How’s the care at the Reno VA?
August 24, 2017
Recently, I was hiking in Horse Thief Canyon, looking for new fishing holes. My cell rang and it was a friend of mine, the father of a veteran who was in terrible pain. The father was obviously distraught; he didn't know what to do, or where to turn. He informed me that the right side of his son's neck was very swollen, his tongue was "pushed up," he was running a fever, and he was having trouble swallowing.
He asked if there was any way that I could see his son right away. I let him know that I would hike back to my truck, and meet him and his son at my office. He told me this problem started suddenly, was getting progressively worse, and they were scared. His son was in the ER at the VA Hospital in Reno for about 5 hours, the day before. He was never seen by a doctor, no one ever looked in his mouth, and after 5 hours he was given antibiotics, opioid pain medication, and was told to "suck on sour candy." He was discharged with no appointment for follow-up, and no appointment with a doctor, even though the VA employs an oral and maxillofacial surgeon.
Once at the office, a quick exam indicated a blocked salivary gland duct. The neck and floor of mouth swelling was due to the continued production of saliva in the patient's right submandibular gland. Salivary glands are not pressure regulated, they continue to make saliva whether the saliva has anywhere to go, or not. The pain is tremendous. As the pressure builds the gland becomes infected, and starved for oxygen.
I informed the patient and his family that the problem was obvious, we did not need any imaging, and we had to operate right away. I dissected into the floor of the patient's mouth, isolated the duct, and made a longitudinal incision. Immediately a great quantity of thick puss came pouring out of the incision. I flushed the duct and the gland with sterile saline under pressure repeatedly until no more puss was seen.
The dissection was continued in the opposite direction and three stones were removed, additional dissection then revealed a stone almost the size of half a dime. I had to use hemostats and removed the stone the same way you would extract a tooth.
I kept in touch with the patient and family over the weekend, he was significantly improved, and a follow-up appointment indicated complete resolution of the problem.
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But, remember now, the VA is a single-payer system. Fortunately for this young veteran, there was a private practice surgeon willing to see him immediately. But what if the entire country was single payer, what then? What would have happened?
This would happen: The pressurized puss would cause the gland tissue to become necrotic (dead). The bacteria would use the dead tissue as a food source. The bacteria would multiply and enter the patient's blood stream, initially causing a bacteremia (bacteria in the blood). The bacteria in the blood would induce septicemia, which would become septic shock, the blood would pool in the peripheral vessels, his blood pressure would drop, his fever would increase, he would lose conscious, his kidneys would fail, and he would die. If he were taken to an emergency room soon enough, he would require an ICU admission, IV antibiotics, drugs to keep his blood pressure up, drugs to keep the kidneys functioning, removal of the entire gland, possible tracheostomy, and on, and on.
I am told that "if only we would copy the socialized healthcare of other countries, and eliminate insurance companies, a single payer healthcare system would be fantastic." The VA is a single payer system, how did it work out for this young veteran? The VA is a government monopoly. I believe we can all agree that the Veterans Administration Health System is in complete disarray. Poor patient care, multiple scandals, long patient wait times, and hundreds of millions of wasted dollars plague this government run system. Would anyone argue that the Veterans Administration is a shining example of what health care could be in our country? Single payer, government run, means the VA for everyone.
Under Obamacare most of Nevada now has no insurance coverage, the Democrats say it is because we need a single payer government run system. Let me say it one last time, single payer is the VA for everyone. Every veteran deserves to have an insurance card that allows them to go to any hospital, or any doctor. If that leads to the closure of VA hospitals so be it, worse things have happened.
Dr. Edward Gray is a previous hospital pharmacist, dentist, and medical doctor who practices oral and maxillofacial surgery in Gardnerville.