Category Archives: Health care

Italian politics

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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

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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!

Knee replacement Italia – Part 3

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I was told at the hospital upon release that I was set up at Prosperius, the therapy center in Umbertide and to go there the next day. The nurse at the hospital seemed puzzled I wanted to go home right away like I wanted to spend another night with them! So uncomfortable there. Anyway we got checked out and it turns out they had ordered an ambulance for me. They were not pleased when we said we didn’t need it. Luther drove us home in the glorious outside. Lovely fresh air. I managed to get up our 53 steps on my hand crutches. And basked in being Home and again with my cats. Home and cats have healing power beyond all else.

I had a welcome home glass of wine and Luther cooked our dinner with a bit of coaching. It was a lovely evening with English language TV for a change. Home!
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Well we found out you don’t know what you don’t know! We went to the local therapy center where I was told to go. And they told me they wanted to keep me for 2 weeks inpatient therapy(!) we had no idea. Gobsmacked. And this, after we SPECIFICALLY asked our GP and she assured us I would not be an in-patient candidate. We know the name of a therapist that a friend recommended who will come to me and we pay him privately. We asked if we could do that. They were fine with it. So we sent a text to him. Meanwhile I will continue to do the exercises I learned in the hospital four times a day. They are extremely painful to do so I have to force myself and remind myself it is important to work through them.
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The stairs are very difficult so I’m adamant I’m staying up here from now on. My doctor is supposed to arrange dressing changes and stitches removal but we are trying to do much of it up here in the house. So, through a friend, I’ve found the nicest nurse who comes here to change my dressing every 2 days. Distressing that she will take no compensation. She is an angel. So one less reason to go down stairs.
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I have also, through a friend, gotten someone to come and give me physical therapy. He is very nice but his job means he hurts me. I don’t think I’d like to do that for a living. But I’m very happy to have him. And he’s told me it’s crucial to do the exercises myself many times a day. I have been dealing with sciatica pain and I asked him about it. He said it’s a side effect of the epidural sometimes. He gave me a good massage which helped some. At least I know why. I want full function so I am going to do these exercises! I know it’s not forever.
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Maybe I was a bit foolish to not just check myself into Prosperius when I got out of the hospital. But at the time I couldn’t face being in another hospital for 2 weeks. So far we are managing here.
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I think my saga is done now except for the hard work of rehab. If there is anything new to add I will write about it as it occurs.

Knee replacement in Italia – Part 2

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Musings
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Normal day.
5:45 am. Time for taking blood. 6:00 am blood pressure and temperature. 7:00 nurse arrives and scans your bracelet. Gets your medicines. Administers. 7:30 breakfast lady brings coffee and dry toast, like melba, with jam. Activity levels in halls ratchet up. 8:00 they come remake or change your bed and wash you some. Around 8:30 a gaggle of medical students comes and hears about the cases. PT person comes around this time too. Lunch arrives around 12 – 12:30. Afternoon is more random. More bracelet scans and meds. Coffee break in late afternoon. Dinner comes around 7pm. After dinner more scans and night meds. Ta da. Day is done.
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I contemplated the Italian word for pain, dolore. Or painful, dolorosso. I looked up an ache. Dolore. Hmmm. Seems like they should have that distinction. Fa male means it hurts. Male is the word for bad. Pronounced mah-lay.
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Some people who stood out. Dr. Pain, the first physical therapist. Nurse Ratchet, evil morning nurse who does meds. Sr. Huffinpuff – he does stuff like move beds, bring dinner, move trash bins out, stuff like that. He constantly sighs and pants while doing his work. One blond nurse who was kind and gave me a sleeping pill one night. The nurse who complained I peed too much. Dr. Trinchese, my surgeon. I call him the stealth surgeon. I saw him in the OR and then he did a drive by visit that lasted at most 15 seconds. “Come stai. Bend your leg. Lift your leg. Belissimo” and gone.
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Random thoughts and observations
Full time monks inhabit the hospital, gliding down the hallways.
Bringing your own coffee cup is key.
Bring cutlery.
Some hospitals do not provide toilet paper. I was told I was in a posh hospital because it did provide it.
They move you around in your bed for procedures.
Some nurses are tolerant of my bad Italian, many are not.
In my opinion the food is pretty bad. They try. You get three courses. Not sure if that’s a plus or minus. Bring salt, pepper, olive oil, lemon juice, Tabasco, anything to spice it up. Next time (hopefully a long time off!!) I would not order all the courses each meal. Breakfast is a cup of your favorite drink (not wine) and a packet of dry toast (like Melba) with a container of jam.
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Stay tuned for Part 3.

Knee replacement in Italia – Part 1

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Much of the following posts about my hospital stay are musings of the experience as well as my documentation of what occurred. Most, I wrote while in the hospital.
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The surgery went well. The hospital is pretty modern. Not a young building but up to date. It is also enormous. A University Hospital. I saw very little of my surgeon. He showed up for the operation. Before surgery they take all your clothes and give you a completely transparent gown! I pulled my blanket up for the ride to the OR. As soon as I arrived they cut it off. What was the point?

Returned to my room. During the operation I had only an epidural. Could not move my legs when the tranqs ran out. The surgeon prescribed a bag of morphine for the first night. Since that there were no opiates to be seen. So my intell was correct. What they gave me was ok but my pain when I tried to exercise was through the roof. I was discussing this with one or Luther’s cousins who is a pharmacist. Opiates are properly used for recovery from surgery and for a short time afterward. As she said, “the pain actually increases the fight/flight hormones and delays healing. Also makes physical therapy a lot harder. I think they were giving prescriptions for too many pills at once and not scrutinizing refills [in the US]….” European mainland countries in general do not give pain meds. They do in the UK.

My PT started the day after surgery. It involved a machine that bent your knee over and over to the most painful angle you could stand. Then leg lifts, toe thrusts, tensing the muscles on the back of your thigh and more flexing. I kinda sat on the side of the bed and stood at a walker for a second. Unfortunately the next day was Sunday and then Monday a holiday so things slowed down. I was unable to lift my leg. It was like the signal wasn’t getting there but with a little help to start I could lift it with much pain. I think this is when some codeine would come in handy 😕 the leg was extremely swollen and I was convinced that had to be a part of the problem. I wanted to learn how to use the crutches. It would give me some freedom in the hospital. That was one of the hardest things, being unable to help myself with anything. I took great pains to keep things from falling on the floor. If they did, they were lost to me. The nursing staff are not there to help you. Sure, they would bring me a bedpan if I asked but one night, I had been instructed to drink water after a shot so I had to pee, three times in around a two hour span. She let me know she didn’t appreciate it and said it was not “normale”. I told her I had had 2 bottles of water. I was no longer trying to be nice.

The other thing was the total lack of privacy. I shared my room with another woman knee replacement patient…and her husband. He literally lived in the hospital with her. He brought a small chaise longue. With blankets and pillows and slept next to her. He was a nice man who occasionally helped me with an ice refill or cranked my bed up or down (no electric bed there!). I noticed other people walking up and down the hall with these beds. They expect family members to come care for the patients. I lived with just visits from Luther but they were invaluable.

I was not ready for the loneliness of not being able to speak to anyone, even to casually chat with the nurse or aide. I discouraged visitors so maybe I must take some blame for the loneliness. Luther visited every day and I know even HE was bored. And he hadn’t been there for 5 days
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Stay tuned for Part 2.

Hospital arrival and first day

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I was told to arrive at noon today. Which I did. But last time here I neglected to take a picture of this directional board with all its colors. There are building depictions on the sides and on the floors everywhere are colored arrrows to help you find your way.
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They checked me in with much paperwork. Then I arrived in my room. It is a semi-private room and has a curtain on one side only and is very much like a US hospital. I guess it depends on the hospital. This one has nearly everything. There is toilet paper. At lunch there was plastic cutlery. There is a small shared TV. But tonight for dinner I did not have a spoon for the broth I was allowed. So I used the one I brought. They don’t provide water.

My roommate was in bad pain and I spent the afternoon listening to her cry and her husband calling for nurses. They tried a few different things none of which worked. Finally she got morphine. She’s eating and blabbing on the phone tonight. I hope they manage my pain OK. Now her husband has gotten his lawn chair and cushions and a blanket to spend the night. I had hoped it would not be necessary for me. Crossing my fingers. Poor Luther has no lawn chair.

The time is now.

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Well, tomorrow is the day. I go into the hospital at noon. I have no idea what I will be doing all afternoon since the preliminary tests are finished. I guess I’ll find out.

During the last two weeks since my pre-operative tests I’ve talked to a lot of people who have told me their experiences which all differ from one another.

In an effort to get some correct information on what to expect we visited Dotoressa Mommi, our primary care doctor. She told me the length of the hospital stay depended on how I was doing. She did tell me a little about the PT process. We have to wait until I return home then we can set something up. I’ll get instructions from the hospital for Mommi to help move forward for us. It is possible to have home visits for a while. But emphasis is that I get out of the house ASAP. The stairs are a problem. I guess we will just have to trust the system.

Going to an Italian Hospital is NOT anything like going to an American hospital. All the information I’ve gleaned so far says I will be in a ward. There are no curtains or privacy. The nurses do not provide much assistance for things like a drink of water, or help going to the bathroom. It is expected that a friend or relative will stay with you. Another difference here is that the hospital provides nothing for your stay. No water or toilet paper, you even have to bring your own cutlery, plate, cup and glass! Here is my suitcase in packing process.
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And, for a bit of good news, they finally removed all the scaffolding from the Comune building across from us. It is quite striking with its bright yellow paint and white trim, new copper gutters and downspouts and earthquake stabilization. The interior is gutted so I have no idea when that part will be even started. Maybe it will wait until the new government in town comes in. So now, I can again see the piazza. Here’s the building from our window.
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Knee surgery scheduled

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About 6 months ago, I told you I needed surgery here in Italy. Non-emergency surgery can sometimes be a long wait, as it was in my case. I got a call last week from the hospital…at long last…to schedule my knee replacement surgery. My first appointment was today, for pre-op tests.

Well, I’m back from my tests. It went well for the most part. Ospidale Silvestrini sits commandingly on top of a hill south of Perugia city. It is the University hospital, so a teaching hospital. The hospital is ENORMOUS. And a VERY busy place. We were to go to the Segretario Ortopedica. Luther looked it up and the instructions said to go to a parking lot called Menghini and find a specific door. The place has multiple buildings connected with enclosed walkways. Our building was A, third floor.

It was 7:50am and our appointment was for eight. We got there and saw a door with the correct sign and walked past a whole room of people waiting and down a hall to the Segretario’s office. Asking permission he invited us in. Suddenly, all the people in the waiting room seemed to swarm the room but he told them to wait. Seems he had no appointment for me. But I was lucky, and he was helpful. Once we told him we had a surgery date and he looked in that book and there I was, he moved to fix it. He called down for my blood work and we went down to building P.

It was a pretty long walk. There, room 17, our destination, had an open door. We asked to come in giving our name and they seemed to be expecting us. Again the waiting room was full. I was feeling we were jumping the line! There was a man and a woman there. He took my blood, she did pulse and BP. They gave me a form to fill out with my history and a number and we returned to the waiting room. I filled out the forms and my turn came and I went in to see a young anesthesiologist. He was nice and even tried a little English. He asked questions and answered mine. A little disturbing is that I may get an epidural only along with mega tranquilizers, so not a general. Man! I hope I don’t wake during the operation!

Next we went to radiology and got a number. Everywhere we went was busy but here was the busiest. They are just next to the Pronto Soccorso or emergency room. When I was called I went down and got a chest X-ray first and my knee second. The chest was because I told them I used to smoke when they asked if I had. And how much. But wow, I quit nearly 40 years ago. But still…X-ray. So all was finito and we headed home. It took about 2.5 hours. All in all, I’d say the hospital was as good as anything in the US. This is reassuring. Everyone was very nice, and patient with my Italian. I’m crossing my fingers the intervento will be as good. I am scheduled to go in two weeks for the intervento, or operation.
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My friend Angela here (I grew my corn at her place last summer) has a friend named Quintino. She calls him Quinto. I knew he brought wood to her house to split. He’d also leave it there. So I asked if he’d need a spot of work to bring me wood. Well he did, back in December and he would not take the money I offered! Un regalo, a gift he said. I said no, no carrying it all up here, and believe me, it’s heavy! So I asked Angela about how to pay him and she said block his way and make him take it. I got some more this week and this time I made him take it. He didn’t want to because I was a friend of Angela’s. Now I have way more wood than I need.🙂 oh well. Rocky has decided he LOVES fires. And Quinto even brought me olive wood. He said it was for carne…meat when I cook.

So last night I tried out the olive wood. Smooth bark and small in size, it pops like firecrackers are going off in the house. So far this has not fazed Rocky. I grilled one of the good steaks we get at Etrusco in Bosco, a town south of us. It turned out very good and I had a nice, warm kitchen.

Dealing with health issues in Italia

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I’ve avoided writing about something for a while now and it’s time I begin to chronicle this new adventure (?) Last year I began to have problems with my right knee. I went to my doctor and she prescribed anti-inflammatories and icing. For a while it seemed to improve but took a nosedive earlier this year. We are very new to the Italian health care system so are groping our way along with many false starts.

We went back to our doctor and I asked for an appointment with an orthopedic doctor. Dotoressa Mommi wrote a prescription for an appointment. And said it was urgent enough to get done in 30 days. The only available doctor was in Deruta, about 30 minutes south of us. We visited him and he was frustrated that we had no X-rays or an MRI. All he could do is proscribe something which turned out to be pretty useless. We decided to go and get an MRI on our own and pay for it. If I didn’t want to pay I could have gone and asked our doctor to prescribe one and waited (again). So we went to a diagnostic center and I paid 126€ for an MRI. Not bad.

Armed with this we could make an appointment privately with a doctor of our choice. The only one we knew was far south in Spoleto. We visited him and he read the MRI. He said I need a total knee replacement. Sigh. We paid 150€ to consult with him.

Back we went to our doctor. In hindsight we could have asked this doctor we went to privately and he could have put us into the system and done the surgery. But we didn’t understand this at the time. Dot. Mommi explained it to us. And she offered to make an appointment for us with a good orthopedic guy in Umbertide. I prefer to not have to go too far for the procedure mainly because I would like it to be close for Luther to visit.

We visited the orthopedic guy yesterday. He was nice enough and even spoke a little English. But mostly it was in Italian. He too recommended knee replacement. Second opinions are good. So he gave us a form to fill in and email to the powers that be to schedule surgery. As always, everything in Italy shuts down in August. In this case last week in July to first week in September for non-emergency surgery. So we are looking at October-November for operation. Sigh. It is a long wait.

I guess my biggest worry is communication while in hospital and rehab. But on the bright side (?) I’ll learn more Italian. We are told it’s 5-7 days in hospital and then three weeks in in-patient rehab. Seems excessive by American standards…but in America it is all about the bottom line so they kick you out fast! For me, I’m thinking by the time I’m done I’ll be able to do the stairs here. Operation will be in the very nice hospital in Perugia, rehab here in Umbertide.

Since this is what I’m stuck with I am going ahead with plans that I was kind of worried about. We have a cruise on the Crostian coast in August and have a friend housesitting. I didn’t want to cancel either. I may be stuck in my stateroom but… Then we have friends in late September and another in mid October. This will mean I can just do what I can do and I and my guests will have to deal with it.

For my everyday life I stay mostly in the apartment. I descend and ascend the three flights of stairs maybe once a day. So far, so good. Hurts but manageable. The good news is knee replacements have generally good results and are not too hard to recover from. Crossing fingers it will be so for me and I will be good as new. This will be great! 🙂

My visit to the Italian Dottoressa

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Well I couldn’t put off visiting my doctor any longer so I steeled myself to do it last week. The way the Italian health care works is like this. You go to the Sanitario office at the beginning of each year. I wrote about that experience earlier this year in this blog. At this time they assign a doctor. I was assigned to a woman doctor who was an OB/GYN as well but she would be my primary care doctor. I had gotten her name from friends who had been through a lot of health care issues and had finally found her. We all speak some Italian but when dealing with something like your health you want to get it right. You don’t want to misunderstand.

I had looked my Dottoressa up on the internet and had her hours. Off I went. After a little trouble I found her office but her hours were completely different than the site said. Dutifully I wrote down the hours that were posted on the door. Rats. So yesterday I went back arriving just before the opening time to find several people there ahead of me. I noted my place and after about 30 minutes I went in. I introduced myself in my best Italian and then politely asked if she spoke English. And she did, and it was good. I had checked my blood pressure myself and it was somewhat high so this was my primary reason to go. She agreed to put me on some medicine for it. She commented that she had not seen me in any of the bars and did I only associate with other English speakers. I got the feeling she didn’t like the expat community. She said she would speak to me in English but if she met me somewhere else she would speak to me in Italian. Fair enough!

As we talked I was surprised at how, how to say it…maybe unprofessional… she was at least when compared to a US doctor. She asked if my husband came to her and I said no he went to a different doctor. When I told her his name she snorted in derision. I asked her if she did not like him and she replied, “have you met him?”  I don’t think a US doctor would do that to a colleague. We talked about her daughter who has several degrees. I commented that she should be proud. She talked about the person who headed the Umbria Sanitario office who had “only a high school degree!!” and SHE was trying to tell the doctors what to do, how to save money… I commented she must know people in high places. She replied she was F***ing everyone! OKAY then. So this was my first visit to the Dottoressa.

Weather is a-changing
Fall is here. The temperatures have been quite cool but nice. The morning fog is again enveloping the big city. It usually burns off by mid-morning. The farmers are bringing in the biggest cash crop around here right now – tobacco. Everywhere are tractors with trailers full of the bright yellow leaves. Sprinkled throughout the countryside are tobacco drying buildings with ovens to partially dry the leaves before shipping to the big tobacco companies. Umbria is famous for it’s tobacco, primarily for cigarettes.

The sunflower fields are now just stubble. The corn is mostly harvested. And so are the grapes. It was purportedly a good year for the wine. Happy happy for the vintners after such a poor year in 2014. Next we hold our breath to see if the olive crop is OK this year. Last year it was devastated by an insect because the winter had been too warm to kill them off. Last year would have been my first olive harvest season. So I am eagerly looking forward to this years harvest and the production of the Olio Nuovo or New Oil. Umbrian oil is particularly peppery and grassy and brilliant green. So good on toasted bruschetta. Can’t wait.

Yesterday we had a gentleman named Marco come and take a look at our big fireplace in the kitchen. We are going to have him make glass and steel doors that fold back for it. He “said” he could get it to us by November. It is Italy after all…Our friend Vera just said to him “before Natale?” (Christmas) He laughed and said November! We shall see… Maybe I will be able to try it out this winter.

This week we have had a lot of storms rolling through. A lot of times they stay west of us, behind the mountains. The Tiber river tells the tale of what is happening up-stream. It is brown with mud and very high. I must have taken 100 pictures to get this one picture of the light show we were having.
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