Entries tagged with doctors

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Evidently, this was jamais vu

Yesterday I accompanied MyGuy to his colonoscopy. We entered a small room with a surgical bed, vitals station, the now-ubiquitous bedside computer, and a parking space for me. After he donned the hospital gown, nursing staff connected him to the vitals station, and started a saline drip. They wheeled him off to the procedure while I waited in the cubicle. I distracted myself with some Sherlock fanfic.

Suddenly the door was opening. An unfamiliar nurse was wheeling a complete stranger backwards into the space—I asked should I remove my husband’s clothing if someone else was using the room. She said, “Of course not, he will be putting them back on in a few minutes.” Seeing my puzzled face, she said, “Don’t you recognize him?” I was still stunned—who were these people? She swung the bed around so I could see his eyes. The estranged swirl of jamais vu vanished, and I saw his lovely face, his smile enhanced by recent doses of fentanyl and midazolam.

All went well, and 45 minutes later we were in the taxi back home. I’d read of the vu triplets—presque, déjà, jamais—in Catch-22 when I was a teenager, but this was my first experience of jamais vu.

Very disconcerting—have you experienced this?

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Vision Hack: My New Approach to Glasses

Since 1960 I've been wearing complicated thick glasses which attempt to correct my divergent eyes. No matter how well made, when my eyes tire I get double vision anyway. I’ve become accustomed to closing my left eye, depending on the stronger right eye. This year I decided to fuck it. I was able to optimize my vision by using other tools in addition to the glasses.

( 200 words and 2 pictures )

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My Fall Vacation: Mohs Surgery

In October I was diagnosed with squamous cell carcinoma on my nose. Last week I learned I also had basal cell carcinoma, while I was having it surgically removed. Good news! That’s it — don’t need drugs or chemo.

Back in 2020, I wore 3M Aura N9205+ masks I had on hand. Its interior nose wire is cushioned by gray foam. After a couple days I saw a little spot on my nose when I took the mask off: I assumed my twitchily-sensitive skin was reacting to the foam.

( Details of skin cancer diagnosis )

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Gross Poses Mohs Nose

As detailed in "My Fall Vacation," overview post, I had Mohs surgery last Thursday to remove a wee cancer on my nose. This entry contains photos during and after that operation. There’s blood and stitches — proceed at your own risk.

truly gross photos inside here

( medical gore inside )

Wound healing protocols have changed since I was little. Now I’m told to keep the wound covered in vaseline, and to not bandage it unless I have to.

I’m uncertain whether my healing face would perturb folks in public. Adding bandages might make it easier for folks who get queasy seeing surgical results. On the other hand, I’m a "let your freak flag fly" kinda person. What do you think?

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Why US Health Costs Are So High, part 308

On 8 July, I got a cortisone shot in my middle finger, in hopes of warding off surgery for yet another trigger finger. The PT handed me an oval-8 splint to wear that would help the synovial sheath swelling to calm down.

In the mail today, I got a notice from my pharmacy benefit manager (PBM) one of four profit-making entities that I buy health care from. This EOB notice comprised six sheets of office paper, mailed flat in a 9"x12" catalog envelope with a custom window. On top was the single-sided cover sheet with my and their addresses (to fit the window) as well as a boxed definition of "explanation of benefits" (EOB).[note 1] Next was another single-sided sheet with that actual explanation (details below). Then there are four more pages printed both sides explaining how to appeal (in type too small for me to read). These six sheets were mailed unfolded in a catalog envelope from Connecticut (although Navitus is headquartered here in Madison). For personal mailings, six sheets folded in an envelope costs $0.74 — sending flat sheets increases the cost 230%. Commercial postage is less but too confusing for me to calculate.

In the end, the EOB informed me that I might need to pay $1.20 for the oval-8 splint — more than it cost to send me the notice.

I know that many, perhaps most EOBs document important (nay, oppressive) amounts of money. Yet and still, this system is borked.

Players in my health care team, or, places to duplicate info and mishandle data:

Health plan (we pay $890/month private insurance) https://www.deancare.com [note 2]
Clinic — almost all my care and equipment comes from staff who work for https://SSMHealth.com They get paid by 1, 5, and 6
Small mental health group, home to the "in-network" APNP who deals with my psych meds. https://madisonpsychiatricassociates.com Paid by 1, 5, and 6
Family-owned and -run pharmacy, which gets money from 1, 5, and 6 https://www.ipcrx.com/pharmacy-profiles/2018/neuhauser-pharmacy-madison-wi
Navitus the pharmacy benefits manager, https://medicarerx.navitus.com co-owned by SSMHealth and Costco. 1 pays them administrative fees to pay 2, 3, and 4
Medicare (US government insurance, $170 monthly deducted from our retirement checks) and the only non-profit. Pays most of the bills for 2, 3, 4, and 5.

Note 1: (I’m not going to attempt to spell out what an EOB is. A handful of places try to explain in plain language: https://www.carepartnersct.com/wellness/how-read-your-explanation-benefits-eob

Note 2: I’m super lucky that MyGuy spent 20 years working for #1; he does a great job analyzing the EOBs, among many other skills.

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Against Obesity Panic

cathexys boosted a good piece from the HuffPost about the cruel impact of medical bigotry due to the obesity panic.

https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

( three links and excerpts against moral fat panic )

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Ann Patchett's excellent meditation on friendship, cancer, pandemic and psilocybin

I adored Ann Patchett's early fiction — The Magician’s Assistant, The Patron Saint of Liars, Bel Canto, and Run. I was fascinated by the parallel experiences of reality gained from Lucy Grealy’s Autobiography of a Face in conversation with Patchett’s meditation on their friendship, Truth & Beauty.

But she fell off my radar. Then this outstanding 20,000 word essay fell into my eyes

These Precious Days in January 2021 Harper’s Magazine

It’s got a big twist, just like she enjoys writing in her novels. It takes its form from the current moment, so there’s lockdowns and air travel and Tom Hanks and more air travel. Along the way Ann encounters Hanks’ assistant Sooki. Ann recognizes that Sooki radiates beauty and competence, and offers her a place to stay during cancer treatment. In return, they develop a true friendship. It’s heartening to learn these magic moments can still lie ahead.

A few quotes: ( 400 words )

https://harpers.org/archive/2021/01/these-precious-days-ann-patchett-psilocybin-tom-hanks-sooki-raphael/

alternative backup

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HIV Crisis in Deaf Community

The HIV Crisis In The Deaf Community

This excellent article highlights big troubles.

https://intomore.com/into/a-sign-of-trouble-the-hiv-crisis-in-the-deaf-community/f8ff168f3766425d

Just one story:

A gay Deaf man new to DC attempts to set up an interpreted appoint at a queer friendly clinic; after waiting for 45 minutes he's escorted to a room with a video relay interpreter:

begin quote

All I wanted to do was to set up an appointment at a later date with the doctor and a live ASL interpreter. That’s all I want.

She looked at the note, smiled, and wrote, “We don’t do that here. ASL interpreters are expensive. This is a cheaper alternative.”

I looked at the note, shook my head, “No.” I got the feeling that this was not going to be a “Deaf-friendly” nor “Deaf accessible” and got up and started to leave when she grabbed my arm. I looked at her quizzically with her writing furiously on the note. She wrote, “You do qualify for our services but you have to understand, we can’t afford it.”

I looked at her disappointedly and wrote: “I find it ironic that the HIV-positive community is knowledgeable with the ADA law and uses it to the betterment for the community and yet can’t provide for their own.”
quote ends

Some context: Since Washington DC is home to Gallaudet University, they have a very large and skilled interpreter workforce. ( Two videos with ASL, captions, and audio )

Current Location: in the lab

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NSAID & Acetaminophen = Better Pain Relief

My doc just told me about a double-blind RCT study showing combo aspirin & acetaminophen was as effective as oral morphine (and both better than placebo) for post-surgical dental pain.

( I'm doing it now and it helps )

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The Intersection of the ADA and Employer-Sponsored Wellness Programs

This question has popped up many times in the last few years. Obamacare encourages "wellness programs," employer-sponsored activities which some disabled people simply can't do. So what's the law?

quote begins
There is a new conflict in town: employer-sponsored wellness programs and the Americans with Disabilities Act (ADA). On several occasions the EEOC has sued employers for allegedly forcing compulsory and intrusive wellness programs aimed to improve the general health of employees. Is there a possible compromise for employers to foster employee wellness while avoiding unlawful medical inquiries?
quote ends

You can hear an expert lawyer's understanding and pose questions
FREE NEXT WEDNESDAY
November 18, 2015 2:00pm to 3:30pm eastern time
Use this link to register
http://www.ada-audio.org/Webinar/ADALegal/Schedule/

The regional ADA centers provide "webinars" open to all on many topics. Archives here:
http://www.ada-audio.org/Archives/ADALegal/index.php?order=ascending&source=FiscalYears#FiscalYears

signal boosts welcome

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Pain and a whisper but mostly theoretical

Been a while, but I've been amusing myself, as well as intermittent low bits. Turned my back on Facebook, abandoned Twitter after the SDS conference, spending way too much time on MetaFilter, which is beginning to annoy me in useful ways, as well as doodling away a happy hour on Tumblr posting nothing. Reading actualfax books—paper as well as e—and fanfiction, of course. Here's a sprinkling of things I've stumbled across. Ask me anything (as they say) in the comments and I'll bloviate.

I've worked as a freelance calligrapher, typesetter, and graphic designer. This cartoon beautifully, and painfully, captures the continual teeter-totter between "being true to your own self" and "getting paid"
http://the-toast.net/2014/08/13/a-cartoon-about-book-design/

I've been having more difficulty understanding speech, especially at noisy places like cons (use your mics!) and restaurants. I've also had a strange two-tone mechanical humming in my ears for the past year or so. Okay, time for a hearing test. Mostly painless: put on these headphones, play noise in one ear and words in the other, parrot back the words. But then there was
( non-consensual penetration of body cavities )

That was a lesson in how to alienate prospective patients. It makes me wonder what in hell medicos mean when they say, "this will be uncomfortable, but let me know if it hurts"? Is there some level of pain which reliably causes a reflex response in humans, and therefore docs can ignore unreliable information like "Oww! That hurts! Stop that! NO."? I know that enough pain makes me pass right out. Or say if I vomit, does that mean I've crossed the line from "uncomfortable" to "hurts"? How about if I curl up on cool bathroom tiles? Or maybe when I sandbag myself with microwave hotpacks? I'm just working back from the "pain behaviors" I've demonstrated when it's hurt too much for me at home.

Anyway, the exam result is: I have

excellent hearing in optimal conditions (cool)

difficulty "hearing in noise" (yeah, that's why I was there)

tinnitus (Checking just now at HearingLossHelp druglist (PDF), I'm taking three meds known to cause tinnitus in some people. Huh and

Hyperacusis

She says wearing 29dB earplugs only makes the hyperacusis worse. (I wear them swimming and when I'm on the bus.) She's making "musician's earplugs" for me which dampen all sound equally across the noise spectrum which should "take the edge off" of the loudness of things.

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Ensuring Supplement Efficacy?

"Supplements" are substances which we can use like drugs. In the U.S. and Canada, supplements are not regulated for purity or efficacy: we must trust the suppliers to ensure these important qualities. When I started using them, my pharmacist was also learning about supplements, and we spoke at length about this issue. She claimed to have researched the best manufacturers. She chose (and therefore I used) "Nature's Bounty."

Supplements have been part of my treatment plan for a long time: they include fish oils, vitamin D3, mysterious Chinese herbs compounded by my acupuncturist, cranberry powder, and a magnesium/riboflavin/feverfew tab called Migrelief (which really relieves my migraines). I've periodically tested their efficacy by stopping, assessing, and restarting them. They help. If that difference is founded on the placebo effect, I don't care.

Last month I had an experience which jerked me out of that happy place.
I mentioned to my p-doc that I was having trouble staying asleep. She suggested I try melatonin. I asked how much; she said, "knowing you, start small." I was pleased to find a liquid version with a marked dropper so I began with 0.25 mg equivalent. And that was enough! Lovely stuff: easy sleepiness within 20 minutes, stayed asleep with energetic and creative dreams, woke refreshed 8 hours later.

When I traveled the following week, I forgot my liquid melatonin. I went to a health food store and discovered the smallest tablet was 1mg, four times as large. I was able to halve it without totally crumbly results, so I thought I'd sleep like a lamb at twice my previous dose. But no—ZERO effect. Was this due to dosing sublingually versus through my digestive system? I kept doubling the pill dose with no result. When I made it home, I was taking 5mg (the typical dose available) with no pleasant sleep. Switched back to 0.25 liquid and slipped into the ocean like a sleepy seal.

The moral of the story: I don't know if a supplement isn't working because it's not effective in my body, or because there's not enough, or not even any, of the active ingredient in the bottle I bought.

And then this week, propinquity! A fascinating article in BioMedCentral:
DNA barcoding detects contamination and substitution in North American herbal products
Newmaster, Grguric, Shanmughanandhan, Ramalingam and Ragupathy

It provides extensive detail on how unreliable supplement labels can be, from a Canadian group with zero ties to the supplement production industry.

So, supplement users, how do you ensure their quality?

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Evil Cost-shifting in Hospital Administration.

Probably news to nobody reading here, but it was such stunning evidence of greed in the hospital industry I just had to memorialize it.

This is from 17 May 2013 NYTimes article on the East Coast hospitals with the highest billing and payment. There's such a disconnect between what's charged and what's customarily paid that one must account for both. The users who pay the most are the uninsured; Medicare pays the least, and most insurance companies negotiate something in-between. ( Bayonne Medical Should be Bayonne Financial )
This is like buying a towing company, distributing your equipment to all roads in town, and then digging ditches across the road to guarantee business. As

laceblade would undoubtedly say, This shit is wrong!

ETA to fix erroneous time travel

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Recommended Browsing

ETA: Cut. Sorry about spamming your droll. :(

Let me offer you a link paté -- I've actually read all these stories, and wanted to share their greatness with you:

( Link Paté )

Current Mood: mischievous

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Mis Cellany

Thanks to sophy, a primary care physician meditates on treating people with chronic illnesses in a letter addressed to us. Looking back on 25 years of good-to-awful interactions with doctors, I peg him "wise."

It's been an unlucky week at our house. Lovely Lucy was walking uncomfortably. She didn't show pain when we pushed & poked her legs. Then we had success with subtracting pain with an ice pack (instead of adding pain with our fingers). Isolated to one leg, we shuffled off to the vet. It's not a ruptured cranial cruciate ligament, but a probable tear. So 5 days of as little movement as possible. First day she was in pain from the vet exam, and basically a stuffed doggy. Second day beginning to be bored. Today she's been nosing me a lot. I was the big meanie who had to take away the squeaky toys she loves to squeeze as she zooms around the couch. Dreading tomorrow.

OTOH, MyGuy is going out to see if he can hit a bucket o' balls; first physical exertion since the surgery.

Monday is the 20th anniversary of the Americans with Disabilities Act, which triggers a stew of emotions. More on Monday, I hope.

Lovely lunch with

sasha_feather. I'd looked forward to Salade Niçoise, but the power went out and so did we.

Current Mood: relieved

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Succesful Scleral Buckle

Still with the polysyllables.

MyGuy's surgery went very well. At his next-day eye check, the doc wanted him to report which lines he saw; MyGuy was able to not only see them but read them. Yay! He look like he's been kick-boxed by a particularly aggressive badger – deep purple restricted to a tiny area. If I posted the results to

shutterspeed I might induce vomiting.

He's having very little pain – yay*yay. He's off work for a week but doesn't have any impending deadlines – yay*yay*yay.

MagicB took me out to the grocery store on Friday. I made the huge mistake of relying on the store's scooter, instead of bringing my own chair. Operating that scooter in the (noisy crowded) store was a lot like piloting a barge in whitewater. Plus! It had a built-in backup alarm. (Which probably makes some sort of sense for very occasional users.) It consumed every last bit of executive functioning in the already low pool. But we've got enough to eat.

So, thanks all for your kind thoughts – they clearly worked!

Current Mood: anxious

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Pneumatic Retinopexy

My latest excuse for not posting arrived around 4:30 this morning. MyGuy had a vitreal detachment in his weaker eye around 6 months ago. The eye doctor counseled "watchful waiting"; the unhappy sequel he was watching for happened this morning: a retinal tear. He will have scleral buckle surgery plus a vitrectomy tomorrow AM. Then they'll create a gas bubble to support the mended retina -- that's what Pneumatic Retinopexy means. He may have to spend the next couple days with his face down.

I hope for the best! The good news is this experience has introduced my dancing tongue to a host of polysyllabic words.

Current Mood: sobered

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Highly recommended: STITCHES by David Small

STITCHES
by David Small
W.W.Norton, 2009

This 300-page graphic novel is a shatteringly creepy memoir. David Small's physician father, following the medical wisdom of the time, irradiated him many times for "sinus trouble." A colleague noticed a growth on his neck at age 11, but the family dynamic was so nonfunctional that no doctor checked this out until age 14, when the tumor, his thyroid and one vocal fold were removed.

The family didn't tell him that he'd been treated for cancer. That silence is mirrored in his own inability to speak until the vocal fold regrew some 15 years later.

Yeah, my mind boggled too. This beautifully drawn book really does evoke Hitchcock and Orson Welles in story and presentation. So the author's self-aggrandizing in this YouTube video isn't hyperbolic.

Current Mood: enraged

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Pointless

[-same as text above with other folks' comments-]

Current Mood: frustrated

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Medical Privilege, Let Me Show You It

In this week's Science Times, Dr. Pauline Chen meditates on her own reluctance to use interpreters, as well as a recent study in the Journal of Internal Medicine.

“[...] physician-patient communication is driven by the physician’s need for patient input rather than by the patient’s need to communicate. Communication is viewed as something that is supposed to change decisions that the doctor can foresee. So the use of interpreters may have more to do with how we think about communication with our patients and less to do with our views on interpreters, limited English proficiency patients or even time pressures.”

Chen provides a vivid example of the unquestioned medical assumption that what the doctor has to say is more important than the patient's needs. She decides her ability to ask Dolor? and that patient's response of thumbs'-up or thumbs'-down is adequate for "routine rounding" (i.e., post surgical check-ins).

Chen is a transplant surgeon; the patient she's routinely rounded has just had a liver transplant. As anyone who's been hospitalized for illness or injury will readily understand, there's nothing quite so intimidating, so important as those 5 minutes a day when you actually get to communicate with the doctor. This is thoughtless privilege at its most frightening. The JIM study concludes:

Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to “get by” without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment.

The comments are interesting, if ill-informed. There's the predictable "don't get sick in a language you don't know," but most get stuck in two issues—cost and availability—for which the study controlled.

Do readers not really read? The willingness people have to defend the indefensible fascinates and repels me. Dr Chen has made a habit of bravely admitting hard realities in a national newspaper; the commenters largely want to give her a pass.