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Thread: Pneumonia vaccine before surgery - how worthwhile? What abt the odds?

  1. #1
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    Pneumonia vaccine before surgery - how worthwhile? What abt the odds?

    I'm definitely a "better safe than sorry" person - one reason I've agonized so about the decision to pursue surgery. There's only so much we can do for ourselves with this operation, to improve our chances of coming through safe and sound . (I've gone through at least ten ops alone with little or minimal help - i.e., got a lift to and from, if that ) .

    But there are SOME things we can do to be safer! Besides planning with back up plans and persons to spare, we can try to be as healthy as possible, going in.

    Also I've been thinking right along about immunizations: Flu shots (there's quite a range), shingles vaccination and last but not least, pneumonia vaccine. Yesterday at Walmart there was a nurse giving a flu shot (each one contained a whole LOT of strains including HINIs). Also, pneumonia shots were offered separately. The latter, $60, contains over 20 strains of pneumonia bacteria. This has been much on my mind lately, in connection with our scoli comrade who is fighting her way back from a nasty attack.

    I've had at least one such vaccination in the past (I WISH I knew when!). I'm troubled because the latest info says patients aren't to have more than TWO in a lifetime and not more than five years apart. I'm trying to get a clear answer from my PCP about the odds of having it even without remembering my exact vaccination history.

    It certainly seems it would be a great advantage to go into surgery with this extra protection! Or ARE there serious risks to possibly going over the maximum? I know some people even worry the side effects of the flu shots (regular. HINI and a few sub-types), outweigh the advantages.
    Last edited by Back-out; 09-10-2010 at 07:28 PM.
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  2. #2
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    More questions on immunizations and infections

    PS It would be very nice not to have to come in to the office of my PCP for a talk abt this, as I've found recently I've reached my max. annual MD consults. This means not only that I have to pay 100% out of pocket for all visits for the rest of the year, but that it's "TOP dollar" too - no "contractual write off" !)

    Meanwhile, I wonder what any other "pre-oppies" are doing in this regard, and what you've been told about the benefits of having protective vaccinations - especially the pneumonia one. What if anything have YOU heard about the limits on the number and intervals of vaccines? It would be fabulous to be able to be immunized against MRSAs! Seems that's the great bugaboo for this and other major surgeries - that and the big bad new germ spreading from the third world. That one is reputedly resistant to ALL antibiotics. I'm sure the odds are still relatively low on contracting any of these, but OTOH - it DOES exist, as we all know and why not be as safe as we can be?

    FWIW do any of you know about the legendary websites which allow one to check the average infection rates of various hospitals? If they exist, they sure seem to be a closely guarded secret. Ho-hum, maybe all this seems like "over-kill" (and perhaps it is indeed, largely a way of coping with anxiety), but it seems to me one of a number of ways to build up REAL resistance. If anxiety reduction is half of it, well so what?
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  3. #3
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    I thought that you only needed one pneumonia vaccine for anyone age 65 or older. When is your surgery scheduled? It wouldn't hurt to get the flu vaccine if you still have a couple of months before surgery. I missed getting my flu shot before my surgery and they won't give you one once you have the surgery and are still in the hospital. Fortunately, I was able to avoid the flu that year.
    Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  4. #4
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    Quote Originally Posted by loves to skate View Post
    I thought that you only needed one pneumonia vaccine for anyone age 65 or older. When is your surgery scheduled? It wouldn't hurt to get the flu vaccine if you still have a couple of months before surgery. I missed getting my flu shot before my surgery and they won't give you one once you have the surgery and are still in the hospital. Fortunately, I was able to avoid the flu that year.
    Sally
    Hmmm. I DID get the multi-flu vaccine yesterday.
    As for the pneumonia one, my best guess is that I had it once up to ten years ago, when I was in my early 50s. (I'm not yet 65).... Surgery not yet set, nor is surgeon. Problems w/helper have contributed to date setting.
    Things looking up in that regard. Hideous anxiety, meanwhile. Appears likely to be happening towards year's end.

    I'm curious abt the pneumonia vaccine especially after Brenda's ordeal. Thanks, Sally!
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  5. #5
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    I have no idea about the pneumo vaccine, but I'd love to know what you find out!

    Thanks,
    Evelyn
    age 44
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke, T4 to S1 with pelvic fixation
    Not "confused" anymore, but don't know how to change my username.

  6. #6
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    I haven't heard about the pneumonia vaccine either, but it sounds like not a bad idea.

    I know you will have Googled it, but you'd think that information would be readily available on the net.

    Anything that reduces anxiety is a good thing Amanada. I have a friend who's a public health nurse, Masters in infectious diseases...I might email her now.
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  7. #7
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    Here is her reply, which I thought was very interesting.

    There are many bugs (bacteria, viruses and also, far more rarely, other types of organisms) that can cause pneumonia.

    If you get influenza, it can weaken your defences against the bugs that get to your respiratory tract and can cause pneumonia, and so an influenza vaccine, if you are thinking along the lines of trying to prevent pneumonia, is a good idea.

    However, with influenza vaccine you need to be aware that it only ever has the most common strains affecting the population this season, so just because you have had the vaccine, it doesn’t mean you will not get the flu.

    With regards to pneumonia, Streptococcus pneumoniae, aka “Pneumococcus” is the most obvious bacteria which causes pneumonia, that you can be vaccinated against. You will only be vaccinated against the particular strains of pneumococcus that the vaccine can prevent against – there are at least 90 serotypes of pneumococcus and in Australia the adult Pneumococcal vaccine prevents 23 of the serotypes, so there are still 67 strains that could get you.

    There are other bugs that can cause pneumonia, which have vaccines, such as Hib (Haemophilus Influenzae type b), but I doubt this would be recommended by those in the know because this bacteria really only harms very young, or extremely immunocompromised people.

    In short, I think the influenza vaccine would definitely be worth it. And possibly pneumococcus. But the person’s doctor would know what is recommended pre-surgery, based on the risks associated with this particular surgery.

    She says she hopes this helps!
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  8. #8
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    Amanda,
    I googled pneumococcal vaccine and got this off the CDC website. I hope this helps

    As an adult, do I need the PPSV vaccine?
    o All adults 65 years of age and older.
    o Anyone 2 through 64 years of age who has a long-term health problem such as: heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid or cochlear implant.
    o Anyone 2 through 64 years of age who has a disease or condition that lowers the body’s resistance to infection, such as: Hodgkin’s disease; lymphoma or leukemia; kidney failure; multiple myeloma; nephrotic syndrome; HIV infection or AIDS; damaged spleen, or no spleen; organ transplant.
    o Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body’s resistance to infection, such as: long-term steroids, certain cancer drugs, radiation therapy.
    o Any adult 19 through 64 years of age who is a smoker or has asthma.
    o Residents of nursing homes or long-term care facilities.

    PPSV may be less effective for some people, especially those with lower resistance to infection.

    But these people should still be vaccinated, because they are more likely to have serious complications if they get pneumococcal disease.
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  9. #9
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    Thanks much, Sally! You are a champeen Googler!
    I don't have any of those conditions but OTOH all research (especially some new stuff) shows that folks undergoing major surgery - think Us'ns - are extremely immunosuppressed afterward.

    I'm especially concerned about the period between stages if one is in line for a P AND A procedure. Make that EXTRA concerned, depending on the facility! Reminds me to plug one of my questions again - asking for websites to compare hospitals re their infection rates. Seems to me, some of you mentioned checking facilities prior to surgery so there MUST be something out there. However, having made many stabs in the dark, it is clearly (deliberately) made hard to find. Maybe it's by "subscription only" - with even paid services hard to find.

    It sure would be a show stopper for many facilities. All the more reason to make it public knowledge, don't you think? What a nerve, keeping such important information secret. I'll bet physicians have ways of checking to protect themselves and their families (noting again that NO surgeons nor other top level medical professionals in my town undergo major surgery locally. Nor do they stay local for cancer treatment.). All my (modest) cancer-stricken friends in town, failed to survive...The worst hit seem to be those sweet women who "don't want to make waves or inconvenience anyone".

    What do you think patients have the right to know? I'm pretty sure keeping the infection/mortality rate proprietary, is justified by claiming lay persons are unable to interpret statistics intelligently. Why worry our pretty (fluffy) little heads? The survival "game" is among other things, definitely a matter of squeaking wheels - loudly - and NOT a time to aim for the MS Congeniality prize. Shame. I'm amazed by the number of nurses on the forum, who've NOT gotten tip top treatment. I'd have thought they would be treated extra well as a professional courtesy!
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  10. #10
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    Quote Originally Posted by JenniferG
    Here is her reply, which I thought was very interesting...
    She says she hopes this helps!
    Please thank your friend VERY VERY much. And thank you extremely much too, Jen!

    This information definitely helped me, and I venture to say, it will help others too - hoping many pay attention to this thread. I'm kind of surprised no one has asked about this before - at least, AFAIK (and especially now with Brenda's horror story). I am interested in the Shingles vaccine too (out of stock nationally until November BTW) - though that is more a shot in the dark. That vaccine is even more expensive, not a sure preventative, but OTOH it's one more bullet that can probably be dodged. I wouldn't have thought of it either if it weren't for this operation looming, though.

    Sounds like the Aussie pneumonia vaccine is the same one Walmart's is selling now. I assume that the two dozen or so in this combo shot represent those most commonly contracted. [?] It's also good that she stressed that flu vacs are also a good preventative for pneumonia as bacterial infections often follow influenza illnesses!

    The only piece of info I definitely find still lacking is what the risks are of having more than one-two pneumonia vaccinations/lifetime or less than five years between shots - especially as they may make different combinations available over time. When you get them at a roving site like this one at Walmarts (or other pharms or grocery stores), there is no record. Their warnings are more mysterious then - how serious side effects can be. The nurse administering, said many besides me had asked her. Methinks she should know the answer!

    I'm pretty sure these warnings weren't issued before, of I'd have remembered. Probably they were arrived at on the basis of (bad) experience. Judging by what I've read in the news and the survey Walmart's was running, Walmart's is about to vastly expand medical services they offer - to free-standing clinics and many more varieties of vaccinations. Maybe even dentistry! Guess later on there WILL be better centralized record keeping . I can easily imagine before long, "mammograms and chemo while you wait" - not to mention free scoliosis screening! Also ultra-sounds for plaque build-up in hearts, carotid arteries, checking for embolisms - same as in traveling U-Sound services. "EQUATE Clinics" coming soon! Something has to fill the gap left by insufficient PCPs... Walmart's/Sam's Clubs might even have 24/7 practitioners to merge with those URGENT care clinics springing up.

    I hate the loss of private practices and Mom and Pop stores, but it's so hard to resist the convenience of these mega chains! Probably tests themselves will be interpreted overseas - MORE outsourcing and more ways to render quality-tiered medical care. It will be a cold day in hell before they have drive-through scoliosis surgery, though!
    Last edited by Back-out; 09-11-2010 at 01:41 PM.
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

  11. #11
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    Hi Amanda,
    I don't have any statistical facts, but I will tell you that my dear husband was asked by our PCP if he had a Pneumonia shot in the past and he answered, "no", and thus received his second Pneumonia shot within two years. It did not hurt him in the least but was certainly a waste of Medicare dollars. Why the good Doctor didn't just look in my husband's chart or ask me, I'll never know.

    Some hospitals report their infection rates and some do not. Sometimes newspapers will report on this. I know that the NE Baptist is very proud of their extremely low infection rate. When they thought I had an infection from my IV when I was in the hospital in April, they gave me a very strong antibiotic which it turned out I didn't need because I was reacting to the antibiotic I was originally given. So it is kind of an overkill. Where are you having your surgery? Maybe I can find something about it.

    Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  12. #12
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    You're very welcome Amanda. I have emailed my friend again, asking the question about how often the pneu. vax is recommended. She works for the Northern Territory CDC, so if she doesn't know, she can find out. (She's the TB nurse, among other things.)

    She's out for a couple of hours but I will let you know what she says, later.
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  13. #13
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    Just caught her before she was running out.

    I am late so will reply properly later, but if it’s ten years since her FIRST Pneumovax, then yes, another is recommended now. The gap between them (at least on the Aussie schedule, and it would not be that different in the US) is five years.


    I'm sure there'll be more to post once she gets home.
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  14. #14
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    Here is a c & p of her reply. Some of it may not be of interest, but I will post it in case it is. I sent her a c & p of your post Amanda, so she's basically replying to you.


    The Shingles vaccine is the Chickenpox (Varicella) vaccine. Most adults today have had chicken pox, so the vaccine is not necessary. You can have a blood test to find out if you have already been exposed. Even people who don’t know they have had Chicken pox could have had it, because it is often very mild, especially in childhood, and can present as just a bit of a cold. The vaccine does not stop you from getting shingles, it only prevents Chicken pox. What happens with CP is that you get the disease (or the vaccine), and the virus (which is live but mutated in the vaccine) stays dormant in your nervous system forevermore. Sometimes, under times of stress usually, the virus represents itself, and the representation is Shingles. So having the vaccine COULD possibly end up giving you Shingles.

    Personally, I think she is far wiser to just get tested to see if she’s ever had CP, and then she’ll know for future reference. I wouldn’t personally recommend the vaccine.

    Yes, the serotypes in the Pneumovax vaccine are the most commonly, OR most severe, that can be vaccinated against. They have not worked out how to create vaccine for all serotypes though, so some of them are not in the vaccine as it’s not been discovered how to make a vaccine against them yet. However, now that there is a vaccine against these particular serotypes, it is possible that the non-vaccine serotypes could take over as causing more illness, this is an unknown as yet, and is why public health systems are now undertaking enhanced surveillance of the disease – which means anyone who is diagnosed with pneumococcal pneumonia is “investigated” with regards to what their risk factors were (do they smoke, were they if a child, born prematurely, are they HIV+, do they have asplenia (no functioning spleen), have they been vaccinated), and the serotype is tested for, to monitor which serotypes are causing disease, and in which people.

    Regarding risks of having more than one or two pneumonia vaccines in a lifetime. None. Except that you are unnecessarily exposed to the side effects/potential severe allergies of a vaccine that you don’t need to have. If you have too many doses, then each time you get the injection, the soreness to your arm can be worse, so you don’t want to get too many doses as it will hurt! It doesn’t help, as research has found that the number of doses they recommend is all that you need, so there is no need to have more than the number recommended. If they introduce vaccines with more or different serotypes, then recommendations MAY change, but they may not because there is often a cross-protective effect, whereby if you’ve been vaccinated for strain 23F, then it can also protect you somewhat against strains 17G and 10A (that’s an example, not a fact!). If you have a shot within the recommended five year interval, then it doesn’t count and you still have to get your “second” shot five years later, again. Eg, if you had the vaccine in 2007, then you get it again this year, then the 2007 dose is rendered irrelevant, and in 2015 you still need to get another, being five years from what has become your “first” shot. (That’s from memory – I am sure it’s the first vaccine that they say no longer counts in cases of over-vaccination).

    It is quite complicated, so I hope I’ve explained it okay.

    As to her questions about why the warnings were not there before, and they are now. There are a number of reasons for this. Partly, the enhanced surveillance we do on every single new diagnosis of pneumococcal disease, will have presented new findings. But also partly, in cases such as America where it is a profit making exercise for companies, then a company such as Walgreen can come up with evidence from the publications, that supports them promoting a certain product. I know that in America there would be all kinds of laws around this, whereby they would have to have research to support their promotions. But this would not be the case in countries such as India, which comes to mind for me because of the TB patient we had recently who returned from India, having been prescribed all kinds of unnecessary “extra” medications that would have made little difference to the outcome of his treatment.

    This is where we are lucky in Australia with Medicare – you only get what is absolutely necessary, recommended to you as far as public health recommendations such as preventive vaccines. In other countries it is complicated and masked by all kinds of other influencing factors, such as companies making money! We also have excellent centralised record keeping, although adults are required to keep their own records, and adults (me included before I went into this career stream!) are notoriously bad at such things!


    Hope this helps!
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  15. #15
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    Real kindness from Down Under, compared to price gouging from down the road!

    Jennifer and unknown friend,

    I am bowled over by your care and expertise in going to so very much trouble in obtaining these detailed replies to my detailed questions.

    Angels from Down Under, thank you, thank you! I am tearing as I look at these personal replies which clearly took such a lot of trouble to put together and think out -- and from quite an extraordinary knowledge base, too!

    Jennifer and kind expert friend, your assistance not only answers all my questions, but also gives me a terrific grounding in understanding the issues surrounding immunizations in general. That means that like all great answers, it not only answers the original queries but provides a lesson and rationale for the answers.

    Now I can walk away not only enriched by having my uncertainty assuaged, but also prepared to deal with subsequent issues that may arise in this area. That's thanks to having been given a personalized lesson in addition to the answers themselves. , having learned from someone who troubled not only to tell me the "necessary" but better still - the desirable! I'm grateful and honored

    This is really striking considering the blow off I received in email correspondence with my PCP's nurse. She by contrast, refused to answer a few basic queries (including this) - instead, demanding I come in for a medically UN-necessary appointment. One moreover, that I'm unable to afford because of the insurance limits I referred to above, this thread. Hitting my consult max now is catastrophic - especially with surgery looming (including many surgeons' consults and MANY other out of pocket expenses outstanding, as you all can well imagine )

    Interestingly, I spent a good bit of time on the phone today trying to get a partial write off on these pending surgeons' fees - based on my not having even the usual contractual write off to defray expenses. Two top surgeons' offices indicated that their docs had already only billed me "asking price" of around $200 anyhow! Wow, that's about the same as the Geisinger corporation wants to gouge me for, for this trivial PCP visit!

    I'll send the nurse's reply to my request in the post below. Sure, it was probably the sheer number of queries, however simple, that pushed them over the "Make appt" line. Nonetheless, there is really NO excuse for forcing a desperate patient hemorrhaging $$, to make an unaffordable appointment, for an otherwise unnecessary visit. Yes, indeed, I maintain mine WERE "basic" questions! That is, they did NOT require seeing me in person to deal with them. And when in doubt , the point could and should have been stretched at this time, because of my finances. Note, I am NOT in the habit of writing them emails. Also, note that this required visit would have cost me at least $150! Entirely out of pocket, because for the nonce I have no insurance for consults. No "contractual write-off" - nothing! Appts are for visits requiring face to face observation.

    Whoever heard of not ordering a urinalysis by phone for a pt, me, who's had so many UTI's and well knows the symptoms? (Had a major urological working at Geisinger Jan-April costing ~ $8K!) And what's with needing to discuss with me adding "blood typing" to labwork already ordered? (how else can I know if family members can donate blood prior to surgery?).

    See what you think...I call it unkind. Just the opposite of you two. Imagine, nursing angels on the other side of the world, helping me so much - concretely and with genuine care. Meanwhile. my well paid PCP practice can't bother to meet my simple medical needs without price gouging me at this financially crushing time! (And don't think for a moment, "Mary" doesn't know about the surgery I'm facing!)
    Not all diagnosed (still having tests and consults) but so far:
    Ehler-Danlos (hyper-mobility) syndrome, 69 - somehow,
    main curve L Cobb 60, compensating T curve ~ 30
    Flat back, marked lumbar kyphosis (grade?) Spondilolisthesis - everyone gives this a different grade too. Cervical stenosis op'd 3-07, minimally invasive

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