Thursday, May 12, 2011

Complete baso-cervical fracture, left femur... Gulp!

There are at least five or six more posts in store about my last diving adventure, but that all kind of went on hold when my mother-in-law broke her leg a few days ago. I was informed about this with the typical, “Oh no, she fell and broke her hip!”

After making the obligatory response, I think I said something like, “Oh, the poor thing! Where is she now? What did the doctor say?”

But my next response was not nearly so sympathetic, which if you know me is typical of me. I became downright accusatory, perhaps over harshly so, which is even MORE typical of me. For some reason I felt like trying to assign some blame as far as to the cause of this unfortunate event. My finger pointing may have been accurate, but admittedly, it was STILL out of line.

I'm ashamed to say that I said rather caustically, “You know, your mom has smoked for a LONG time, and with her being in her late 70s now, she was practically ASKING for osteoporosis. And by the way, I can guarantee you that she did NOT fall and break her hip. It was the other way around; she broke her hip and fell. People ALWAYS say that because they can’t imagine that someone could snap a leg or fracture a hip merely from standing on it, but you know what? Once the osteoporosis sets in and the bone mass disappears it’s ONLY a matter of time—bones WILL break! Man, I wish all these dummies I see smoking while they’re still young could SEE what’s in store for them, to SEE the damage they are subjecting themselves to after years of sucking in that nasty stuff. And osteoporosis is the least of what they do to themselves usually. ….And to think usually all these horrible conditions befall these smokers when they are too old to pay for the hospital treatment and to take care of themselves, just like your mom.”

Yes, I DO go on. I say these mean things and always feel bad after I say them, but knowing this almost never stops me. I tell myself that I should either find a more sensitive way to expound, but I rarely do. I’m an evil out of control know-it-all. I MUST be stopped.

My wife brought home the x-rays and report. The findings fully explained what actually happened to her mom:

Pelvis—anteroposterior lateral
Complete baso-cervical fracture, left femur, with marked disalignment of fragments
Soft tissue swelling is discernible
Visualized pelvic bones and right proximal femur appear intact
Lumbosacral spine-lateral
No demonstrable compression fracture, visualized lumbar vertebral bodies
Incidental finding of senile osteoporosis

(The xray photo above depicts a similar broken femur)

Another reason I shouldn’t be so hard on my wife’s mom is that she went through life not really understanding how much damage her smoking was doing to her body over the decades. To be even fairer, not even Americans, who should have no excuse for NOT knowing about the dangers of puffing away on cigs, would have known how smoking can lead to weak bones, since science didn’t make the connection until only about 20 years ago.

I tried to guess as to how smoking would lead to low density bone mass. Knowing that smoking causes restricted blood vessels, I conjectured that bad circulation would lead to malnourished bones. After all, bones grow from the inside out by way of the marrow which IS fed through the blood supply. It turns out I was close but no cigar.

From what I read on the internet, there are actually two reasons why an older woman would be more likely to develop osteoporosis from smoking:

The first reason applies to all genders—smoking leads to joint and connective tissue pain from degenerative joint disease so that mobility is lessened. It follows that a person then becomes less active which leads to low bone density. So, when it comes to bones, it’s true what they say, “use ‘em or lose ‘em.”

The second reason applies ONLY to older women—smoking not only causes a woman to go into menopause on average five years earlier than she otherwise would, but being post-menopausal itself tends to lead to osteoporosis due to low estrogen levels. Combined with smoking, the effects of menopause are a double whammy, because smoking reduces estrogen even more—low estrogen means low bone density. So there you go.

Anyway, she finally had the operation this morning—poor thing. It took some doing to talk her into it though, primarily because she felt guilty about the costs of it. There is nothing like Medicare here; few people have any kind of real coverage, and unless someone in the family comes through to cover it there would have been no operation. My wife came home “empty-handed” twice after being told both times by her mom that she didn’t want it done. Her mother said the operation was too expensive, and that she had lived long enough and it was better to just let it be. Finally, I explained that there was NO CHOICE; with her femur broken and splintered she would likely die of a long drawn out painful infection. I sent my wife back and told her to TELL her mom that she WOULD have the operation and it didn’t matter WHAT she said. At this, realizing that she could just relax and be the cared for dependent again, she bowed to our more aggressive insistence and relented.

The cost of putting her leg back together would be out of the question for the average Filipino—150,000 pesos, about $3500. Not so much by US medical cost standards, but it might as well be a million bucks for most folks here. Luckily I am not the only person in the family with at least some form of means, or at least access to getting a loan for it. One of my wife’s older sisters married an American more than 30 years ago and has a life in the states. They make fair money but they just put big bucks on a house in New Jersey and are as strapped as me. But, between the two of us we came up with it. It’s all part of marrying into the average family here—as a foreigner, you basically become the go-to-guy when these sorts of emergencies inevitably pop up. If you aren’t willing to step up and help out you shouldn’t even consider marrying one of these girls. Or maybe you can marry one that comes from a well-to-do family. Good luck with that.

A fellow expat recently required almost the exact same operation as my mother-in-law. Out of curiosity we found out what the same hospital was charging him for the same operation. Unbelievably, they charged him 400,000 pesos! That’s $9300, more than two and half times MORE than what they charged to do the same thing for my wife’s mom. It’s an unfair practice that bugs us expats to no end—to get charged so much more than the local rate. It SHOULD be illegal, but I guess it’s not. Pretty much anything goes when it comes to commerce it seems. There’s the Filipino price and then there is the foreigner price. It applies to almost everything. It’s why I NEVER go with my wife to the market. But there’s not much I can do about it if I’M the one requiring medical care—I can’t very well wear a disguise trying to fool ‘em into a local price, or COULD I?


Ed said...

I always tell people that I don't have just one dependent, I have a entire family of them on the other side of the ocean.

PhilippinesPhil said...

Heck man, you're good to go; you have dr wife to cover them. Gotta love that...

PhilippinesPhil said...

Yup, but at least you have Dr Wife to help out when the calls for help start coming in. Gotta love that.