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R. Spence
slipping through the cracks
Wed Jan 9, 2013 08:55
184.3.63.239

Slipping through the cracks

How did he end up homeless? Didnít he have family, friends, people who cared about him? How do people fall through the cracks you may ask, I think I have- at least in part- an answer. Let me tell you my story, which by the way I am writing as a last attempt to stay out of the crack ahead. I have type 2 diabetes, uncontrolled, with complications. In addition to that I have severe peripheral artery/vascular disease, intermittent claudication, hypertension, and peripheral neuropathy. What all that means in lay terms is I have extremely poor circulation in my legs due to narrowing and plaque blockages in the arteries, a condition that is made worse by diabetes and hypertension, claudication is simply not enough oxygenated blood being delivered to the muscles in my legs, causing severe cramps and muscle spasms, and acute pain, made worse by peripheral vascular disease and diabetes. Peripheral Neuropathy is damage to the nerves, commonly in the hands and feet, in my case feet, that causes numbness and a pins and needles sensation, which is caused and made worse by diabetes.
Two years ago, I had two toes on my right foot become extremely painful and turn a purplish blue, this is while I was still working, I went to the emergency room (the only place an uninsured person is guaranteed treatment without cash in hand) first I was told I had stubbed my toe, probably in my sleep and it would be fine, a week later when the pain got worse I went back and was told that my toe was necrotic (dead) and would need to be amputated. That led to a surgical consult where the vascular surgeon informed me I had a small blood clot and that if we could get it to move my toe might come back, thatís when I had the first stent put in place, and got put on blood thinners to dissolve and keep more clots from forming. By this time the chronic pain in my legs had gone from a dull ache, to an acute pain that came on suddenly after short walking distances, a pain that would subside with a few minutes of rest, I am now out of work.
Without insurance, it was impossible for me to have very much follow up care with the vascular surgeon and I was told I made to much money in the prior tax year to qualify for assistance. For the next few months my attention got diverted to caring for my mother who had been diagnosed with an aggressive cancer, I tell you that so you will understand how it was possible for me to put my health aside, in addition to that my wife, at the age of 34 had two massive heart attacks back to back, another excuse I used to ignore my health. Shortly after losing my mother I again found myself back at the emergency room, again for a blood clot in my foot and toe pain and discoloration, on my left foot this time. Since I had a past due balance with the vascular surgeon on staff, he decided that before he could treat me I needed to pay a significant amount on my past due balance. Mind you, I have now been out of work for a full year. The medical doctor that saw me in the ER had ordered a cat scan that showed a large blockage in my left carotid artery this was the reason for my admittance to the hospital not the toe, I was given a referral to the free vascular surgical clinic offered by one of the University hospitals in my state, and also approved for primary care treatment at the outpatient clinic at my local hospital. Finally I thought something good had happened.
I have now filed an application for disability and Medicaid, a long and daunting process, in the meantime the University hospital wanted image studies done and CT scans with contrast dye, and ultrasounds, and blood pressure studies for comparative studies as treatment progressed. Iím not going to bore you with all the specifics; I will summarize to say that this entailed 6 trips to Chapel Hill (a 200 mile each way trip). After the initial studies were run it was determined that I needed two more stent placements to increase blood flow, during the procedure they found two more blockages that the studies didnít show, they placed three stents one in my groin and two in my left leg. Two weeks later I took my 7th trip to Chapel Hill for a follow up visit, where I explained to the DR. that I felt no significant reduction in my symptoms or the length of time it took for the onset of pain to become acute. I was informed at that point that while he hoped the stents would help, he knew there was a chance that they would not be enough. Apparently the procedure that I now need is two arterial graphs, one where the ileac artery branches into the femoral artery, the occlusion starts in the single artery and grows down into both branches, the second will be on my right leg, that is 100% blocked and will require a graph bypassing more than 60% of the entire leg artery, a procedure that will last approximately ten years and due to the size of It, a procedure that can only be done once. Consequently he is unwilling to do that procedure any sooner than he has too, I have been told to manage as best I can, keep up with my walking therapy and try to hold off as long as possible. It was also suggested that I seek treatment at a pain management clinic, of which there are none that offer any financial aid. In addition I should mention that the blockage in my neck has been pushed to the side and deemed something to ďkeep an eye onĒ.

In the midst of all the trips back and forth and the tests and the procedures I have been denied both disability and Medicaid, appealed, and on review denied a second time. Now is where the crack starts to show, I have appealed both decisions and am awaiting a judicial hearing, to that end I have of course been trying to secure legal representation. All the lawyer needs to take my case is a letter from my doctor describing my condition, symptoms, and how they could keep me from being able to work. Both my primary care Ėremember him?- Probably not since he has only seen me once- and the surgeon at the University clinic have both informed me that it is against their personal and clinic policies to get involved in disability cases. Do you see the crack? I need a simple piece of paper, one that only require facts so they are not being asked to offer opinions, without it I cannot retain legal service, and as most of us know; a man who represents himself in court has a fool for a client. Without approval from disability and Medicaid I will not be able to maintain my bills or receive continued medical care, without a lawyer I will most likely not get approved, and the only two people that can help me retain that lawyer refuse to get involved.
Please keep in mind that I have now been out of work for two years, my wife is on medical disability for a severe heart condition so we are on an extremely limited budget, and I have had to spend literally hundreds in gas to go back and forth, and now i am supposed to find a doctor who will see me with no insurance and very little to pay for the visits and tests, and hope that he will be supportive in my application for disability and Medicaid, a very big gamble considering I will have to take a loan against the small trailer that I own, and take the risk of not being able to make a loan payment and lose the only thing I have. Suddenly that crack is now a huge gaping chasm, one that I do not see how I can escape and I can find no one that can advise me on what to do.
What I see in my future; ten years down the road, a man alone, sick, waiting to die. A man who willingly walked away from his family to keep from dragging them down with him, a man who ran out of options and had nowhere to turn, a wasted existence

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