Medical Monday

I know it should be a "proper" medical Monday today, but I just don't have time to research something thoroughly at the moment. And if I can't do it right, I prefer not to do it. So before getting to a short Medical Monday, first an update on the kids.

It's exam time again. :-( Gosh, feels like yesterday we did last term's exam. So I'm in over my head with summarising. This time not only for Boeboe, but for Mr N as well. He's never learned to properly summarises, and struggles with it. So now I'm doing it, so that he can see how. Next term I'll do it with him, and last term he better do it on his own. This is hard work!! I need to concentrate on Boeboe, but she's done so well last term en Mr N so badly, that I find myself concentrating on him. Not sure if it's the right thing to do. I'd hate for Boeboe to fall through the cracks while I try to help Mr N when he technically shouldn't need assistance. Isn't it just crazy that the work is SO much, and SO difficult, that a very intelligent (most definitely way above average) boy needs parental help and support at age 13 just to PASS??? I just don't get it. Honestly, there's something very very wrong with our educational system. And (or) with our school.

End of this week we're seeing a pediatric pulmonologist who on the side, has an interest in bio-transformer markers (or something like that?!). According to the peadiatrician that referred us, this is our best option because they (she and a few collegues) believes that Monkeyman has something going on at cellular level. So we'll see. Of course, my tummy is already in knots about it, and I feel nauseous. Gosh, I hate appointments! And on Wednesday is Boeboe's check-up with the psychiatrist, and again my tummy's aching because we feel that her medication needs adjusting and I absolutely hate that idea. At this moment, she's "okay". But she had a big dip during last exam, which only got better 2 months later! So if that happens again this time (and I'm already seeing signs less than a week into studying), we're going to face an awful June and July. Sigh. Feels so WRONG to medicate my child so that we can cope with her behaviour! But I also see how much happier she is when she's stable on the meds and not flying off the handle every day. She feels like her brothers hates her, because she gets angry at the smallest things and then blame them. A vicious cycle then ensues. Maybe the psychiatrist can just give us something to tie her over during exam times so that she doesn't have that dip due to the stress and anxiety. Ai.

I turned 40! Maybe that should be my Medical Monday. What happens when you turn 40.... LOL. Well, I don't feel any different. It does make me long for my mom, but that's more because I'm always sad, and when I'm sad, I want my mommy. I wish I could throw this sadness off, but how? When your child may have something fundamentally wrong on the lowest of levels in his body, wouldn't that scare and sadden anyone? I know there's something wrong. I can see it. I'm not a very observant person in general, at all, but I am very good at observing people's signs, especially my children. I won't be able to tell you what someone had on yesterday, but I'd be able to tell you what mood they were in and what signs I saw in them (if they looked ill, sad, happy, etc.)

Same with my children. I know when something's up. I've never been wrong before. I would love to be wrong this time, but I know that there's something that Monkeyman has either been born with, or developed in his first 6 months of life. I can see when he has an off day. Yesterday was such a one again. I wish I could describe it, but I'm pretty sure eveyone's reaction would be "but that's normal for a child", or "maybe he just didn't sleep enough?" or "maybe that's just who he is?", etc. Believe me, I've heard it a 1001 times from family, friends and other people involved in his life. Including doctors. At least we now have the peadiatrician on our side. I'm pretty sure she also believes there's something wrong. The way she structured her phone message. And I doubt if she would've gone through so much trouble, talking to other doctors and searching for what we can and should do next, if she too didn't believe something's up. Anyway, I want answers, and I'll fight for them as long as it takes to get them. Just as I did with Boeboe. But it's NOT easy. It makes me so scared, and so sad. So yes, I'm always sad. And I don't know how to throw it off. I know I need to see someone, but money is a bit tight with all our other expenses.

Anyway, back to yesterday. Monkeyman was really tired. His eyelids hang half-mast all day, he only played for short stints with his visiting cousin (taking a break every now and then to go and sit where Mr N was playing games on the computer, or playing on his tablet). He was pale, he sighed alot, his voice was monotone, his mouth withrawn and tight, and his shoulders hanging. All of the signs that appears when he's tired. He slept for 10-11 hours the night before, like most nights, so it's not that. We didn't give him the vitathion over the weekend, and ontop of that, he stepped on a honeybee earlier the week. I believe it was on Tuesday?! He cried just a little bit, and then lied down to watch a movie. There after he was fine. We gave antihystamine and pain meds. His foot/toe didn't even swell or turn red. Until yesterday! About 5 days after being stung. What's up with that?! The top of his foot is red and clearly swollen. Maybe that also influenced him being tired yesterday. The cardiologist once said that it seems to her like when his body has something out of the ordinary to deal with, his heart struggles and takes a dip in function. Maybe that's it? She speculated that it's because of mitochondrial problems. Urgh, no wonder I'm always sad and worried!!

For interest sake, I'm going to explain how our country's medical support works, for today's Medical Monday. There's more people from the rest of the world reading here, than in SA, and I know it must be confusing to them. Especially as "Medical Aid" in our country is similar to "Insurance" in America, and people in Canada and England won't understand how we can get into a specialist within days or without referral.

Due to our long, awful history of Apartheid, our country is basically split into two distinct groups. The haves, and the have-nots. Those with money, and those without. For those without, the state provides hospitals, clinics, medications and doctors. But, like everything else, the state isn't very good at running things. So state hospitals are renowned for the mistakes they make (basic mistakes, costing peoples' lives), for looooong queues, for looooong waiting periods for things like surgery or scans, and for sometimes not providing all the necessary medication (like pain medication to burn victims - WTF????). So the conditions aren't the best in most state hospitals, as you can imagine. We're not as bad off as some of our Northern countries. And at some things, like trauma, we excell. So much so, that some European doctors come here for training and experience. I guess here they get more than enough chance to see people with knife wounds, bullet wounds, car-crash victims, etc. Sad really.

So, to be able to get better care than that, we have a medical insurance scheme in the private sector. This is called Medical Aid, and there's a number of schemes competing with each other for the millions of members able to afford this care. They all have different options, which you can choose from. The higher level option, the more expensive it is, but the better coverage you get. The lowest option usually only afford the member (and his family, if he pays for them too) private hospital care. Then you can go to a private hospital if you need to be admitted for any reason (illness, surgery or trauma). Private hospitals are clean, well-run (it's a financial business) and has enough theatres, medication and doctors to do all care for any procedure needed. Some is a little more busy than we'd like, for example, to see our "local" pediatric neurologist at our closest private hospital, you need to book an appointment about 4-6 months in advance! Others, like our pediatrician, can be seen within a few hours to a few days (depending on the urgency of the reason).

If you can afford better than just a hospital plan, you get a higher option on your medical aid. This include GP visits (general practitioners). So you don't need to go and sit in the queue at a state clinic or hospital, to see a doctor when you have the flu or strep throat. You can go to any GP anywhere in the country, who is in private care. The medical aid will pay his bill as well as the medications he gives, as long as it's not just vitamins or such (those you pay for yourself). So we can go to our GP (ours is a few km's from our house) any time for any reason. I just phone them, and usually get an appointment within 24hrs or less. We've seen this same GP for 16 years now. It's fabulous, because he knows EVERYTHING about my family. Exactly like I believe a family phycisian should be.

If you can afford a little more, you get the Medical Aid option that allows you to not only get hospital care, and GP care, but also specialist care. This option allows you to go and see any specialist you need to, at any time. Thus, you have neurosurgeons, neurologists, orthopeadic surgeons, geneticists, peadiatricians, pulmonologists, pshychiatrists, psychologists, specialist phicisians, ENT's, Occupational and physical and speech therapysts, etc. at the tip of your fingers. You just call whoever you want to see, and their receptionist will make you an appointment. Most of these specialists, especially in the part of the country where I live in, is the best of the best. The best our country can offer. And probably comparing very well with their peers in the rest of the world. Unfortunately, they come at a price. A very steep price. On Friday, our appointment with the pediatric pulmonologist will cost us R1400 (which is about $140). For comparison - a GP visit costs about $30, a Big Mac is about $3 or $4 (I don't eat it, so I don't really know), a liter of coke $1 and an entry level laptop about $300.

The Medical Aid will reimburse you for these specialists and any tests they order, as long as it's within reason. If you go to a specialist that asks $200 where-as it should be around $140, they only pay the $140. The rest comes out of your own pocket, as it is your "choice" to go to that specialist. I put it in quotes, because sometimes it isn't really. You get referred by another doctor, or it may be your only choice within reasonable distance from your house, etc. But, they're in private care, they can ask whatever they want. Some (most) are reasonable though, and charge what the medical aids will reimburse you. Others charge double or even more than what you'll get back from your medical aid.

The Medical Aid will also pay for all tests, within reason again. Like only 1 MRI per person per year. And only dentistry that's really necessary, not just cosmetic. Most bloodtests. Endoscopic procedures will be fully covered, but you need to pay the first $100-$200 out of your pocket. Etc.

Unfortunately, the Medical Aid also isn't unlimited. Once you reach some set limits, they expect you to pay. Either for up to a certain amount, or for everything the rest of the year (except hospital care, which they'll always cover). Once you have paid for the set certain amount, some will start paying again. Unfortunately, only the highest plans gives unlimited funds then, ours don't. So how ours work is that the first x-amount they pay. Then we pay y-amount. Then they pay z-amount. When x,y and z are all depleted, we have only hospital cover, as well as unlimited GP visits. No specialists, tests or medication gets paid.

So, for this year, we have already spent our x-amount, and we're almost through paying for our y-amount. Then, we have our z-amount left. If I'm not mistaken, this year our z-amount is about R20 000 (about $2000). Not alot. After that, we're on hospital plan. Scary thought, with 2 children needing so many tests and things. And just our chronic medications (Boeboe's, my heart pills and all our reflux meds) amounts to R1500 (about $150) per MONTH. So 20k won't last us very long. And more than half the year is still ahead of us! And of course, the care we get, costs an arm and a leg every month (for our family, it's about $600 per month). Add to that the extra expenses coming out of your own pocket (vitamins and such medications), top-up amounts the medical aid didn't cover for specialists, medication or tests, and you end up paying a huge chunk of your salary per month just to keep your family healthy.

Hope all of this made sense. So that's why we've decided to leave Boeboe's testing be for now, and concentrate on Monkeyman. We don't know how many more tests he'll need to undergo, and how many thousands it's going to be. His last bloodtests were R3000! So goodness knows how much it'll be for this specialist on Friday if she wants bloods. Sigh. The sad thing is that Boeboe really should go for another evaluation with a speech therapyst, and probably some weekly therapy, and preferable with an Occupation therapyst as well. She also desperately needs to see the psychologist, but at $80 a week we just simply can't afford that now. The neurosurgeon also asked us to bring her back and have an MRI taken of her back when she's 11 (apparently girls have a growthspurt between 11 and 13). That's in 3 months' time! We'll probably let that stand over until the new year as well. An MRI costs around R7000 ($700)!

So you can see why I know I need to see someone for my own sake, but won't go. Because of medical finances. I can't spend money we might need for our son later on in the year. So for now, I'm keeping an eye on myself. I know that a mommy that's not well, is not helping a family. So if I see that it's getting too bad, I'll go. But until that point, I'm just hanging in there for now. :-)