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

[mgs]

All I can add, even if it might not be of any help in anyone's decision making, is that last year - late Aug/early Sept when I was in the hosp for my surgery - the staff strongly encouraged me to consent to a flu shot and a pneumonia vaccine. These were given to me then. They also strongly suggested that I have the H1N1 vaccination, once it came available (at that time, there was a back-order of the vaccine). Unfortunately for me, I ended up not needing it because, a few weeks later, on the 6 hour drive home from my mother's funeral, I started to feel flu-like. . . (Swine flu is miserable.)

[Back-out]

mgs

That's a HUGE help in decision making! What more does anyone want? I find it hard to believe though (I read it quickly - maybe TOO quickly), that they urged you to have these immunizations I'm writing to ask about, WHEN YOU WERE ALREADY IN THE HOSPITAL FOR THE SURGERY!

Do I have that right?

That's a shocker if I understood OK. I'd have thought they would have insisted on at least a month to develop resistance before the Op..

[jsully]

#1 ask your DR.
#2 what is you age
# 3 what is your physical condition.
Pneumonia post op is usually related to being sedentary. So don't be. Walk. Sit up. Use incentive spirometer.
I always get my flu shot because I am at risk for exposure. You should be get a pneumonia shot if you are at risk for exposure, not because you are having surgery.
I think vaccines are great but don't believe they should be given unnecessarily.
Janet
PS. This is urged only if you are 65 or older or have chronic health conditions like heart disease, diabetes, renal impairment or COPD.

[Back-out]

Email correspondance via MEGA US Med'l Corp. "Cutting Edge" non-Care

Supposed to save money/time...Instead, witness price gouging at work (to refer to the Indian patient in your story, the one who had been over-treated to feed the US for-profit System!).

How email communication w/PCP actually works in RL practice. Note, for one - it is impossible to actually reach the (vastly overworked) physician - one of the rare ones who stays more than a few years before moving on, from this exploitative practice. He's a nice guy who's only staying because of our good school system and his small children. He doesn't have time to be the doctor he wants to be, victimized by this corporation's exploitation of both patients and physicians.

The whole set-up is typically American - A money making "for show" act - all Froth, record-keeping and "method" - little actual care rendered (at excessive cost).

Underpaid staff ends up resenting patients who actually ask for care especially if they need it. Dr. S began as one of five internists and is now one of two, forcing his "own" patients to wait weeks for even a short appointment.

Their highly vaunted after-hours availability and easily accessible pt. electronic record keeping, are both shams - #1 was long ago discontinued (though it's advertised on phone announcements); #2 is untrue; they have gaps of years in lab and other results, because critical records are never down-loaded from ALL unaffiliated facilities and even most internal clinics . Why? Lack of time and technology.

Physicians are also NEVER able to actually access records of any sort from outside their own practice -> NO real consolidation of information even from in-house specialists.

There is no such thing as same day appointments which forces pts to go to ER for routine care - risking being billed for entire service if (likely), insurance plan refuses to pay for non-urgent care. OTOH the facility forces pts to come in for trivial causes (as witness my care here) even though they claim to attend to such issues by email in "same day service". This clogs their availability at the same time it's a great money maker for them.

The system only works well for patients who are not really sick, looked after by sub-par doctors who don't really care if they get well!

Pts with chronic health conditions requiring follow-up, are rushed, getting inadequate attention. Conscientious staff (like my doc) are visibly frustrated by their inability to attend to pts w/complex conditions. Nurses act/ARE harassed by legitimate claims on their time, leaving pts feeling they are "imposing" by asking questions.
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Secure Messaging [Inbox]
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To:

Amanda XXXXXX
From:

Mary E XXXXXX Lpn
Received:

09/13/2010 9:14 AM

Amanda,
The issues you listed are more than what we would term basic, you will need to schedule an appt to review with Dr XXXXXXX.
Thanks,
Mary XXXXXX LPN

----- Message -----
From: XXXXX,AMANDA
Sent: 9/10/10 04:36 PM
To: Scott A XXXXXXX, DO
Subject: Other Medical Question


For Amy XXXXXX LPN,

Confused abt reply as concerns indicated don't seem to require appt, to wit:

1) Need urine culture (have had many UTIs for decades and
am familiar w/signs),
2) gout (uric acid?) test - request add to other labwork. Need to R/O gout before consult w/ out of town bunion surgeon (he did prior surgery. This is a cheap, non invasive test).
3) Question abt insurance pol. application - request to change improper diagnosis. Urgent time limit with permanent repercussion. Explained to Dr. S at prior appt.
4) question re pneumonia vaccine - frequency? Nb Walmart instructions and pending surgery.
5) request order for dexascan test, also prior to surgery.
6) need tetanus booster.

The latter two were both discussed at previous appointment and "reminder" messages were sent to me through Geisinger mail.

Lastly, I CANNOT afford more MD consults for time being, owing to insurance max-out. Am applying for Geisinger reduction for consults but meanwhile these requests (above) are subject to time constraints - surgery and other.

W/O contractual write off, all visits cost ~ double "asking price" (=$150+ - EVEN FOR "BASIC VISIT" CPT!) Surely, basic issues noted above (tests, etc) can be dealt w/in this format!

To:
Amanda XXXXXX
From:
Amy N XXXXX Lpn
Received:
09/10/2010 3:43 PM
Hi Amanda--

I understand all of your concerns. [HARDEHARDAR my prior letter - the one to which this one is replying - was already deleted] Please call to schedule an appointment with Dr. Sulman as they need to be addressed at an office visit. There are appointments available tomorrow at Gray's Woods for your UTI symptoms. We cannot write orders without having you evaluated.


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What a sad comparisons of ways of life/ways of death. Compassion (you) versus "exploitation" !

Thanks to you and Sally, I have decided to have the pneumonia vaccine, even if the interval is slightly too close - I don't remember exactly.

It seems like the worst risk is "overkill" due to excessive immunization which is, however, not dangerous. At worst, uncomfortable.

Who knows how many people you guys have helped? THANK YOU!!

[jsully]

????Not sure what all that meant. Does something have you upset?

[Back-out]

#1 ask your DR.
#2 what is you age
# 3 what is your physical condition.
Pneumonia post op is usually related to being sedentary. So don't be. Walk. Sit up. Use incentive spirometer.
I always get my flu shot because I am at risk for exposure. You should be get a pneumonia shot if you are at risk for exposure, not because you are having surgery.
I think vaccines are great but don't believe they should be given unnecessarily.
Janet
PS. This is urged only if you are 65 or older or have chronic health conditions like heart disease, diabetes, renal impairment or COPD.

Janet, you don't think having this massively invasive surgery is enough of an indication for both flu and pneumonia immunizations (not together) - as a precautionary measure?

Especially for patients over 60?

I am considering the situation of Brenda too, who certainly didn't have time to be sedentary before becoming ill with pneumonia between her "staged" procedures. It's precisely that intra-operative period (for patients who are having both posterior and anterior stages), I'm most concerned about. Recent research stresses the extreme immunosuppression hence, vulnerability of pts at that point in surgery.

Which is not exactly surprising. I don't favor excessive immunizations or use of antibiotics either. This surgery does seem to allow for bending the rules a little, erring on the side of caution, though - especially for older patients. Your thoughts?

[jsully]

I think if you are over 60 it could be a concern. How is your health? If you Dr. doesn't want to give the shot is it available at drugstores? Of course, you can request it in the hospital, whether it will be too late, I don't know. Sometimes your posts are a little "over my head", even being a nurse. It is obvious you are very educated so you should go by what you think is best. I would. Surely a staged procedure would put you more at risk. Also, ask you MD about antibiotic usage. My DR gave them pre and post op and inside the wound before closing.
Janet

[leahdragonfly]

Amanda, just a quick thought here...I think the pneumonia vaccine is mainly for community-acquired pneumonia, and may not necessarily be very effective against perioperative/hospital-acquired pneumonia.

A good question for a physician or perhaps a knowledgeable pharmacist if offered at the drug store.

Good luck,

[JenniferG]

Hi Amanda.

No thanks necessary on my part, we're all in this scoli boat together. I knew my friend would be chuffed to receive such a warm thank you so I c & p'd your post to her, and chuffed she was. She is always very generous with her time and knowledge so I knew she'd be only to happy to pass on any information in the hope of it being of use.

She also said that you sound traumatised by your health care system, which is probably not unusual for people who are so dependent on the system, which has such limitations. We are not all born equal. Some quite simply need more care than others. The ideal situation would be that there is always "enough" care for everyone...but I'm not sure such a utopia exists anywhere.

Best of luck on your continuing medical journey!

[Confusedmom]

Antibiotic use

Also, ask you MD about antibiotic usage. My DR gave them pre and post op and inside the wound before closing.
Janet

Hi all--

First I've heard of this. Is it routine to be put on antibiotics pre and post-op? It would seem to make sense, given the serious problems infection can cause with scoli surgery! What did others experience?

Thanks,
Evelyn

[loves to skate]

Amanda,
I was given two different antibiotics just prior to all three of my surgeries. I am pretty sure this is the norm.
Sally