Monday, March 8, 2010

When Tune-Ups Don't "Fit"

Today at lunch Ronnie and I were just discussing the busy couple of months we have coming up in our lives. My brother, Josh, is getting married, Ronnie goes out of town to speak at an event in Albany, Ronnie needs to get in for a tune up, we have wedding prep, our wedding, and our honeymoon. We had tentatively thought through timing of it all, but we hadn't talked about it all since Ronnie's trip to Albany was scheduled. As we started chatting, we began to realize it was going to be a TIGHT squeeze to get Ronnie's tune up in. Josh's wedding is March 28th, and he is standing in it, so he can't go in until after their wedding. Then, Albany is April 16-17th, which means he can't go between Josh's wedding and Albany, because that's only 2 weeks. We get married May 22, which means if he goes in after he gets back from Albany, and stays 26 days (4 days under his typical stay). That would get Ronnie out 1 week before the wedding, just enough time to help with last minute plans and moving all of our stuff into his condo or into a new house (details on the house hunt possibly next week). Talk about a TIGHT squeeze. If anything goes slightly wrong while he's in, it could get interesting for the wedding day. But, we need to do it that way. The hospital stay needs to happen, so we're going to make it happen, and trust that everything will go smoothly.

All this to say, we truly believe that hospital stays are IMPORTANT. It is CRUCIAL to be proactive and not reactive when it comes to taking care of CF. Could we push off the stay? Yes. Could that result is him getting sick and causing irreversible damage? Yes. Is it worth that? NO. A little frustration and a little uneasiness about timing and scheduling is well worth preventing potential, long term damage. I would love Ronnie to be around the month before the wedding to help with last minute planning, errands, moving, etc. I will be forced to do a lot more work, and potentially all of the work, but one month of more work on my end and missing my fiance is well worth maintaining his good health and lung function. So I'll take it. Ronnie is being proactive and not waiting until he's really sick to go in, so it's likely that his stay will be nice and quick, and he'll be out and feeling awesome for the wedding and honeymoon. So we're going to work really hard this next month so he goes in as healthy as possible.

Comments (17)

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I am so glad to know that I'm not the only one that "plans" her hospital visits - as much as something like that can be planned. I generally know that after about eight weeks home that I'm going to be on that slippery slope down to my next hospital visit. I usually try and push it at least another week or so. On the flip side of that coin, going in more routinely has made me healthier in between hospital visits, I think. I have plans for the end of the month which is at the start of my eighth week, so I am trying so hard to be faithful to doing my therapy, treatments, and exercise everyday before then.
Since my wedding is a week or so before you guys, I too am trying to 'schedule' or not my tune up too. I am not feeling good right now but I am hoping that it is just the cold that was going around and that I can kick it out before it goes there. Well I see my doc on Thursday so we will see what he has to say. My fiance is out of town right now for a total of 6 weeks and I have the kids right now for Spring Break so this week won't work. The next 2 weeks could make the cut except I have the kids on the weekends so it would have to be during the week. I usually am in for 5-7 days and then finish IV's at home. I then have to fly to Gulfport to drive back with my fiance back home. So then it will work in April at some point. Oh the joys of CF and scheduling sick time...lol!
Shannon 30 w/cf
Hey, Ronnie. Why do you go "in" for a tune-up? Why not home IVs? Insurance generally covers home care 100%. We haven't paid a dime for home health and it saves your insurance company a ton of money... and the food is WAY better.

The thinking here is that they don't want you in the hospital unless your life depends on it that moment because they don't want any exposure to MRSA. 'Sup?
5 replies · active 786 weeks ago
Good questions for which I have multiple answers:

I've never responded to home health like I do to the hospital.
My docs are not huge fans of home health.
A big thing for me getting better is rest. I don't have the discipline to rest a home :)
I already have MRSA :)

One of the days I'll probably give home health another spin, but today will not be one of those days....

Ronnie
Well, there you go. Good answers. And 30 days is their normal routine? Wow, we live on opposite planets of CF doctors, methinks. Dunno if I should move out there to get your care or be thankful for how long I do treatments, you know?
Yeah, there is definitely different schools of thought on this subject. They would just like me in for 10-14 days, but usually I don't respond that fast :)
Ronnie,

I'd like to suggest a future post from you. Can you get your cf team to give an explanation of this four-month rotation you're on? It's interesting. I've never really heard of it before. My docs are the opposite. I have to be dying before I go in for IVs. Are yours concerned at all with resistance? I do get the logic of maintaining lung function because the day is coming when we're going cure this disease and we'll all be stuck with the lung function we have at that moment (kind of like a game of musical chairs - when the music stops . . . ).

So, if you can shed more light on the logic of this strategy, I'd be interested in knowing more. Also, you remind me of all those great characters in prison movies - the ones who get put in solitary for six months but take it like men and pop out stronger than ever. 26 days in the hospital? YOU'RE THE MAN!
I *wish* my insurance covered home health! I have an amazingly wonderful policy through my job, except for that. For example, whenever I go in the hospital I pay $250. That's it. Doesn't matter if I stay 14 days, 21 days, or 30 days. However, if I decided to do home health care I would have to pay the $250 for the one - three days that I would be in and then pay 20% of the remaining expenses out of pocket. Looking at my average pharmacy expenses, that'd put me (close to) $2000 out of pocket for every hospitalization. Ouch.
I was going to ask the same question about the hospital verses home IV's. My son is 9 and so I am still taking care of him verses his own choice, I am thinking when he is older, I will be flexible to do what he desires. Right now, we go in 10-25 days at a time, then go at home 1-4 weeks on IV's. He seems to get more rest at home (me too) but that may change as he is older, also, he gets to go back to school most times which helps. I know when school isn't a factor, that might change. Thanks for the update and insight to your life. Praying for the "tune up" and your body "to fit" in your plans and for a great wedding!!
1 reply · active 786 weeks ago
I can append my question with my history. I was always in the hospital in August before school started for the "annual tune-up" so I didn't miss any school. Usually the only days I missed K-12 were days I was out for blockages. They usually landed me in the hospital for 1-3 days back then.

Since the 7th grade, we've done home health. Man, have things ever improved. I used to need a portable syringe pump to infuse my meds over a period of time, but now the latex balls are awesome and can slip in my pocket and I leave the front of my shirts untucked. I've even been on IVs and my immediate family didn't know, because the system is THAT good.

Why don't I go into the hospital? Several reasons on this end:
1) I've had a full-time job since I was 18 (I'm now 31, married, and have a mortgage, yikes!). I just can't take the time off to go into the hospital or I'd lose everything.
2) The doctors here are really big on keeping us out of the hospital because of MRSA. I already have a pretty heavily resistant pseudemonas. My treatment they put me on IVs with now is tobramyacin Q24 and Dorabax Q8. I'm definitely losing some hearing qualities after so many rounds of tobramyacin. I'm never on more than 2 weeks unless the gram-positive and gram-negative bacteria start to fight in a teeter-totter effect half-way through treatment. Then I'm on for 3 weeks total.
3) I just can't rest in the hospital. The nurses piss me off (do you really need to wake me at 1am and ask me if "sleepy sheet marks" on my skin during the night is normal for me?) and need constant attention to make sure they don't kill me. I also don't get any good food there. I lose weight every time I get out... after the IV fluids get flushed out and I return to a normal state of hydration.

I think it's cool to see the various treatments people have and figure out which are because of doctors and which are due to the genetics involved.
WOW WOW WOW! First I would like to give you an internet high five for doing 30 days in the hole at a time!! I am screaming to get out by at least day 10. I actually made it 13 this time. My husband and I both discussed just the other night about asking to stay 21 next visit. I have never done it before and for some reason I don't respond really well to the meds, like you said. So maybe staying longer is better??? Not sure. I am always afraid of catching extra infections and my anxiety gets the best of me and before I know it I am busting out the front door heading home!!! I don't have MRSA. I did culture it years and years ago. It went away and I asked if it was still there and we just didn't know it. The doctors said no, it would have reared it's ugly head by now. Plus I know ACTIVE MRSA can cause more lung infections and I usually don't have a huge problem with that. My MRSA was dormant. They said it wasn't growing, spreading or anything. Just sitting there. Luckily we got it out however I know how easily I can catch it again. So I try to steer clear of hospitals at all for that reason. I didn't even go when my sister had her baby. I just waited until they came home. I would love to know more about what treatments you take at the hospital. What cocktail of antibiotics they have you on so to speak. =) You have now given me the courage to do the 21 days. If you can do 30, then I most def can do 21!!! =)
1 reply · active 786 weeks ago
I think it's always worth a shot. I generally won't leave unless I'm 100 percent sure that I can keep up with my workouts outside of the hospital!
hey ronnie, how often are you hospitalized?
are you starting to feel crummy again?
or do you go in for automatic tune ups at a schedualed amount of time, even if you are not feeling bad?
1 reply · active 786 weeks ago
I'm in about every 4 months...I don't feel to bad. I think I may be coming down with a cold though :) I generally go in every 4 months or so regardless of how I'm feeling. But, I usually am not feeling so great at that point.
ooh i see.
do you have a port? or do you get a picc in every time?
1 reply · active less than 1 minute ago
I get a PICC line ever time. Who knows when that will have to change though :) I've had over 35.
It's so interesting how different each person is in terms of their CF. My boyfriend only goes into the hospital every 6 months- 1 year and only when he's really feeling bad. So no regular "tune ups" for him.... and he is a big proponent of having an outpatient PICC and doing home health!

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