Dangerous work...PO Day 207

When I was in the hospital I was amazed at how many different nurses and aides took care of me. There was a dry erase board on the wall opposite the foot of the bed and as each shift changed they would write their name so I could read it. That was very helpful. What was really surprising was that the staff in the middle of the night was just as bright and cheery as the morning or afternoon staff. Communicating between nurses, between shifts, between floors, and between patient and the rest of the world  was a challenge but they did a good job.

Some times a nurse would disappear for a day or two, then reappear as if by magic but it was really just the result of a clever administrator arranging work times and days off. I suppose there is some computer program that shuffles nurses and deals them out where they are needed. Other than having to reset the alarm clock or reprogram the DVR they seemed to transition from days to nights and back without missing a beat.

But the March 2015 edition (yes, it runs on a fast time clock) of American Journal of Preventive Medicine reports the results of a 22 year long study of nurses' health and habits. Nurses who rotated night and day shifts for more than five years had an 11 percent higher risk of death from all types of causes. Nurses who kept that up for 6-14 years were 19 percent more likely to die from Cardio-vascular disease and if they continued that routine for 15 or more years they were 23 percent more likely to die from CVD causes and 25 percent more likely to die of lung cancer.

Similar studies with people like police officers showed the same risk to health due to rotating night shift work routines.

I wonder what it is that creates the problem. Is it the constant readjusting to a new sleep pattern? Is it stress related? Does working rotating hours create unhealthy habits like eating wrong foods or taking sleep medications to be able to drift off? And who would have guessed the lung cancer connection? Does day sleeping somehow facilitate smoking which increases the risk of lung cancer?

Finally, the study does not say that working a permanent night schedule, instead of rotating between night and day, is any better for the nurse. But if it is, then that's  the solution. But I wonder if there are enough nurses willing to work overnight permanently? Either system, nights only or nights rotated with days, should be pay a premium for altering the natural course of life and keeping the nurses in an unhealthy situation.













Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to normal. November. -still in recovery, December-6 months and holding. 

Visit the ER...PO Day 206

My neighbor was being released from the hospital a few days ago and I was picking her up. The aide would bring her down in a wheelchair but I had to meet them inside so we agreed to meet at the emergency room entrance. I could call the floor from the ER to let them know I was there. Sounded good.

I should have known things were bad when there was no place to park outside the ER. When I walked into the emergency room it was like walking into Dante's Inferno. Oh, there was no fire nor brimstone. There was no sign that said "abandon hope all those who enter here." But I'm thinking there should have been. Every chair (of the particularly uncomfortable type to discourage lying down, I'd guess) was filled. Each sick person was accompanied by two or three not sick but miserable people. There was some wailing, not just from the two or three babies. There was a low constant moaning sound, not just from the ill patients. A woman leaned against the registration desk, probably because she could not stand, trying to fill out a multi page questionnaire. The two nurses on the other side of the glass were busy triaging the charts to see which lucky soul would go next. They barely acknowledged my presence and when I spoke to explain that the "floor nurse" wanted them to call so they could bring down the patient I was picking up, they shook their heads no and put on their masks which very effectively cut off further communication.

It didn't matter because I had been holding my breath ever since I walked in and had reached my oxygen deprivation limit. I darted for the door to the hallway and barely got through it before I had to inhale, just escaping the toxic miasma that filled the ER.  Thank goodness for cell phones and the honor system. The floor nurse accepted my word that I, a licensed driver, was there to drive my neighbor  home and soon she rolled into sight and we were off for home.

The thing is that this scene is repeating itself all over the country. Emergency room visits have increased and it is partially due to Obamacare and partly due to our aging population.

" In the wake of the Affordable Care Act (ACA), many hospitals report a rise in the number of patients seeking care in their emergency departments, according to the Los Angeles Times. In Los Angeles County, ED use for problems too minor to require an admission rose nearly 4 percent in the first half of 2014 compared to the first half of 2013, according to the publication." When people who have not previously had health insurance are unable to get a doctors appointment it is natural for them to seek help from the ER. Across the country communities are hard hit by this year's flu version and it is not only frightening but debilitating. Help - crowded, chaotic, slow, not terribly personal, and institutional - is dispensed by stalwart doctors and nurses day and night who deal with heart attacks and runny noses with equal attention. Well, maybe not quite equal but they do it nonetheless.  Bless their hearts for being there when we need them...even if they would not talk to me!

Sign life away....PO Day 205

I went to the doctor today, not my orthopod, another doctor. I like him and his staff. It's always a good experience to see him. BUT I felt as if I were signing my life away! First I had to sign a form stating that I had insurance and it was the same as what I had last visit. Next there was a form averring that I understood the HIPAA rules regarding privacy. I wanted a copy of a recent lab report so I had to sign that I was receiving a form to take away. I was getting a new prescription so I had to sign a form
 stating I understood the drug and the directions of how to use it. One form simply said I was actually there on this date! Finally there was a special form asking if I had been to certain west African countries recently, did I know anyone who had, and had I had a low grade fever recently? All this was for Ebola. Wow.

Then I stopped at the pharmacy on the way home. Their system uses a touch screen rather than real paper. My signature is bad enough with pen and paper, a stylus and a touch screen produce an almost unreadable scribble. But I signed.  I signed that I was picking up a new prescription. Then  I signed to say I was picking up an old RX. Next I signed that I did want the RX's on auto fill. For some reason I had to say that twice. I think there was one more form and then I was good to sign for the purchase which I did at last!

Well I can report I probably only generated six or seven pieces of paper today. Pages that have to be filed or launched as paper airplanes.

What happened to the paperless society? I don't think there is anything efficient or time saving about this process.

Consumerization...PO Day204

We are seeing a trend in health care, treating the patient like a consumer and courting them. We see it in the review surveys we receive after visiting the hospital or in the services offered like better food choices while an inpatient. But, so far, we are not seeing it in the way fees are negotiated.

According to Consumer Union, most countries have standard fee schedules and give estimates of your charges prior to a procedure or hospitalization. But not the U.S., even though about two thirds of us have said we would like to know in advance what we will be responsible for. Sleeping in a hospital bed is like riding in an airline seat. What you pay can be more or less than the patient next door but is seldom the same. The price of a procedure is not what it is worth, the price is what your insurance company will pay. And if you have no insurance, the price is not limited by company negotiations which means the poor soul without insurance will pay the highest fees.

But in this new consumer oriented medical world, the patient is increasingly holding the power. It just hasn't trickled down to the Billing Department yet. How do we make progress in this area? We simply ask. Ask what your bill will be before you see your physician. Ask what your blood work, Cat scan, MRI, or mammogram will cost before you undergo the procedure. Ask what the average cost for using the surgical suite is, what the usual in hospital daily fee is, ask how much your routine medications will cost and if you can bring your own Meds to save money. Of course, no one will be able to answer your questions. Smile and ask to speak to a supervisor. But prepared to be delayed considerably while registration grumbles and points at you from across the room. You will probably have to give in and give up. But you will have made a point, that you want to know how much something is going to cost and mostly, that you care what it is going to cost.

If the administrators of our health care get the message that we are monitoring how much our care costs and that it is at least as important as whether there is a recliner in every room or if we can order wine with our dinner, they will respond appropriately.

We just might change the system!

What goes up...PO Day 203

What goes up must come down. 

Remember all those Department 56 houses that went upstairs back before Christmas? Well, today they had to come back downstairs. Big job. Plus I had to make room for them in the window seat storage area. Bigger job. 

The window seat was full of boxes of old professional records, mostly financial, and boxes of family photos in frames that have been replaced with more recent photos around the house. Plan 1 was to de- frame all the photos so they can be put into albums and the frames are going to the thrift shop. The grandchildren will love seeing pics of their parents as kids or of themselves as babies. The way they are now no one sees them! Plan 2 was to empty out those boxes of records. But how long do you have to keep financial papers?

According to a couple different web sites, you can dispose of bank statements after only one year. Keep tax records and returns for seven years. (Some say four!) Save home purchase records until you sell the home so you can prove your cost basis. Complicated transactions like a rental exchange should be kept, perhaps forever. Either you or your broker should keep stock purchase records until the stock is sold so you can prove your cost basis. Ordinary receipts can be thrown away after one year, if they are used in preparing your taxes keep them three or four years. There are other, rarer documents mentioned in a Google search.

I'm embarrassed to admit our boxes dated back a minimum of ten years! Some were twenty years old. We were brutal and fearless. Everything was toted outside to be burned in our little fire pit. What a walk down Memory Lane. It was hard to not pause and remember what that check paid for or that letter complained about. It took more than an hour to burn through half the stack. More to torch tomorrow! 

This is the kind of job that does make my shoulder hurt. It's not that any part is so strenuous, just the whole package. I took two ibuprofen which are very effective but keep me awake. If I weren't tired I could carry the second half of the houses down. I can only carry four at a trip though so the second half of the houses will have to wait till tomorrow. The window seat is still in a bit if disarray but things are looking up. I'm going to have to figure a better way to use them next Christmas. I love the store displays where a whole village surrounds the Christmas tree. Maybe even a train winds through the town. I could do that if we got rid of the television. 

I kind of doubt that is going to happen.









Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. -still in recovery, December-6 months and holding.

Cancer causes?...PO DAY 202

I can't say it better than the summary printed by the AMA Morning News so I have just copied and pasted the article here. I don't know if it is better to believe a cancer is random and unpreventible or to carry the guilt or anger that something you did caused it. Furthermore, it seems like the cancers that are suspect are the worst of the worst. Not that any cancer is a good thing.

So the next question is what can be done to prevent the gene mutation that causes the cancer? I am not convinced early detection is the answer. I read an article years ago that said people were not really living longer with breast cancer; that it was just being diagnosed earlier making it seem like they were living longer. I can't quote statistics but I do believe that very little has changed about a true cure rate for breast cancer. In fact the most recent news is that women are receiving more radiation than necessary. What is a girl to do?

Sorry to be off-topic but this article was really interesting.

        Leading the News

Most cancers may be caused by random mutations.

The Wall Street Journal (1/2, Whalen, Subscription Publication) reports that research published in Science suggests that most cancers may be caused by random mutations occurring in DNA during stem-cell division, rather than by inherited genes or an unhealthy lifestyle.

        The U-T San Diego (1/2, Fikes) reports that investigators “examined the frequency of cell divisions in 31 tissue types over an average person’s lifetime, compared with the lifetime incidence of cancer in those 31 tissues.”

        TIME (1/2, Regan) reports that “after examining” the “31 cancer types,” the “researchers found 22 were from mutations in stem cells that could not be prevented.” The “cancers that could be explained with biological bad luck included pancreatic, leukemia, bone, testicular, ovarian and brain cancer.”

        The New York Daily News (1/2, Engel) reports that the researchers “concluded that 65% of all cancers are because of random genetic mutations that happen when cells divide, and that more needs to be done about catching cancer ‘at early, curable stages,’ according to co-author Cristian Tomasetti.”

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. -still in recovery, December-6 months and holding.

Back to the real world...PO Day 201

It's as if I have been on a vacation from thinking about shoulders and surgery and complications over the past week. But it's time to get back to the reason for this blog, shoulder surgery, particularly reverse Total Shoulder Arthroplasty.

A high volume practice did a review of patients who had experienced dislocation after shoulder surgery. Of the group there were 21 patients who had the reverse total shoulder procedure and experienced an acute dislocation. All 21 were initially treated in the office by reduction (popping the joint back in place) and immobilizing the arm for six weeks in a 30 degrees of external rotation position.

Thirteen of the patients experienced the dislocation within the first ninty days after rTSA surgery. The average length of time to the first dislocation was 200 days. 

Of these 21 patients, 13 were successfully treated by reduction and immobilization, 6 required revision surgery and 2 remained unstable.

It was concluded that cause for dislocation fell into three general categories: soft tissue impingement or asymmetric soft tissue tension, undersizing the implant that resulted in excessive laxity in the shoulder, or acromial fracture that caused a secondary laxity. Men seemed to experience excessive laxity of the shoulder more often and women patients more often had impingement or soft tissue tension problems that led to dislocation.

Nearly half the patients experienced the dislocation while doing nothing to knowingly contribute to the complication. About a third were engaged in a physical activity like carrying a heavy weight or moving in an extreme manner when the dislocation occurred.

The researching doctors concluded that dislocation can occur at any time post operatively. They felt conservative attempts to repair the joint were quite successful whether the dislocation occurred early or late. The consensus was that anesthesia and surgical revision should be reserved for cases wherein dislocation occurred repeatedly or could not be properly repositioned in the office. But it was certainly worth a try to reposition the shoulder without resorting to surgery.

I am happy to be 201 days post op which puts me one day greater that the average to dislocate. I don't see me having a laxity problem. My complaint to my surgeon is always about how tight and sore the muscles are. Laxity means a slackness or loosenes on the joint. I read in the operative notes about all the trouble the surgeon had fitting the almost too large stem in my arm so I don't think my implant is too small. But carrying a heavy weight? That could be a problem. Dillards was having a BIG post Christmas sale today. Getting my packages to the car was all I could do! I'm not going to say the bargains were so good that it was worth a possible dislocation but it was a really good sale...just sayin'.  

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, 
August - recovery and physical therapy, September - thinking medically, October - getting back to 
normal. November. -still in recovery, December-6 months and holding.