Thursday, August 27, 2015

Health Benefits

Our local DES office. We spent a lot of time here right after Mark came to stay.

When Mark first got out of prison, he was told by his parole officer to head on down to DES and apply for food stamps, cash assistance, AHCCCS, and whatever else was available. Since he had no income and no assets, Mark would surely receive all possible benefits to help him get by until he found a job. That's what he was told.

Regardless of your reason for being there, everyone had to wait in line
to be seen at this window first. And they stood at that window for a very long time.

So that's what we did. We waited in long lines, filled out 12-page applications, went through phone interviews, and jumped neatly through every hoop they placed before us.

In between people, it was an empty window for a very, very long time.

Then came the irritatingly bad news: despite the fact that Mark and I have been divorced and lived apart for 9 years, despite the fact that I had full custody of our children all that time, despite the fact that Mark hasn't paid a penny of child support since 2007... the government in its infinite wisdom made the determination that since Mark and I were living in the same house as our 17-year-old (at that time) son, they had to include my income as part of Mark's income.

What?! If Mark had moved in with a total stranger (even if that person were rich), that person's income would have been inconsequential and Mark would have qualified for all the benefits available. But because we had a child together who lived in my home, suddenly I was responsible for paying all of Mark's expenses? How does that work? I guess it's true, no good deed goes unpunished.

While we wait in line, lots of open windows are waiting one.
Not surprisingly, the other side of the building was usually totally empty--
the side that houses Job Services--while the benefits side was always packed.

Fortunately, it only took Mark a month to find a job, and he hands over most of his paycheck each payday for rent and to pay down what he owes for the goods I provided before he could purchase them for himself. He's almost paid it all back already--not counting the child support, of course.

Even more fortunate, the criteria to qualify for AHCCCS (Arizona Health Care Cost Containment System) is more reasonable and did not include considering my income. He was finally awarded a health insurance card, and it's a good thing.

The clinic of Mark's primary care physician.

That first week Mark was with us, it was clear that we had some health problems to explore. First, he'd been experiencing severe, chronic back pain for a couple of months. In prison, they gave him muscle relaxants for it but he hadn't seen a doctor. Secondly, he has some major hearing loss. I think he hears less than half of what we say. Third, Mark was exhausted all the time. He fell asleep by 9:00, slept in until 9:00, and fell asleep on the couch throughout the day. I'm not sure he ever saw a TV program from start to finish.

So as soon as he was approved, we selected a doctor and took him in. We were very much surprised when the back pain and hearing issues were set aside because they discovered that Mark had a dangerously fast heart rate (around 130 beats per minute) and a potentially fatal, irregular heartbeat called atrial fibrillation. The doctor began writing out orders and prescriptions, fast and furious.

Lab Corp is where Mark gets his blood drawn regularly.

The first thing they did was put him on a blood thinner to prevent blood clots and stroke. That meant regular visits to a clinic to have his blood drawn, to monitor the thickness of his blood.

The cardiologist's office.

Next, Mark had to see a cardiologist. We've all been seeing a lot of each other. Thankfully, I like Dr. Ata much better than I did my own cardiologist back in 2009. A couple of cardio tests, including an echo-cardiogram, confirmed Mark's atrial fibrillation, plus a leaky valve and one chamber of the heart enlarged. The doctor said this meant Mark has had the A-fib for a long time.

Because Mark's heart rate and heartbeat haven't responded to the medications so far (lucky for Mark, the irregular beat doesn't cause him discomfort), he's had several EKGs and "rhythm strips" to see what his heart is doing. Dr. Ata put him on a new medication two days ago that he thinks will work. If it doesn't, he told us they may have to shock Mark's heart back into a regular rhythm. Aargh!

Preferred Homecare's office. They provide oxygen services.

A common cause of A-fib is sleep apnea, so the next step was to make sure Mark was getting enough oxygen while he slept. He has always snored in his sleep, so I figured this was a likely problem for him. They began with an oximetry study, where he wore one of those oxygen readers on his finger while he slept at home one night. 

The readings showed that his oxygen levels were dropping quite low while he slept. They put him on an oxygen concentrator with a cannula to deliver oxygen throughout the night. We all noticed right away that the snorting and muttering and rumbling sounds from Mark's bedroom stopped that very first night.

Then he spent a night in a sleep study clinic, where he was hooked up to literally dozens of wires while a tech monitored his breathing all night long. The verdict: severe apnea. He stops breathing about 30 times per hour. So next week they will add a cpap machine and mask to the oxygen concentrator, which will force the oxygen into Mark's lungs all night long. (My second husband, Ed, also had severe apnea and had to use a cpap machine and mask.)

Our local hospital, Summit Healthcare (just 3 miles from home).

Meanwhile, the doctor hadn't completely ignored Mark's back pain, which sometimes extends down his buttock and leg. For that issue, we made some trips to the hospital, first for an x-ray and then for an MRI. The x-ray revealed spinal stenosis, but they followed up with the MRI to see how serious it was.

Spinal stenosis is a narrowing of the open spaces along the spine, which can put pressure on the spinal cord and nerves. I'd heard that it's extremely painful, but after seeing Mark deal with it in his quietly stoic way, I can now imagine how awful it really is. Mark rarely complains, but the way he moves when he hurts speaks volumes.

The MRI showed that Mark's stenosis is so severe that the doctor won't even try to treat it. Instead, they referred him directly to a neurosurgeon, who has already contacted us. A trip to Flagstaff awaits us in a month or so for a consultation, but if we decide to go the surgical route, we'll wait until we return from our northern California trip in October. After discussing the surgery with the cardiologist, we decided to wait because Dr. Ata wants to get Mark's A-fib under control first.

Mark shows off his wrist tag in the hospital.

It seems so funny that Mark is only 47, almost 14 years younger than me, and yet his health problems seem so much larger than mine. Clean living, right?

The one issue we have not explored is Mark's hearing loss, but I suppose we have bigger fish to fry for now. We're all learning to speak more loudly and to make sure Mark is paying attention.

Mark in the "Atrium" wing of the hospital, 
where the x-ray and MRI machines are located.

Since he's started sleeping with oxygen, Mark's exhaustion is all but gone. He can stay up as late as 10:00 or 11:00 and then wake up by 6:30 or 7:00 in the morning. He still falls asleep in front of the TV sometimes, but only occasionally now. And he has much more energy to accomplish tasks during the day. That's progress!

I love the local photographs featured on the walls of the Atrium.
We truly live in beautiful country here.

And so, despite my love/hate relationship with government programs, I am grateful we've been given the opportunity to address and resolve Mark's too-long-neglected health issues. I think we're on the way to better health now.

A scene from one of our favorite lookouts on the Mogollon Rim.

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