All booked up. Many clients have booked "permanent" rides such as those who have perpetually ongoing trips to dialysis clinics for weekly treatments.  Others have full-time jobs and have booked up daily trips into work and home again.  The slots are quickly filled up.

One bus driver told me that city hall has cut funding for disability transport even though the "boomers" are getting older and living longer with age related issues.  Perhaps the city councilors have no relatives needing assistance - or have no compassion.  Can funding really not be found?

Well, I did get a ride to my MRI by constantly selecting an earlier time period for ride to the hospital.  I found a slot two-hours before my appointment.  I would read a book while I wait.

Another time I was placed on a "wait list" to see if someone cancelled their trip in a time-slot closer to what I needed.  No one did.  One is faced with having to cancel long-standing appointments or to hire a private taxi at a substantially higher cost, to get one to where they have to be.  This adds significantly to one's stress.

At present, I have no alternative.  I'm grateful the service exists but it's inadequate.  I choose not to use it for frivolous trips - to shop or for entertainment, hopefully leaving the service for those who truly need it for medical concerns.