No ice for his swelling: Medical travel insurance

Mary Billard's story:
My husband Barry and I took an hour’s cab ride through steep and winding hills, past the undeveloped, Eden-before-the-fall landscape near the beach town of Senggigi, Indonesia.

We were wandering down the main street, reading menus, when the lights went out. A few more steps and, suddenly, Barry disappeared from my side. I looked down into an open concrete drainage ditch about four feet deep, and there he was at the bottom, getting to his hands and knees.

It was so dark I used a cell phone light to see a bleeding wound on his forearm. Then he felt a pain in his ankle. Over the next eight hours, we learned his ankle was fractured.

We went to the nearest clinic. Barry called the number on the back of his American Express card, connecting him to the Global Assist Hotline to find out what kind of medical help they could provide and to explore our trip back to the United States.

In the subsequent hours, we were on the phone almost constantly as Barry lay in a bed in the bare-bones clinic – with no ice for his swelling. We reached doctors in New York, family and others, and American Express, which monitored the diagnosis and care provided. (After we got home, I got a phone bill for $903.)

A decision was made: Barry would have the local doctor put a cast on his broken ankle, and then we would travel back home to New York City. He would not have surgery in rural Indonesia.

How to get him home? As premium American Express card members, we are eligible to receive emergency medical transportation assistance. But a fractured ankle does not justify getting an air ambulance. (Even if we had a medical travel insurance policy, it wouldn't cover an air ambulance, because this injury didn't require hospitalization.)

It's possible that a travel insurance policy would cover a ticket to fly home promptly, depending on medical necessity.

Next trip, we are definitely buying a comprehensive trip insurance policy. And bringing a flashlight.

Mary's advice: Before embarking on an overseas vacation, travelers should check their medical policy to see what is covered.

Read a very different medical story of a tourist to Asia.

Thanks to Mary Billard for the source article in today's New York Times.

Six pack? I have a keg: Vince Wilfork, diet and diabetes

Vince Wilfork plays nose tackle for the New England Patriots. He's listed at 325 pounds. That girth is needed to hold his ground – a key responsibility for the nose tackle.

"Six pack? I have a keg and I’m proud of it," he says.

But in the off-season he read "The Abs Diet." His wife grabbed it before he could read it, and she began conducting weigh-ins and demanding three workouts a day, starting at 5 am. He lost weight, but kept his strength. Indeed, without his normal girth he has been just as strong, he realizes, if not stronger, and quicker too.

As of mid-December, he had made 64 tackles while anchoring the New England Patriots' fourth-rated defense. He earned his first Pro Bowl (all-star) berth on Dec. 18. He says he owes the honor to his wife's nudging.

He'll keep working at controlling his weight after this season ends. "I know that overnight it's not going to happen. It's going to take time, and every year we're going to attack that."

Vince's father had diabetes and died at 48. His mother died at 46 from complications of a stroke. Now, Vince and his wife host an annual NFL draft party to raise funds for the Diabetes Research Institute.

Advice: Be as unyielding as Vince Wilfork in defending against the strong pushes you feel toward binging. Good luck with the New Year's Resolution!

Browse for related stories in the index at the very bottom of this page, or read an athlete story.

Thanks to Christopher Gasper for the source article in the Dec. 20 issue of the Boston Globe.

Should I accept this new version of my husband?: Chronic pain management

Dear Annie,
My husband and I have been married for 20 years. He's had health problems during his time, but has always managed his pain.

Last year, he went to a pain management clinic and they prescribed narcotics. He takes them every day and is in a fog every night. He has gained weight, become sloppy, and stopped caring how I feel.

I have suggested counseling, but he refuses, saying he has no problem with our marriage. I have seen a counselor myself, but am totally torn up by this. I still receive attention from other men. I don't want to spend the rest of my life with someone who is continually numb. I have a solid job offer in another town close to family. Should I stick it out and accept this new version of my husband?
--Signed, Falling Out of Love

Annie's Advice:
Your husband doesn't want to stop taking this medication because he feels good for the first time in years. However, if he is "in a fog," he may be overmedicated, and his doctor should be told. If you've been with him for 20 years and this latest phase has lasted only 12 months, please stick it out and give him time to adjust his medication. If that doesn't help, insist on counseling for your sake so he can understand how close he is to losing his marriage.

Browse for similar stories in our index at the very bottom of this page, or read a pain management story.

Thanks to "Annie" for the letter and her response, published in Annie's Mailbox, in the Dec. 27 issue of the Boston Globe.

My wife made the appointment for me: PSA test and prostate cancer prevention

Adam’s story:

My name is Adam. I’ve been diagnosed with prostate cancer at the age of 45.

There is NO cancer in my family. I had absolutely no symptoms.

In May of 2007 after some blood work from my annual physical a red flag occurred. My PSA jumped from 1.0 to 3.5 over a 2-year period. PSA (Prostate Specific Antigen) is a test that screens your levels of protein in the prostate gland to se if there is danger of cancer. The rise in my PSA led me to see a urologist who had my prostate gland biopsied. It was this test that showed I have a very aggressive cancer (Gleason 9) growing inside me. The Gleason score of 9 basically said I had the most extreme form of growing cancer and the prognosis is NOT good.

This PSA test has been approved by the FDA to be tested for men over the age of 50 unless there IS cancer in the family. For some strange reason, my internist runs the test for every man over the age of 40. HE probably saved my life. Why??? Because I was tested early and often. Most people who get a Gleason score of 9 or 10 in their 40s do not have a good chance of surviving more than 5 years. The reason is that the cancer is growing so fast that it is likely spread to other parts of the body. Because I was tested, it looks like my cancer was caught early enough so that my prognosis is better than most with a Gleason 9 in their 40s.

The irony of this is that my wife made the appointment for me. You know you get wrapped up with work, family and life. Never seemed able to make the time. I just kept coming up with excuses. Thank God she made this appointment! Don’t be like me!

Adam’s advice to middle-aged men: Make sure you get your annual check-ups and make sure your doctor tests for PSA. They are already taking blood for other tests; they can do a PSA too.

Maybe this exam will save your life or a family member or friend. It most likely saved mine.

Read another story of how a wife saved her husband.

Too Much of a Good Thing: Lesson Two

Mrs. A. is a heroine of the story, for providing the hospital resident the key information about her husband's vitamin and mineral supplements. She could have acted even sooner--when the mineral supplement was first prescribed. At that point, she could have asked the surgeon how and when the mineral supplement would be effective. If the answer was, "It should help the wound heal within two weeks," Mrs. A. could then ask, when the wound hadn't healed two weeks later, whether the mineral supplement should be continued. The lesson: When receiving a prescription, ask when and how the prescribed drug will likely be effective. If it has not been effective, follow up with the prescribing doctor.

Readers: Has something similar happened to someone you know?

Medical Error of the Week: Too Much of a Good Thing

Mr. A., a bearded, pleasant-looking married man of 47 with three children, loved to eat. His weight had become alarming, and he had gotten diabetes. Four years ago, he had had gastric bypass surgery to reduce his weight; he lost more than 100 pounds--and his diabetes. Two years ago, he developed a hernia (a protrusion through the abdominal wall), which was repaired surgically. To speed the healing of the surgical site, his surgeon prescribed multi-vitamins, with a zinc supplement. However, the four-inch wound didn’t heal, even after intravenous antibiotics in the hospital. Indeed, he became anemic—tired, and lacking red blood cells, achy, and neutropenic (having lost most of his bacteria-killing white blood cells), along with a fever. A young hospital resident [physician] determined that both his anemia and neutropenic fever had been caused by too much zinc. The doctor told him to stop taking the zinc supplement, and he recovered fully within two months.

What was the error?
A preventable adverse drug event/adverse drug reaction to zinc. The dosage may have been too high (wrong dose). The patient might have been instructed to take the zinc for too long (wrong time).

Why did the error occur?
The surgeon had prescribed the high doses of vitamins and zinc because of evidence that they can speed healing after surgery, especially early on. However, the surgeon, the hospital doctors who treated him later, and his primary care physician did not link the complications of anemia and neutropenic fever to the zinc supplement.

Lessons for Caregivers:
Mr. A.'s wife had shown the hospital resident the list of Mr. A.'s home medications, enabling the resident to learn of and look into the role of zinc. Mrs. A had included vitamins and minerals in the list--not only medicines. She both wrote the list and brought it in to the attention of the doctor at the right time. Bravo! Please do the same for your family members.


Later this week we'll discuss more about Mr. A.; stay tuned.

This summary is drawn from Dr. Lisa Sanders’ article, “The Healing Problem,” in The New York Times Magazine, Nov. 12, 2006.