Category Archives: Health care

Another day

Ginastica today was much better. Good workout. Felt good to do it. There’s one lady there who had both knees done! I’d couldn’t do that. Of course I didn’t understand all the directions but once everyone had started I imitated them. One funny part is at one point I gave the thumbs up to Francesca (my roomie) for her good work. The instructor said the odd couple me and Francesca, she is from Bari Puglia and doesn’t understand Italian any better than l’Americana! I guess we are the odd couple. 😀

If you didn’t know, all regions have their own, very different dialect. They don’t necessarily resemble actual Italian at all. After the formation of Italy they mandated one language as “Italian” and they picked the dialect of Florence as the official lingua. Places like Puglia, Calabria, Sicily, Campagna (actually every region) all speak totally different languages. My roommate speaks Bariese dialect. I’m sure all her family does, as well as her friends and the people where she lives. She’s never needed Italian. I’ve listened to her on the phone with her friends and wow! Really strange language.
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Yesterday I washed my hair! It made me very happy. I had to figure out the bathroom. It is commodious and very green. Sink at one end, shower in the middle, which drains into the drain on the floor, and toilet with bidet on the wall opposite. I like this bidet thingy. It eliminates the need for the separate appliance. It allows you to clean yourself better and easier than the bidet. Quite well thought out.

Since I couldn’t get my bandages wet I couldn’t actually shower so I did it piecemeal. Start with the bidet. Go to sink and wash face and bits. Then wash hair with shower attachment. Easy peasy.
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Other news
The administrator brought a form, helped me fill it out and Luther has to take it to Prosperious. Then we will see what they say.
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Life goes on outside the hospital. Luther and I had our appointments to pick up our long awaited Permessi di Soggiorno. He went and got his and told them I was unable to come. This time it took 7 months 🙁

Ginastica Italian style.

    First off, latest news. I got a new piece of information yesterday. It’s always something it seems. So I was counting on being moved from here to Prosperious for the rehab, as you know. I had a gaggle of people in the room to include the “big” doctor. I guess he’s the head guy – il capo. He has everybody’s charts and makes decision about care. I asked when I’d be moved to Prosperious and he explained that the hospital I am in is a rehabilitation hospital and they don’t send people other places. So if I want to go somewhere else it’s on me to figure it out. Again, blindsided by the System. Luther had asked the nurse on Friday and she had confirmed I could go there but nope. But misunderstanding again. He asked can she go to Prosperious after she’s finished here? Well yes, of course I could do more after. But after means after two weeks of rehab HERE. There has been much gnashing of teeth. Should we pursue the change to Prosperious, considering we didn’t know exactly how? Or should I just tough it out here. I knew my doctor was here and that’s a consideration. But Prosperious is one of the best in the country. We slept on it.

    Any orthopedic docs in the house? This was interesting to me. A list of my new parts that they gave me.

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    Another scrumptious lunch. 😏 I could eat the pasta, but not the secondi. It was unknown fish and crustaceans and extremely fishy tasting. Not to my liking.

    Physical therapy Italian style
    So, today was my first ginastica, or Physical Therapy session. I’m finding it hard to slow down to the pace they want here. I started walking with a walker yesterday. And he told me to slow down. I naturally move fast. Italians naturally move slow. And he caught me carrying the walker once and I was reprimanded. I was not to ever walk without using it. In trouble again 🙄. This morning a gaggle of us headed upstairs to the top floor (which is orange) for a session. 5 women and one man. We laid on beds and Rikki and Francestino told us what to do. I did a total of four exercises. Blink. I think the session lasted maybe 30 minutes. The man to my left fell asleep. The lady at the far end was snoring. So what’s this going to help? Of course it didn’t hurt to do some exercises. I’m sure it did some good. If/when I transfer to Prosperious we will see what difference there is. One thing is all the ladies are in their 70s or 80s, one looked to be in her 90s, so how can they stress them too much. And the man? He did as little as possible.

    Afternoon we were all herded up to the top floor again. They let me use my crutches. This session they placed two electrodes on my injured leg and for an hour I sat bored to tears listening to the other 4 Italian women talk. These ones aren’t very old. Some could be early 50s. I need to look up the procedure to see what it does.
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    Final news flash
    Il Capo of the hospital came to our room on his rounds and in our conversation he mentioned that my surgeon had initiated a transfer to Umbertide to Prosperious! So the decision was made for us and I’m sure it’s the right one. That my doctor did this means he is fine with me going there. And this hospital is fine with me going there since it is convenient for family and friends to visit. Totally different viewpoint. Since it’s National Health, it’s not for profit so they are fine with me going elsewhere. Interesting.

Hospital impressions

Now for my hospital impressions.

Two hospitals: Silvestrini (S) and Casa di Cura Liotti (CCL). I had my first operation in January 2018 in Silvistrini. It is a huge University Medical center. Casa di Cura is a small, partly private hospital in downtown Perugia where I am now, September 2019. Here are my impressions of the two plus some other things I found interesting. Some are a bit mundane but it’s what I noticed!

(CCL) Is rather dark and dreary due to the lurid paint they use here. And they don’t like putting the lights on in the halls. (S) Was more the norm that you’d see in the US with light walls and neutral colors.

The colors they choose differ with each floor. What were they thinking? 🤭

(CCL) The beds are electric and I can up and down as I wish. You don’t know how empowering that is! (S) had cranks, and I was stuck in bed and couldn’t get to it.

(CCL) There are two beds. No curtain between them. Cozy. A bit hard to get used to but it is what it is. (S) DID have curtains in it’s shared rooms.

(CCL) Each room has a private bath to share by its two residents. (S) there was one very odd bathroom which was shared between two rooms by four patients.

(CCL) The food is not so bad. Palatable I’d call it. And with my little pack of additions it’s almost good. I don’t have a lot of appetite but my blood is low so I’m eating. (S) practically inedible.

A little different from my normal food pictures ha ha. I ate the pasta which was pretty good. Not the mystery meat or eggplant. I normally like eggplant but not this.

(CCL) All the staff are young and nice. They go about their work cheerfully to a person. Not one has been mean or short with me. I don’t have a nurse Rachett or a Senore huff n puff like last time. Way better here than (S).

(CCL) Provides water for patients and delivers it, and other help you need if you ask for it. (S) Did NOT provide any water and would not bring any. Nor could you drop something on the floor and ask someone to help you get it back or ask your bed get cranked up or down. They expected the family of the patients to do that. Two very different places.

My medicines caused a stir. I always wondered why they have their pills in little blister packs. Lots and lots of waste. I prefer the easy bottles we have in the US. Well, today I think I figured it out. I had brought my own blood pressure medicines which I had removed from the blister packs and placed in small jars. No, no, no they aren’t good if not fresh. An aha moment.

They have a passaggita in the hospital. Just like in a village! All the crutches and walkers come out and it seems like all able patients walk up and down the hall.

I have a room mate. She’s a small rotund Italian woman who had a fall which got her here. I’m guessing she’s 80. Her name is Francesca. She’s sweet and we’ve become friends. She’s been here over two weeks and I just heard she leaves Thursday. Happy for her. And, get this, she came with at least three family members from Puglia! 550km away. Her doctor said she wouldn’t get the good care she could get here. So I guess he got her set up here. I had heard the health care is much worse in the south, a definite consideration if a person is planning to move here. Just goes to show the huge difference people talk about may be true.
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More tomorrow.

Ginocchio intervento 2 – knee operation 2

This will be a brief post just to update on how I’m doing.
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So the day arrived to check into the hospital. We arrived at 4pm as instructed. The orthopedic floor was full so I was put on the floor above. I had a nice quiet room to myself. I had broth for dinner.

Next morning I woke early and waited and waited for the surgery. Finally got wheeled off about 10:30am. First big surprise was they did the anesthesia differently. I had known I would get an epidural which numbs you from the waist down. The last operation they used mega tranqs to make me sleep and did the spinal in my sleep. This time it was done while I sat on a table! It was scary more than painful but it did hurt. And when they wanted to use gas to make me sleepy I said “I don’t want to hear, see, or feel what is going on!” Make me sleep. They did.

I woke on the way to my room. I guess I got there around three. The doctor came and explained the entire old prosthesis had to be replaced. The other one was defective. This was interesting news. They did give me morphine for the night. And another pain killer the next day that was different but strong. I’m afraid I was woozy and I don’t remember it well.

The next day the doctor visited and lifted my leg and bent it slowly. I was actually amazed at how far he could bend it with no pain. They put me on the bend machine which repeatedly bends the knee to a percentage of flex for an hour. Twice a day. And the flex increases daily. But I’m up to 70% with no pain. I am so happily surprised that this is so totally different from my last experience.

Next post I will give my impressions of the hospital experience and compare with the last one. It’s pretty entertaining.

Packing…

When a person goes to the hospital in Italy they must bring everything they think they will need…and then some! In some areas of the country this even includes bringing your own toilet paper. On my last hospital stay I didn’t need to bring that, but I did need to bring my own coffee cup if I expected to have coffee in the morning, and my own cutlery. I also had to provide my own water.

Since my trip this time will be over three weeks long (!) I need to bring a lot of things. I have a little bag which I filled with things to improve the horrible food. Like olive oil, vinegar, salt and pepper, and hot sauce. Maybe this will help. We’ll see. I also have soap and a wash cloth and towel. And a bowl to use as a basin. I am bringing the noise canceling headphones we have. I had some last time and they were invaluable since my roommate had the TV on from 7am to midnight, tuned to bad Italian TV of course. I’m also bringing my own pillow. Better than the hard-as-rocks hospital pillows.

For the rehab I need clothes I can wear to work out. I got some capri length pants with wide legs so my knee will be easily accessible. I need to bring gym shoes and tee shirts too. Of course, I can get Luther to bring anything I find I need in the meantime.

Here is the array of things I’m bringing.

Note the cup, spoon and cutlery!

These are the things I’m bringing to fight the horrible, bland hospital food. Olive oil, hot sauce, balsamic vinegar and salt and pepper. I should be all set I hope.
So today is the day I check into the hospital at 4PM. The surgery is tomorrow morning. I’ll try to post later on the rest of the story!

Now for something less cheerful


As some of you know, my initial operation in January 2018 to replace my knee was less than successful. In April of this year I consulted with a new doctor, Dottore del Citerna. I had met him twice previously in consults about both my knee and hip. If I had understood the system better he would have been my initial doctor. But I did not understand. I had thought I must go to an in-system doctor. So I chose Dottore Trinchese. He practices at Silvestrini hospital, the big university medical center in Perugia. It is where my first surgery was done. When I chose him I did take time to get recommendations and looked up his reviews.

I don’t really fault Dottore Trinchese with anything. The knee was problematic before the surgery. I DO fault him with not admitting there was something wrong when I went for a checkup six months after the surgery. I knew there was something wrong! He said not. So I kept on. Eventually it got worse, not better. So that’s when I turned once again to Dottore del Citerna. He examined me and he thinks it is the ligaments and muscles which are not holding the kneecap securely. But he won’t know for sure until he does the surgery.

So that’s the back story. My surgery is scheduled for September 27. I am now lasered in on it. All this spring and summer I’ve concentrated on the 3 major trips I had planned. I had put the surgery off until after them. Now, nothing stands between me and it. 😳 There are some differences this time. First, my doctor is private. Second, the hospital is different. It is smaller and part of it is private. I am still on the Italian Health care system so it will cost nothing. I hope this means the hospital experience will be better than the big, busy University hospital. I guess we will see.

Last week I went in for my pre-op tests. It took six hours! Everyone was very nice but there were interminable waits between each procedure. The hospital is called Casa di Cura Liotti. It is rather dreary and right in the busy middle of Perugia.

I was waiting in one of the waiting areas and saw my doctor arrive. He came back through again on his phone. The next time he came over to me and asked me if I was pronta? Or are you ready? I said no, not really. But I was impressed that he recognized me after seven months and spoke to me. I don’t think that would have happened in the US.

Now I have to pack for my ordeal. Next post about what I’m taking 🙂.

Not good news

If you follow my blog you’ll know that I had knee replacement surgery here in Italy in January 2018. I learned a lot about the Italian system before and after the procedure. I learned all about what to expect when you go to the hospital. And what to bring with you, which is very different here.

2018 Knee replacement part 1
2018 Knee replacement Part II
2018 Knee replacement Part III

I learned that the nurses don’t help with many basic things like bringing water. Or ice. They do blood pressure, medications, take blood for tests, basic bed making and body wash. But for your personal self, it’s on you to have a wash cloth, water, soap, a basin and toothbrush, toothpaste etc. for personal clean up. For anything like this you would need a helper. A family member or friend. Odd but true. Different hospitals have different rules. And, of course, very few people speak English. It makes for a lonely time without being able to speak to anyone.

OK so, my operation last year was fine, the PT in hospital was good, if painful. No opiates or pain killers in Italy. I was released but didn’t really understand I was supposed to go into in-patient rehab for 3 weeks. When I found out, this floored me. I couldn’t face it. After being in the hospital for a week I wanted only to be home. So I didn’t go. We arranged a nurse to help with re-dressing the incision. And hired a private therapist for PT in house. And all went ok.

I was told it would take 6 months to a year to recover. So I waited. And did my exercises… and I was in pain. Especially going up and down our 56 stairs. I returned to the doctor 6 months after the operation with concerns about how my knee “looked”. There was a malformation in my opinion. But the Dottore said all was well. Tutti va bene. So. I waited.

Now, more than a year later I am still in pain. Rising from a sitting position and doing stairs are quite painful. And getting more so. I decided to consult another doctor. I knew him from previous consults. I like and trust him. He sent me for X-rays of specific sorts. I returned and he said I need another operation. There are three issues. First the kneecap is skewed to the side because the ligaments and muscles are not holding it in place correctly. Second the top part of the prosthesis is too large for me. Last the bottom part of the prosthesis is slightly twisted off center. He said I could get lucky and they would only have to repair, realign the ligaments and muscles over the kneecap. But if the other two things seem to be an issue I’ll need an entire new implant. He will only decide once he can see it. Sigh. I have to lay this at the feet of the other surgeon. 😡 Not what I wanted to hear but I expected it, I guess.

My doctor asked me when I wanted surgery. I was taken aback. Last year I had no choice. The doctor put me in the queue. It took about 7 months and I had no real choice for the date. This doctor seems to have his schedule in a book he keeps and is able to pick dates. I will never understand this crazy health system here. Since I have multiple trips planned this year. And I don’t want to cancel them. First a week trip to Sicily in April. Then a 10 day trip to the US for my nieces wedding in May. Finally a special anniversary cruise in the Greek islands in July. I decided to choose end of September, after my friend Eunice goes home from a visit.

So I’m scheduled for surgery on 27 September, in Perugia in a small clinic/hospital and I will be in a total of 18 days. To include rehab. This time I will stay in for the entire rehab. It will be easier if hard to be in the hospital that long. I’m sure not looking forward to it! But it is what it is. On the bright side, I’ll lose weight! Food is awful in hospital.

The news for my blogsters is that I will share another exciting hospital stay experience with you. This time to include all that in-patient rehab! 😳 and Hey! I will learn more Italian.

Meanwhile I’ll enjoy spring in Umbria. And hopefully I can enjoy my upcoming trips. Fino a dopo i miei amici!

Trying to move onward with the knee

One of my posts prompted a comment about recuperation in the US vs Italy. I opined that in the US everything is go, go, go and get well, and back to work. Here it is piano, piano, take it slow, heal, you’ll be fine in good time. So which is better? Hard to say. I’m following instructions and trying not to feel competitive with those who are moving faster than me…after all, whats my hurry? 🙂 piano, piano.

That said I am not really happy with my walking ability. The knee is quite weak with it buckling unexpectedly when I take steps. This makes me less confident in my ability to walk. Other things are going well. The knee bending is very well. Sleeping is easier but I wake a lot when shifting positions and going from bent to straight leg. Next week I plan to go to the local pool with my friend Joanne who will show me the ropes there. Then I can do aqua exercises. I’m told this is an excellent way to work the knee.
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Other than the knee last week I had a unique experience. I had received a letter in the mail with an appointment for my annual mammogram. So we headed to Città di Castello to the hospital. I’d been once before so felt fairly confident going again. I sat at the desk where the woman, in pretty violet scrubs, looked up my records online and nodded to a man, wearing brilliant red scrubs, who came and took me to the scanning room. I had a bad feeling about this. His hame was Marco. He asked a couple of questions and indicated I should take my shirt etc off. Well. I had never had a male mammogram techician before but one has to go with the flow as it were so I did. It wasn’t so bad. I just have to wonder why a man would choose this profession. Yes he gets to see and touch lots of breasts but it is hardly titillating.
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Afterwards we visited one of our butchers. We needed provisions. Then, while Luther parked the car I made a loop through our Kilo zero market. The veggie people have just what is growing nearby. Cabbages…many sorts. Kale. Chard. Spinach. A few root veggies. This is the time of the year when the farmers who lived off of their crops are ready for some spring growth. They have been eating the available greens growing now, supplemented by the preserved bounty from last summer. Nearly gone. The good news is that spring has started to put in a pretty steady appearance. I am starting to look forward to the spring early veggies.
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I’ve also started to clean up our terrace. I bought a nice wood rack for the wood we didn’t use.

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And I’ve been scrubbing the grout and tiles. My pots are being slowly dug up and the old plants relegated to the trash. I will be ready in May when we start to plant again. I am thinking about what to try this year. Always fun to plan! I have lots of pots now since my failed corn adventure last year.

Italian politics

So, maybe you’ve heard that Italy had a pretty important election last Sunday. I don’t pretend to understand it all. But I’m going to try to do a little synopsis of it.

Even here in little Umbertide opinions and emotions ran high! Back in the day, Umbria voted reliably Communist. The party is the Democratic Party or the PD now. They had the most power until Sunday when they got less than 19% of the vote prompting Matteo Renzi the PD leader to resign. A real awakening for them.

The main players are the Five Star Movement, the Lega Nord (La Lega) or the League, Berlusconi’s Forza Italia (FI), and the PD.

The Five Star Movement won the most votes. The other big winner was the right-wing La Lega led by Matteo Salvini. But no one party or group reached the 40% necessary to form a stable parliamentary majority. The group achieving anything near this was the right-wing coalition formed by Forza Italia, La Lega and the Brothers of Italy (Fd’I) with 35%.

It is now up to the President of the Republic, Sergio Mattarella, to decide which party leader to ask to try to form a government.

I am told that this is a huge deal in Italian politics. Sunday’s election marks the end of an era.

Italy now has to make a choice between a right-wing coalition led by Salvini and the Five Star populists. Europe has seen a big rise in the right in the last years. Here in Italy it comes mainly from two issues — austerity and immigration, both of which have hit Italians hard. Both parties that have gained most in this election are anti-immigration and Eurosceptic. 😕

Europe was shaken by this election but it has itself to blame. It has done far too little to help Italy deal with the huge influx of migrants across the Mediterranean, 640,000 in the last four years. They have insisted that arrivals be processed in the EU country where they touch land. This has left frontline countries with an intolerable burden that has fuelled anti-immigrant and anti-EU sentiment. I am not Italian but I really resent the other countries in Europe for shirking their duties to a United Europe and dumping it on some of the poorest and least able to handle the crisis…Italy, Turkey, and Greece.

So to sum up…the two biggest winners have said they will not form an alliance. No one knows what the next Italian government will look like after the election. So, unless someone forms a coalition there will be another election in two months.

Finally, Umbria went hard for the center right. A big change from being reliably red.

I’m not sure this clarifies anything for you all. I got a lot of this info from the Italian papers myself so I could understand better even though I can’t vote.

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Knee update

So, today I had an awakening. I had a lesson with my Italian teacher today. She always asks about how I’m doing with my knee and all. So I vented that it was taking so long and wasn’t like in the US where people are walking in a week..blah, blah. She looked at me and said…sometimes it’s better to go slow like here in Italia rather than go, go, go faster, quicker like in the US. Suddenly it made sense. It’s my effing American mindset ! I need to chill!

Monday I get my final X-ray and consult with a doctor and I hope I get the OK to move forward with walking etc.

The Deep Freeze…. brrrr

All of Europe is being affected by a Siberian front bringing frigid air where it has no reason to be! This morning I woke to -9C temperatures.
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The photos on the nightly news and of social media of a snow covered Colosseum in Rome are amazing. Mount Vesuvius is snow covered as is Naples. The Italians do not deal well with snow. They only got 2” but it snarled all the trains up for a day and a half and caused all kinds of traffic backups. Amusing for those of us used to “real” snow.
Here is our piddling little bit of snow we woke up to on Sunday.

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Today is market day and I bet a third of our regulars didn’t show up. It’s so cold the produce is freezing and they have to cover it. They have a fire in a barrel to try to warm themselves. And resourceful folks that they are, they are grilling up sausages on the fire!
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Knee replacement update
It is a month from the day I returned home from the hospital. I feel like I’m doing well with the recovery overall. Still not walking except with crutches. My PT guy is encouraging though. I have an appointment at the hospital for an X-ray and consultation with a doctor in a week and a half. I am looking forward to that.

We also found out from a couple of sources that it is important for us to arrange to get all my records from the hospital now or it would be very difficult to do so later. So this is another thing we have to scope out…who do we see…how do we see them? Always something.

Looking forward to springtime. March is around the corner!