Dm Ii And Vascular Disease

[harleyman]

Does anyone have referenes or experience in getting vascular disease of the lower limbs service connected as secondary to DM II?

Veteran is s/c for DMII and PN with loss of use of one of the lower extremity ( 2 K awards one for loss and the other for ED),and also s/c for IHD. But recent claim for DVT (blood clot and infection in lower leg secondary to DMII ,VA has denied stating the leg condition is not related to the DMII.

Might the veteran get the DVT (clot and or infection)s/c as secondary to IHD?

Thanks!

Edited July 27, 2013 by harleyman

[Berta]

Jim...Sorry about the coffee on the keyboard!!!!!And that mamasan comment!!!!!!What a hoot!

We sure all need humor when dealing with the VA.

Harleyman said:

“I didn’t know the VA could refuse the care of a veteran like that “

VA Inspector Generals office would intervene if this had been a safety issue. I dont know exactly how they define safety issue ,but they helped a vet here some time ago....

when VA was not giving him his meds.

“That’s why he doesn’t think it ever was a blood clot he still believed it was an infection from the beginning “

I agree:

http://www.sciencedaily.com/releases/2012/04/120403124358.htm

In part:

“Research shows iOlder adults who get infections of any kind -- such as urinary, skin, or respiratory tract infections -- are nearly three times more likely to be hospitalized for a dangerous blood clot in their deep veins or lungs, University of Michigan Health System research shows. “

An infection due to the fact that anyone with SC CMII is prone to infections, and therefore this disability should be service connected, via 1151 or direct SC as secondary or by both avenues of attack.

I havent had time to research a little on cellulitis....will try to find time......

“I am hoping Dr. Bash will take a look at this, but I need to have it all time lined out to make it easy reference and the Veteran needs to get me all the rest of the records “

That is what I did.... in brief emails he said it looked like I had a good claim adding “if you have what you said you have”

Boy did I have what I said....

I prepared a chronological cover letter referencing the malpractice and then directly referred him to Exhibit A, B, C and so forth and tabbed those exhibits with colored tabs in the stack of med recs and the other stuff. In the exhibits I highlighted with majioc marker the stuff he needed to focus on.

He sure read the whole 9 yards but the cover letter made it easier for him to review the claim carefully to make sure he covered all bases in the IMO.

He is expensive but my IMO fee was a very good investment, easily recovered with the retro accrued award.

[Berta]

To add just clicked on Mayo clinic....apparently cellulitis sometimes does not present a fever....

http://www.mayoclinic.com/health/cellulitis/DS00450

But Johns Hopkins didnt make that point:

http://www.hopkinsmedicine.org/healthlibrary/conditions/dermatology/cellulitis_85,P00266/

It definitely could be the type of infection he got.

I forgot to add I gave Dr Bash some medical abstracts and citations he could use but he used a big Cardio text (Braunwald) that I could not print off from on line due to Copy write laws.

My daughter bought it for me for Christmas , to the tune of almost 300 bucks and it was so heavy I couldn't even lift it to scan from it on my scanner.....

VA uses Braunwald as quoted within Harrison's Principles for the AO IHD claims.

So Dr. Bash could use medical references you send him but might well have an updated one or two he prefers to use instead because he has access to med stuff we laypeople cant get to on line.

ALL the work you are doing Harleyman, for this vet, is exactly the proactive research and leg work many claimants need to do.

Most VSOs dont have the time or even the expertise needed to delve into stuff like this. It isn't really their fault either.....

Sometimes this stuff is very hard to do....not to mention time consuming.....

[Berta]

infection and cellulitis

I found a little more on cellulitis:

“Cellulitis is an infection of the skin and soft tissue of the skin. The infection is usually caused by bacteria, such as staphylococci ("Staph") or streptococci ("Strep") that are commonly present on the skin or inner surface of the nose or mouth of otherwise normal and healthy people. The infection develops when there is a break in the skin, such as a wound or injury, which may be minor or even unnoticed. This allows bacteria to enter the skin and grow, causing infection and swelling.

Many cases of cellulitis are mild and heal completely with antibiotic treatment. However, some cases of cellulitis can be severe and lead to generalized infection. Thus, it is important to seek medical care promptly if the infection is associated with fever, rapid worsening, other signs of progression of if you have other medical problems, such as diabetes.

This topic discusses the symptoms and treatment of cellulitis. Other skin infections are discussed separately. (See "Patient information: Methicillin-resistant Staphylococcus aureus (MRSA) (Beyond the Basics)" and "Patient information: Animal bites (Beyond the Basics)".”

Source: http://www.uptodate.com/contents/skin-and-soft-tissue-infection-cellulitis-beyond-the-basics

Fever is not mentioned as a common symptom in this link,except here:

“Thus, it is important to seek medical care promptly if the infection is associated with fever, rapid worsening, other signs of progression of if you have other medical problems, such as diabetes.”

Being a diabetic it does not seem he received the ;prompt' care he needed at all....

It does appear this is the correct diagnosis of the infection. Cellulitis and I feel every single complication it has caused should be found as secondary to his diabetes, and it sure sounds like a 1151 claim basis too:

“went to the urgent care down the street from his home. They sent him to the emergency at the local hospital. The hospital gave him antibiotics as they suspected infection.

He stayed on antibiotic for a week or so, but the symptoms stayed the same, so he went to the VA clinic. His regular VA doctor said she didn’t know what was wrong and suspected compartment syndrome.”

Compartment syndrome my butt:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002204/

I think the VA doctors should use Google .in seconds I found this NIH link ( always good to check National Institute of Health)PubMed Library, and then checked

http://www.mayoclinic.com/health/chronic-exertional-compartment-syndrome/DS00789, and also

http://www.medicinenet.com/compartment_syndrome/article.htm#what_is_compartment_syndrome

and I think that VA doctor was wacky and this might well be VA malpractice.

Still ,best to have a definitive medical opinion from a real doctor.........

this is a sad and scary situation and should not have happened to this disabled veteran.

[harleyman]

Berta, I don't have a scanner so I am typing. This is the history of the illness as decribed by the Vascular surgeon, who perfomed the emergency surgery. This is the pre-op report of findings and assessment just before the emergency surgery.

This is a 67 year old male. aditted to the Medical Center with left calf pain and tenderness. He has massive swelling as well. This patient's problem with this specific problems near Thanksgiving at 2012. He was initially seen and evaluated and felt to have cellulitis. A duplex scan was performed showing NO evidence of DVT.The pateint was treated with antibiotics. His problem continues, so he went to VA hospital, a different system, and an ultrasound SUGGESTED DVT. He was started on anticoagulation after an inpatient admission. He has progressed with problems with pain so much he can no longer ambulate. He is now in an eletric wheelchair, and the patient finanally is not get satifactory results from either system. He sought out a primary care doctor and Dr. XXXXX looked at him, and felt he needed hospitalizatin and sent him to this Medical center.He had an ultrasound here which shows NO evidence of a DVT, but showed a MASSIVE 27 x 5 x 8 cm heterogeneous mutiloculated fluid colletion, and so he ended up having an MRI, which shows a hetergenous massive fluid collection in betwenn the gastrocsoleus and superficial to the soleus as well. While Dr. XXXXX (at this facility) was examining today, he started to have a purulent material emanating from a small pin hole and I was consulted for abscess drainage. He has over anticoagulatd with a PT/INR of 34.2 and an INR of 3.6.A PTT yesterday was 71.9. He is also on Effient for coronary artery stents that were placed in recent months. He has had a 50 pound weight loss since this began. He consistently denies fever or chills during all this time.

Assesment: Massive calf abcess and possible osteomyelities.

I think the VA is guilty of Mal practice as the VA ultrasound suggested a DVT, and it was never confirmed. According to the VA records it appeared they suspected a DVT but they were looking for confirmation testing or at least thats what it seems from the report. I will dig it out and put exact wording here for you to review. This is really a horror story.

Edited August 1, 2013 by harleyman

[harleyman]

Berta, I wanted to add this report was on March 28, 2013. Four months since this started and all that time trying get VA to figure out what was going on and also in another local hospital. The abcess was

27 cm long 8 cm wide and 5 cm deep. It went from his ankle to above the knee into the thigh. How could that VA doctor not want to do further testing. This is absurd. This was only the first of 3 surgeries. He ended up with a knee surgery from above the knee down over the knee cap and to the patella. about a 6 or 7 inch scar. The another surgery for I&D on the calf which is still mending even now. This scar is about 8" ilong and was 5 inches deep. Still is indented by about an in, this is nasty and the area is painful and very hard, like a board still. He also had an upper thigh asperation of infection fluid done by the radilogist after the seconda surgery. It is getting better but.. it certainly is not normal. The Veteran can walk for very short distances like to the mail box and back. But cannot do grocery shopping without a powered chair. He can no loger ride his motorcycle as the leg is not strong enough to support the weight of the bike without being dangerous. I really feel like he needs to file the 1151 and get a private attorney for the hospital that look at his foot but never address the massively swollen LEG.

I am venting here, everytime I read this file I get pi$$ed off.

Edited August 1, 2013 by harleyman

[Berta]

“He was started on anti-coagulation after an inpatient admission “

I think the anti-coagulant caused the anemia. An IMO doc might agree.

I can support that theory with some med stuff but then again I am not a doctor (I just know too much about how one misdiagnosis can cause a snowball effect that,in turn, causes additional problems, with the wrong treatment and meds. I think this vet could have died.

I also see he is still within the 2 year statute for FTCA cases against the VA.

It appears there was non VA negligence too.

Malpractice lawyers:

There are plenty on the net with FTCA -VA experience:

http://www.govtclaim.com/laurie-higginbotham

fre case consult form on line

:

http://www.dallastexaspersonalinjurylawyers.com/practice-areas/medical-malpractice/veterans-administration-medical-malpractice

free case evaluation via form at their site

http://vamalpracticeclaims.com/

Free consult form at site

and many other lawyers who may or may not have VA FTCA experience but can handle non VA malpractice issues. I think for non VA related cases against private hospitals, the attorney must be member of the bar in same state the malpractice occurred.

http://www.marksandharrison.com/medical-malpractice.html

http://shlpc.com/what-we-do/medical-malpractice/?utm_source=google&utm_medium=cpc&campaign=google&utm_term=%2Bhospital%20%2Bmalpractice%20%2Blawyers&utm_campaign=Medical+Malpractice

free consult form at site

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