PS to PODay 168

Does anyone use the post script anymore? Probably not, since everything can be edited on the computer nowadays. But I am a traditionalist. So...

PS. My hair is STILL falling out! I don't think it has slowed at all. Not handfuls but a steady sprinkling of short curly hairs on the iPad screen or the vanity. Will it ever stop?

November Addendum...PODay 168

At five and a half months I am getting along fine. The appearance of the scar is great. At the mid point of the length of the scar there is a point, a spot that is almost electric in its sensation when I massage it. But the scar looks as good as one could hope and no complaint.

The arm, shoulder is marvelous in its function. It has nearly the function of the other arm. I still lack good strength on the right side but that will come. I am not doing much physical therapy but I use my arm in every normal manner now. I do still stretch it, especially on awakening. That 's when it often feels tight.

I cannot move my arm back, like position my elbow behind the plane of my back. That's when the deltoid attachment really makes a fuss, a pain that tells me to not do that. This is why dressing can still be a bit if a problem but I am getting better. I do plan to discuss this with the doctor in mid December.

I am waiting till I see the surgeon in mid December before I get into lifting anything too heavy. I want to kayak but that involves moving them from the shed to the water so need to wait to see what the doctor says. My next appointment I will be six months post op so surely I will be ready for anything.

My sleeping is terrible. Part of it is due to trying to find a comfortable position for my arm. Why do things bother you in the nught when they don't in the daytime? But then, I am not lying down in bed in the daytime. I know I would still sleep better in a recliner or on the couch but I am trying to break the habit.

There are occasional things that are difficult or impossible but mostly I can do anything I want now. If I can get back to carrying a gallon of milk, even tipping it to pour a glass, I will be happy.

I definitely baby that arm. I want this shoulder to last a long time so try not to stress it. I really don't know how careful I need to be. I need to discuss that with the doctor too. Better make a list!

I think I am mostly recovered from the pneumothorax. I am back to walking two to three miles. I do get very slightly out of breath but very much improved. I see the pulmonologist in January so we'll see what he thinks. Anemia is no longer an issue. Hooray, I hated the iron supplements. I would say life is pretty much normal again although it seems I do still have too many doctor appointments. If I could drop one more specialist from the team I'd be pleased. But I should not complain. I am so fortunate to have such good medical care.




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 recovering.

Surgery not indicated?...PODay 167

I have read that if you have a full thickness tear of of the rotator cuff you can only be helped by surgery.

But in a study of 93 patients with documented rotator cuff tears symptomatic at least three months there were some interesting findings.

The patients age averaged 60 years old and 42% were female. Half of the patients suffered a traumatic incident to cause the tear.

The patients were given three months of treatment involving stretch exercises, followed by strength exercises. The treatment was considered successful if, after the three months, the patient and their doctor agreed that there was considerable improvement and that surgery was not indicated since the patient was mostly asymptomatic. A failure was declared if the patient remained symptomatic and still opted for surgery.

The study found that 75% of the patients were deemed a success based on their assessment of their situation. After two years 89% of the 75% maintained their immediate post treatment status.

Since the tears were chronic small tears the authors of the study thought there was little harm in trying the exercise program and delaying surgery.

As my surgeon told me, there is no need to rush to a decision. In my case, waiting would not make things worse. But I opted for surgery since I had already waited a year from my accident, I had had physical therapy without improvement, and torn ligaments were not my only problem. So I am not second guessing my decision. Just find this new study interesting. It would be nice to see the study repeated with more patients.

Equal Tiime...P O Day 166

Well, now that I've started down memory lane I have to give equal time to Dear Son.

His job has taken him away from home and family for the first time since he went away to college. 

Oh sure, he has been on business trips, stuff like that, but now he has taken a permanent transfer and he has gone ahead alone to find a house and get settled before his family joins him when the school semester ends. So we were talking this morning and reminiscing about his first thanksgiving away from home when he was in college.

He collected a contingent of other "lost boys" and a few girls who couldn't go home for the holiday. His over ambitious plan was to cook a turkey. Now I was not a modern mother. For whatever reason, good or bad, I did not teach my son to cook. He was the child who would stand in front of a full refrigerator and announce "there is nothing in this house to eat!" I knew when I was defeated.

But he embraced the idea of cooking for his new friends, even a new girlfriend who became a wife. (I bet she saw the turkey project as a sign he would be a help in the kitchen later on...boy, was that wrong!) Anyway, there were a few consulting phone calls the day before...how to defrost it, what kind of pan to use, things like that. But things got serious Thanksgiving morning and the phone calls became more frequent and a little more urgent. By noon I was answering the phone "Turkey Hot Line." And this was before caller ID.

I asked him this morning how that particular first Thanksgiving turkey turned out. True or not, he remembers it as the best turkey he has ever had. And I look back at those phone calls as one of the last times he really needed and sought  my advice. I'm just awfully glad things turned out so well.

We did a good job.

The holiday is here...PODay 165

I know it's Thanksgiving. I got "the" phone call.

We have a family recipe for a sweet potato dish. It doesn't really originate in our family. I got it from a co-worker about thirty years ago. It's half way between a vegetable side dish and a sumptuous dessert but we count it as a veggie. There are similar recipes on the web but nothing quite the same and definitely nothing as easy. It's a melange of sweet potato, pecans and lots of sugar.

This dish has been part of Dear Daughter's thanksgiving dinner since she was about ten years old. (You can do the math.) In the beginning she merely ate the dish, for many years she helped prepare it, and since marrying and moving to California, she is responsible for getting it on the table for her own family. I have told her the recipe in person and on the phone, I've written it down on a special recipe card and given it to her, I've emailed it in text form and more recently from my official recipe program. But every year, a day or two before Thanksgiving, the phone rings. Sometimes she is calling from work and will stop at the store on her way home. Often, thanks to tne miracle of cell phones, she is in the grocery store buying cranberry sauce and apple pie ingredients. Once in a while she is at home, making a list and checking it twice.

But always,  she is calling for "the" recipe. She doesn't even have to ask, I can tell by the slightly embarrassed pause why she is calling. Being a mom, I have to fuss a little and remind her that I sent her the recipe last year (and every year for at least ten before that). This year, feeling somewhat more fragile after everything that has happened in the last six months, I had to point out that I might not always be "here" to share the recipe. We had a good laugh about the possibility of her being able to reach me via a seance should the need arise...when the need arises, I should say.

But pulling out my Mom's psychiatric license, I've decided it's not as simple as a lost slip of paper. We play a sweet mother-daughter game every Thanksgiving. The recipe is a connection, a way for her to say I still need you and for me to be there to save the day once more. We aren't  together for Thanksgiving but there is something we share through the years and the miles, something more than a family recipe.

Serious stuff again...PODay 164

In spite of all the security problems with electronic health records and the known breaches in the systems, sharing our medical information is a way we can contribute to medical advances. Anonymous collection of data on such mundane medical interactions as your well patient check up can translate to real advances in medical treatment for all of us.

An online website for people with chronic conditions, PATIENTS LIKE ME, has begun a social media campaign for sharing information about your disease, its treatment and your progress. The goal is to build a data base of personal histories that will lead to better treatment for everyone. If participation is anonymous, it seems like a very good idea. Patient and physician stand to learn a lot from members.

Of course, everyone from government administrators to medical professionals to ordinary patients worry about the apparent proliferation of security breaches since the advent of the electronic health record system. The "stealing"of information has graduated from computer hacking from remote locations to a recent episode where a hospital employee was physically coerced into providing passwords for stolen computer equipment so the criminal could have access to personal patient data.

Department of Veterans Affairs Chief Information Officer Stephen Warren stressed that, while security breaches were a constant concern, we cannot let them thwart the drive to provide better medical decisions, gain new insights, new discoveries and better health for everyone through data collection.

If the data can be compiled anonymously, it appears safe. The problem arises when our personal information comes along with it. Just like here, I can pour my heart out to total strangers under the pseudonym Willet. But the day my Willet identity accidentally was replaced with my real name I was panic stricken until I got my nom de plume back. It's not that I don't love you all, I just don't want you knocking on my door!

Too cautious? ...PODay 163

I went shopping today and for the first time in a long time I tried things on. I've been taking a chance and buying things after just holding them up to me. Why? Because I still can get stuck! I can ease my right arm, the operated side, into a sleeve, no problem. But getting my left arm into the armhole usually ends up with the sleeve stuck at about the elbow. With a lot of struggle I might get the top to finally inch up and squirm into place but getting it off is even more difficult. I can't do that shoulder shrug thing that drops the shoulder of the shirt or jacket off your shoulders. If I finally get the shirt or jacket  to drop off my shoulders I'm kind of stuck. It's like a three stooges comedy where someone has pulled Moe's jacket down off his shoulders so his arms are pinned down and they can knock him  on the noggin. Don't even talk about zipping up a dress. I might get the zipper part way up but down...no way.

So my worry has been I will get stuck half in or half out of an article of clothing and have to call for help. Good grief, I might have to buy something just because I couldn't get it off.  Poor Dear Husband hears me calling for help at home frequently. I don't know what you would do if you lived alone. But today I made a little progress. I am getting more brave about slipping my right arm behind my back. It doesn't hurt to reach behind with it really. I just need some reassurance that the joint is settled in with enough tissue ingrowth that it will not dislocate. I was cleaning out a closet the other day and was sitting on the floor. I just had to use my right arm to get up and amazingly, it did not fall off or collapse when I put quite a bit of weight on it..

I honestly think I have been too cautious. I read too much on the Internet about all the things that can go wrong. Most of the warnings have come from the Internet, my doctor has not had a lot to say about do's and don'ts. The physical therapist was very careful in her admonitions of what I could not
do and I have largely followed her lead. Would I have done just as well, or better!, if I had thrown caution to the wind? Of course there was some restriction due to pain or just plain inability to move my arm in certain positions. But especially now, many restrictions are self imposed.

So I am ready to take some chances. It's been five months and I am ready to take charge. I am definitely able to raise and stretch and use my arm increasingly well. It's time to take it up a notch. Surely dressing without assistance is a reasonable goal.

By the way, I bought a really cute brown blouse today and it wasn't because I couldn't get it off!

There's a way...PO Day 162

There's that saying, "where there's  will, there's a way."

If you're going to mess around with burlap, you've got to be able to run a vacuum cleaner! You can walk past a piece of burlap and suddenly your socks will be costed with fuzz and threads. If you dare to take a pair of scissors to a piece of burlap long strings of hemp fiber will mysteriously show up in your lingerie drawer. If you are asthmatic a burlap project will likely land you in the emergency room, lungs filled with burlap lint.

The dessert table tablecloth project has proven a challenge. There are two household tasks that I still struggle with; one is putting clean sheets on the bed and the other is vacuuming. Pushing and pulling the vacuum cleaner with the operated shoulder/arm is just impossible and trying to do it with the other, the left arm,  I have  no control.

But a floor covered with burlap debris, no matter how cute the tablecloth, is unacceptable a few days before Thanksgiving. I tried picking up the individual threads by hand but that was an unending job. I glared at the old Hoover like a cowboy checking out an unbroken stallion. Who was going to get the better of the other? With my right hand I grasped the handle like the pommel on a saddle. My left arm was dramatically arced in mid air holding the cord as if it were reins. The toe of my boot was poised over the power switch ready to goad the beast into action. One quick nudge and he sprang to life. He lunged right when I wanted to go left and forged straight ahead when I tried to turn left. Just as I was about to despair, my left hand reflexively grabbed for the handle. Suddenly I had control. The strong left hand pushed and pulled and the weaker but coordinated right hand steered. The powerful creature was subdued at last. And I was victorious.

In other words, if you're having trouble running the vacuum cleaner, try using both hands. I don't know why it has taken me so long to figure this out.

Cleaning out the freezer..PO Day 161

I think we had the next to the last pre-rTSA frozen food for dinner tonight. I found four small frozen chicken pot pies that I prepared and froze way back before my surgery. They were wrapped in aluminum foil and hidden away in a small fridge- freezer that I don't use often. Cooking and freezing food before my surgery was a good move. It wasn't a lot of effort. In the month before surgery any time I was cooking I just made extra servings and froze them.

Frozen entrees like the ones made by Stouffers are pretty good and not at all expensive. In the first month or so after surgery they are a real "go to" when fast food has lost its allure and dining out is not  desirable yet. Grocery stores now offer several prepared foods that are more like homemade and are pretty convenient. If you are really lucky a family member or a neighbor or friend will supply a couple meals.

Tonight's discovery was part of "cleaning out the fridge." I don't really need to as we are having Thanksgiving dinner out but the habit is ingrained. The tradition is a big grocery shopping trip followed by a general fridge move-around to make room for the turkey, sides and desserts. This year I only have to make room for the desserts as we will reconvene here after dinner to talk and have dessert. Pumpkin pie is a must and chocolate  cake would be a hit with any and everyone. I'm leaning toward key lime pie instead of pecan pie. And maybe some lemon curd cupcakes. Sounds good.

The cloth for the dessert table is finished. I saw it in a magazine and just loved everything about it but the price. Shocking! It is a fitted burlap cloth with three tiers of ruffles. Kind of looks like a burlap prom dress. Is that an oxymoron? The burlap is coarse to handle and does not drape well but the color and texture are thanksgiving appropriate. Loaded up with desserts, plates, flatware and napkins  the structural flaws would not be apparent to a man on a galloping horse, a standard for home made projects my friend's mother in law found amusing.

I think Thanksgiving is my favorite holiday. It's all about family and food. There is no gift-giving pressure, church services are strictly optional, and post dinner naps are not considered rude. And we are reminded to be grateful for all the things we tend to take for granted the rest of the year.

I am particularly grateful for a right arm that hurts less than it used to and works better than it used to. It's not perfect but it's the one I've got.

Am I a barometer?...PO Day 160

My arm, my shoulder, the operated one that has done so well and only hurts where the deltoid muscle is connected to the bone...that one... Hurts! It has been sore and aching ever since it turned cold!

I'm embarrassed to complain about the weather. The rest of the country is suffering with record low temperatures, record high snow fall, and record bad weather in general. Here in the southeast we have had what we call a coldsnap, a brief few days of unseasonably chilly days and nights. I actually had to wear a jacket when I walked yesterday morning! But that is when my arm began hurting. Could it be true? Does climate change affect out joints?

According to research by Dr. David Borenstein, rheumatologist and professor at George Washington University, patients can actually predict rain before it occurs. According to Dr. Borenstein it is not the wind, rain, cold nor snow. It is the barometric pressure. Pressure presses on the tissue around the joints and prevents the joint from swelling. When weather turns inclement the barometric pressure falls and that allows the joint to swell which makes it hurt. While this is scientifically unproven, it is pretty well accepted as fact.

The idea persists that moving to a warm climate will improve many aches and pains. People often go to Florida or Arizona and report they feel much better. Dr. Borenstein's explanation is simple... When you visit an area you are on vacation, possibly staying in a nice hotel dining out, relaxing and enjoying yourself. Of course you will feel better and it has little to do with the weather!

All I know is that my shoulder that never hurts is hurting. I would rather attribute it to the weather than the fact that I worked in the yard, spent four days sewing a ruffled tablecloth for the Thanksgiving dessert table and have started sleeping at least part of the night on that side!



http://youtu.be/QCG3kJtQBKo

Major malfunction...PO Day 159

Well, this is interesting.

Just after 3:00 AM this morning I logged in to my blogger account and began to post today's entry. At that hour I make a lot of erroneous keystrokes. Honestly, I do all the time. Anyway, suddenly the print on the page changed and everything, every word, every instruction that I did not personally type turned into a kind of rectangular "0". I thought I had accidentally hit HTML or something weird like that.

But I hadn't. I tried to reset the page. I logged out and logged back in. I logged into my account with safari instead of chrome. I turned off my iPad. I muttered a few bad words, like oh darn and drat. I reported the situation to google via the help line. I looked at the community help line. I didn't get any help but but did find that something similar had happened to other users but no recent complaints and no solution offered.

Half way guessing I managed to click enough of the right 0000 or 000 0000 boxes that I made it to the "post" box and zipped off PO Day 158. I decided sleep would solve my technical problems and went back to my usual restless 3:00-6:00 AM repose. First thing on awakening I logged in to confirm life was back to normal.

It wasn't and at 5:00 PM it still isn't. By habit and a fair memory I can move around the site. I occasionally open the wrong box and find myself in unfamiliar territory. But so far I have managed to not lose anything. And the 000 disease has not spread to my actual posts so I am still typing letters and hopefully you are still reading ewords. Normally I can tell if readers are in the US or France or The Ukraine. But now you are in 00000 or 000 0000000 or 000000 and I haven't deciphered the secret code.

So I don't know what is going to happen. If I disappear for a day or two it will only be to try to fix things. I wonder if I open a new blog if that would solve the issue? Or is this a message from the great computer in the sky telling me to quit talking about rTSA and get on with life? 

What about my hair?...P O Day 158

I'm sorry to say my hair is still falling out. I think this has been going on long enough now. It started at about six weeks  post op and according to a Google search this is a fairly normal response to surgery, anesthesia and the stress of it all. But it is supposed to stop eventually. My hair is falling out as much now as when it started. I inspected a few of the fallen hairs yesterday and they do not appear to have a root attached. But I am pretty sure the hairs are not breaking off.

When I brush my hair, several hair appear on the bathroom vanity. If I lean over my iPad and just give my head a firm shake-tossle, at least two or three hairs flutters down to the glass iPad screen. My hair started out pretty thick but I don't think it can hold out much longer. I've never felt hirsutely threatened before but things are getting pretty serious.

My really short haircut is doing a good job of disguising the thinner hair. But I am beginning to wonder if I should be doing something.  I've read that women can use minoxidil, the rub on lotion to stop balding. My brother in law used it. He said when he sweat, the sweat and lotion ran down his neck and back and that's where he grew a lot of new hair! But not on his head. I don't think this is a treatment for me!

I do "color" my hair but I looked on the web again (Google) and was reassured that hair coloring, properly done, did not damage the hair follicle  and root. Thank goodness, as I just am not ready to be dull grey. Actually I don't see a lot of grey as my hair grows but the "natural" color is just dull, bland, boring. I'm not ready to go au naturale, but when does one stop being a strawberry blond or a reddish auburn? Will I still be dying my hair at 90? Speaking of hair coloring, has anyone else noticed that the female blond newscasters seem to now purposely show some dark roots? Is it a modern look?

I am ready for Telogen affluvian to be over but not ready to try minoxidil! A hairy back is bad enough on a guy!





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - rXecovery and physical therapy, September - thinking medically, October...returning to normal. November - almost there.

Walking...PO Day 157

I am back to walking my old distance daily. Hooray! I aspire to walking 2 1/2 to 3 miles each morning but it's been since before I broke my shoulder that I could  manage it very well.

First, walking and wearing a sling are incompatible, at least for me. Having one arm restrained in a sling seriously affects my balance. Normally you swing your arms as you walk but the sling restricts that movement and has the trickle down affect of throwing you off balance. The last thing you want when you have a history of falling and breaking a bone is to feel like you might fall again! So for six weeks post injury and six weeks post surgery I didn't feel safe walking for exercise.

Second, post injury and post surgery I had physical therapy most mornings for several weeks. Not only does the daily commitment interfere with attempts at other forms of exercise, it just does not leave energy for them. I was tired after PT and by the time I got home the mood for other exercise was gone.

Third, post injury, walking made my arm hurt with every jarring step. By the time I finished a walk my arm was hurting so much I couldn't muster the enthusiasm for any other physical activity that day.  This pain never let up or improved in the year between injury and surgery. Post surgery, my biggest problem has been the lingering effect of the collapsed lung I experienced. It seriously affected my breathing and walking just made too much demand on my lung capacity at first. I started out walking 1/2 mile, increased to 1 mile by three months post op.

The best incentive to returning to full exercise is a walking buddy. It really helps to have someone to partner with, who expects you to be out there with them rain or shine. My friend and I solve the world's problems as we walk and talk, and 2 1/2 or 3 miles melt away, along with a few pounds! I am still just a little breathless as we walk but even that is getting better. My arm and shoulder tolerate the
swinging without complaint. I do walk with hiking poles, usually two but since surgery just one, so I can switch back and forth between hands. The poles add upper body exercise plus some stability and have the added bonus of providing a weapon of modest use against wayward dogs and suspicious strangers.

So I am feeling pretty smug. Life is getting back to normal and it is about time! I've been an invalid long enough. Walking does not put any strain on the post rTSA shoulder and so long as you can stay upright it is a safe, low impact form of exercise.

http://youtu.be/L0wCuwUneSM

EHR=Big brother?...PO Day 156

Already collected on our Electronic  Health Record are not necessarily medical details of our lives such as alcohol consumption, tobacco use, race or ethnicity, and residential address. Now IOM (Institute of Medicine) wants to add other self reported data. Suggested categories are educational attainment, financial resource strain, stress, depression. Physical activity, social isolation, intimate partner violence, and neighborhood median household income. These were the eight categories chosen but there are others under consideration.

Social scientists on the committee believe the new data domains are linked to health or longevity but clinicians and medical practitioners were concerned with how the information would be collected and stored. Unfortunately the report did not take these issues into consideration. There are two problems  with the proposed additions: 1. The data would be self-reported. And 2. Securing the information in our EHR is becoming burdensome and worrisome.

The plan already is to link the EHR data to local health departments and community agencies. While this may be beneficial to identifying problems like environmental exposure to pollutants or recognizing the effect of housing concerns or lack of adequate nutrition on patients, it does expose our  intimate life details to a growing network of government agencies. Is it much of a leap to think information could be shared with local law enforcement agencies too? Furthermore, is it already factored in that we are going to fudge the facts when reporting our less desirable qualities. Will I exaggerate my educational achievement and under estimate how much wine I drink? Does having a higher income guarantee better health? I wonder how my neighbors are going to take it when I go door to door asking what their household income is? Without polling the neighbors I wouldn't have a clue how to answer that question!

Maybe it is none of my business. And not the business of my medical practitioners, local health departments and community agencies.


The IOM is an independent, non profit organization that works to provide unbiased and authoritative advice to public and private entities. Many studies are requested by government agencies but the IOM is not funded by the government.

How much is too much?..PO Day 155

The first thing that happens when I go to see my orthopedic surgeon is that my shoulder is xrayed. It's the only way to "see" what is happening, I understand that. There are two or three shots from different angles. I always make some remark about how much radiation I am getting to the technician and she always responds that it is minimal.

Prior to surgery I had a whole series of X-rays plus a special CT exam to determine the size of the implant needed and the state of my shoulder. I also had an MRI but it doesn't count in the radiation equation, thank goodness.

Post operatively when I developed the collapsed lung I had two chest X-rays in the ER, then daily chest X-rays for five days until I was discharged. The hospital has a marvelous portable X-ray machine that can bring your daily millisievert dose right to your bed.

I've certainly had my share of mammograms, more than. And I have had therapeutic radiation from one specialist and diagnostic CT scans from another. Is anyone adding all this up? Does it matter?

Of course it does and the CT scan is the biggest contributor. The average CT scan provides radiation equal to 72 mammograms or 442 chest X-rays. No wonder my orthopod's X-ray tech isn't worried about a couple little old chest films!

The problem is that even though I worry about it, I inquire if the latest film or scan is necessary, I ask how much all this radiation is adding up to...No one is willing to give up the advantage that a look inside provides them. I do understand that.

At least I do not glow in the dark...yet.



http://youtu.be/8myK93FqbYc

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 - almost there!

Taking the day off...PO Day 154

Today I am not a post rTSA patient. I'm not going to obsess about that today. I am not the housekeeper. Yesterday was a big cleaning day and things are fairly neat. (Except for the downstairs bedroom where I put everything I don't otherwise know what to do with) I am not the gardener today. But the garden does need work so today's respite is short lived. I am not the chef, not even the cook. We have leftover lasagna to nuke. I am not the secretary to the president ( AKA dear husband) nor the treasurer/bookkeeper today. The support staff has the day off.

I am going to  a rummage sale. Today I am a scavenger, getting back to my evolutionary foundation, I am a hunter-gatherer. I am looking for some wonderful jewel that has been overlooked by all the other treasure hunters who ignored the "no early birds" admonition in the notice in the newspaper and showed up before 9:00 AM. It isn't a matter of whether I need it or not. Of course I don't, no matter what IT turns out to be. But the thrill of the hunt and the excitement of scoring the best buy of the day  will stay with me long after I have forgotten what it was that I could not live without.

It is a beautiful day, pleasantly warm and sunny. A great day for a garage sale or a yard sale or a rummage sale. I am getting my coat and my hat and checking out the sunny side of the street...if that is where the bargains are.


http://youtu.be/Va29hvaDY10

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - rXecovery and physical therapy, September - thinking medically, October- getting on with life, November -  almost there.http://youtu.be/Va29hvaDY10

Computers create work...PO Day 153

We knew it, didn't we? We never did buy the idea that computerization saved time. We sit down at the machine for just five minutes and don't get up for an hour! It's turning out that is true with the Electronic Health Record system too.

In an October 2014 article in the International Journal of Health Services Drs Woolhandler and Himmelstein, New York Internists, analyzed and compared time spent by the average US doctor on bureaucratic tasks and job satisfaction. The following information is excerpted from their report.

The average doctor spent 16.6 percent of their work time on paperwork unrelated to patient care, in 2008, the last year that data was available. The data came from the 2008 Health Tracking Physician Survey of 4,720 physicians. The paperwork involved billing, getting insurance approvals for treatment, financial and employee management and contract negotiations. Paperwork that directly concerned patients such as writing notes in charts, ordering lab tests and writing to other doctors was not included in the paperwork estimation. "Paperwork" is used here euphemistically for computer work. So any time one sees "paperwork" you should read data entry on the computer.

The greater the amount of time a doctor spent in "administrative" paperwork the less satisfied he was with his chosen profession. Solo practitioners spent more time on administrative duties than did members of a group. Psychiatrists had the greatest burden of paperwork, followed by internists and General practitioners. Pediatricians spent the least time on non-patient tasks and were the most satisfied of doctors.

Now here is the come-away information: those using electronic health records, either solely or a mix of paper records and electronic records, spent more time on these administrative chores than did the doctors who used solely paper records. Proponents of EHR have maintained that computerization would reduce doctors' paperwork but it appears the opposite is true. Over the last two decades the

bureaucratic burden has grown for physicians. Fewer doctors are solo practitioners and many have moved into small group practices where bureaucracy rules.

Dr. Himmelstein commented: “Our crazy health financing system is demoralizing doctors and wasting vast resources.“Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction,” Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. International Journal of Health Services, Vol. 44, No. 4.

The only rebut to these remarks is that they are based on a study from 2008. However, I have not had the sense that my doctors nor their staff are any happier with the amount of paperwork the EHR has created for them now.

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 - almost there!

Shingles vaccine...PO Day 152

Perhaps more dreaded than pneumonia, although less deadly, is Herpes Zoster, better known as the Shingles. Friends who have had the shingles will tell you how painful it is. If you had Chicken Pox as a child ( or ever) you harbor the virus which can show up later in life, manifesting itself as a very painful rash.
Early signs of shingles are sensitivity to light, flu-like symptoms without a fever, and headache. This is followed by a tingly feeling that develops into a painful, blistery rash. The blisters follow the distribution pattern of the nerve and spread on only one side of the body. There may be more than one area of rash or blistering, usually on the torso but can appear even on the face. The lymph nodes may be tender and swollen.
The active phase usually lasts about a week. People describe the pain like sharp needles in the skin. Eventually the oozy blisters scab over. Most threatening are blisters that form on the face around an eye, especially if they spread to the tip of the nose. This is a sign the blisters could infect the eye which would be sight threatening. This phase lasts two to four weeks before the rash begins to fade. 

The post active phase is perhaps the most devastating. Aching, burning and stabbing pain in the original area of the rash can linger months or years. The area can be extremely sensitive to touch, even clothing. This chronic pain usually affects the forehead or chest area. Most people do not experience this extended  suffering but if one does it can lead to depression due to the unrelenting nature of the pain. 

Definitely a condition to avoid! The vaccine isn't 100% guaranteed, some people still get the shingles even after vaccination but hopefully it is a milder case. The vaccine is a live virus vaccine. It's most common side effects are redness, pain and swelling at the site of injection.You should NOT receive the vaccine if you have had a serious allergic reaction to gelatin, neomycin or other ingredients in the vaccine. Also do not get vaccinated if you have HIV-AIDS, lymphoma, or leukemia. If you are taking immune suppressing drugs like steroids, humera, remicade,  enbrel, radiation therapy or chemotherapy you should not be vaccinated. Nor if you have active tuberculosis. And not if you are pregnant. These warnings are from the Mayo Clinic web site.

 I did get the shingles vaccine during the "year of the broken arm." I just felt like I could not cope with anything else going wrong, especially something that I had the possible chance of preventing. I really had no reaction at all to the shot. Except for the financial "hit." For some strange reason it is not treated the same as a flu shot or the pneumonia shot by insurance providers. So there is a significant cost for the drug. And like those vaccinations, you go to the pharmacy, not your doctor's office. While  it is approved for people fifty and older, it is only recommended for people sixty and over by the CDC (Center for Disease Control).

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 - almost there!

Taking MY SST...P O Day 151

Back in October, P O Day 132 , I created my own SST, Simple Shoulder Test because the standard SST must have been written for a retired professional baseball player. "Throw a ball overhand, throw a ball underhand, carry a 20 lb weight by your side with the involved arm, lift a gallon of water to head height without bending your elbow!" I couldn't do those things with my good arm. My needs are more prosaic. So I created my list of things I wished I could do but could not. Now I really get the point of the SST! It is so rewarding to look at the test and realize the progress I have made in the last three weeks. THREE WEEKS!

I can now do eight of the twelve tasks on the list. I admit my ice cream scooping is a bit creative but I can get it done. I can't sleep on my operated shoulder all night but I can shift from left to right occasionally which makes sleeping much easier. I lifted down that really heavy pot all by myself and with a good bit of grunting and groaning I can shift the sofas for cleaning behind and under them.  I put on a lovely Amber necklace yesterday with no trouble and I managed to clean up some of those wayward ice cubes.

I don't think I will ever even try hooking a bra behind my back...too risky. My bicycle and the kayaks are going to have to wait a while, at least until I see the doctor again in December. So far I am still able to come up with something to say. I'm not sure how great an achievement that is. But it does keep me entertained.

So the SST has really helped me see the progress I have made in a very short period of time. I think putting your goals down on paper, or on a computer screen, and seeing them realized is empowering and encouraging. As much as I obsess about my situation I was totally unaware of the strides I was making.

I am ready to take on the next challenge!



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 - almost there!

The New Parts...PO Day 150

If you watch a lot of television, like I do, you probably know one way the detectives identify "the body" is by serial numbers on some body part implant. Well, as far as I can tell, there are no serial numbers on artificial joint implants. It would seem that there would be but I can't find any evidence on the web.

There have been some "recalls" by joint manufacturers. The couple I found were not for the joint parts themselves but rather for one of the very specialized instruments used in fitting or assembling the parts at the time of surgery. It would be very upsetting to have an implanted part of your artificial shoulder recalled if you were doing fine! Could you be required to have surgery to remove it? I wouldn't think so.

There are reasons that a re- operation is necessary but they do involve problems with the existing shoulder. Instability or dislocation are two main reasons a patient may be looking at repeat surgery. While these situations are not common early on, instability  due to wearing of the liner of the glenosphere is one reason the surgery is said to "last", depending on who is talking, seven to ten to twenty years. RTSA patients who use their new shoulder in more physically demanding ways, in sports or physical labor, face this problem earlier. Chronic, recalcitrant infection, when it simply will not respond to antibiotic treatment, can necessitate surgery.

Rarer is base plate failure. In fact, it might be a problem that has been resolved with design changes as it is seldom mentioned in current literature. I hope so. But, having just said that, I found an article that says it is the biggest post operative complication. I can't tell when the article was written, this is the problem with web research. Let's hope it has been resolved. Periprosthetic fracture of the humerus and acromiom fractures can occur but do not require surgery as far as I can tell.

I am counting on none of these really bad things happening. I suppose there is no avoiding the relentless march  of time and the normal wear and tear of life. I expect ten years and hope for twenty. Dr. Kai is young, I hope he will still be around when I need him.

http://youtu.be/qy1A5KQhq28


Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--

Time for a change...PODay 149

It's the time of the year when we Medicare patients are allowed to change plans. We can choose a traditional Medicare plan or a Medicare Advantage plan and we can choose a Medicare plan with Part D coverage. These choices can be made when we turn 65 years old, if we move, if a sponsored plan is terminated, or between October 15 and December 7. If we choose the traditional Medicare plan we may choose our own physician and hospital. If we opt for the Medicare Advantage plan we are limited to seeing only the doctors who are part of the plan and must be referred to specialists by our "plan" primary care doctor. The latter plan is less expensive so naturally there are restrictions. But the lower cost to the patient is significant and many people join an Advantage Plan.

But there can be a problem. In the Journal of the American Medical Association Dermatology it was reported that Medicare Advantage insurers overestimate how many in-network dermatologists are actually enrolled in the plan. Many of the "listed" dermatologists were dead, retired or not accepting new patients. Of 4,700 dermatologists listed as participants in various plans 45% were duplicates. More than half, 51%, were not available to see patients.

This problem is not unique to dermatologists. Many plan members have problems finding doctors who will accept them as patients. In their zeal to sell the programs the sponsors exaggerate physician membership, leaving new members struggling to find medical care after they have made the commitment to the new plans. There is a window for changing your mind. If you become disenchanted with your new plan you can disenroll between January 1 and February 14. After that, you are stuck for the rest of the year.

I love a bargain but until there is some oversight of the Advantage Plan sales people I'm sticking with traditional Medicare. I do realize there are excellent Advantage Plans that live up to their promises but it's hard for the non-medical person to know which is which.  A personal recommendation would be reassuring. When I decided to seek a second opinion about my broken shoulder I had an appointment with my primary care doctor within one day, an MRI the next day, and an appointment with a specialist orthopedic surgeon a week later. Decisions were made between each doctor and me, there was no plan administrator looking at the statistical cost effectiveness of reverse Total Shoulder
Replacement surgery and deciding if I were worth it.


http://www.youtube.com/watch?v=pl3vxEudif8&sns=em


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 - almost there!

Looking better...PO Day 148

I am wearing a long sleeve white cotton shirt today. It has a collar and cuffs and a button placket down the front. So, what's so special about that, you say? It is not a wrinkled mess. I can IRON again! I don't know when something changed, maybe in the last ten days. That's kind of how these advances occur, they sneak up on me. It's not that I haven't been trying to iron. I would tip the iron down and slide it around, doing a half good job on the flat front and back and leaving sleeves, cuffs and collars a mess. I just could not pick up the weight of the iron and reposition it and support it to touch up those small areas. It has been easy for me to avoid iron-worthy shirts but poor Dear Husband has looked a bit disheveled since my surgery. At last, we are neat and tidy again.
 
Furthermore, I have been on a cookie making binge and I can stir the chocolate chips into the cookie dough and the oatmeal and raisins into the batter, no small accomplishment! My secret weapon is a "Danish Dough Whisk" (made in Poland) that cuts through the batter better than a big spoon, less resistance is the key. I have the BEST oatmeal cookie recipe...write me for a copy. Actually it is Cook's Illustrated recipe but I understand you cannot copyright a recipe. Thank goodness.

I still can't dip ice cream with an ice cream scoop but I have discovered that a small metal spatula will shave off thin layers of much too firm ice cream quite efficiently. If one is desperate for ice cream one can become quite creative. Our french door refridgerator is one of those frustratingly malfunctioning bottom freezer models. Periodically the freezer "freezes up" and the refridgerator warms up and I have learned to take a hair dryer to the freezer coils to defrost them and get the cold air circulating again. If you are thinking about buying one, Google the problem before making your purchase. Just a word to the wise. Or is it from the wise?

Last night I almost slept on my right side. There were a lot of pillows involved and I didn't stay long but it was almost normal and felt so natural. I know these are little steps but they all add up to life
returning to the way it should be. I am looking forward to the next serendipitous discovery of what I can do.


http://youtu.be/8YE14Wbsx3w


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 - almost there!

Pneumonia vaccine...PODay 147

Have you had the pneumonia shot, properly called pneumococcal polysaccharide vaccine? Apparently the medical industry thinks it is worthwhile, even life saving. On the fast paced morning that I was being discharged from the hospital two days after my shoulder replacement surgery, the joint replacement coordinator came in my room. She asked me if I had had the pneumonia shot. When I  said no, just had not gotten around to it, she disappeared, returning moments later with all the necessary equipment. She really did ask if it was okay to give it to me, but under the circumstances I can't imagine how I could have said no. I was pretty ambivalent about it but now, having read the informational flyer that came home with me, I am so glad she was the "don't take no for an answer" type that she was.

Yes, it's true. I am just now weeding through the reams of paperwork that I accumulated in my two hospitalizations in June.

Back to the subject: Pneumococcal disease is caused by streptococcus pneumoniae. It is the leading cause of vaccine preventable illness and death in the US. People over 65, the very young, people with certain health issues, people with weakened immune systems, and smokers are at greater risk. Pneumococcal disease can lead to pneumonia, bacteremia and meningitis. Pneumococcal pneumonia kills about one out of every twenty people who get it. Bacteremia kills about one in five and meningitis causes death in about three in ten who are afflicted.

It used to be that treatment with penicillin and other drugs was effective but some strains of the disease have become resistant to those drugs. That makes it even more important to be protected.

The vaccine (called PPSV which is easier to say) protects against 23 types of pneumonia bacteria, those most likely to cause serious disease.

Who should get the vaccine? People over 65, anyone age 2 to 65 with long term health problems or with a disease or condition that lowers the body's resistance to infection, anyone 2 to 65 who is taking long term steroids, certain cancer drugs or radiation therapy and anyone who is a smoker.

Disclaimer:
Generally one shot is all that is needed but sometimes a second is advised. Ask your doctor. Some
people with certain severe allergies should NOT get the vaccine. Again, talk to your doctor. And it is best to be vaccinated before becoming pregnant. Some people have mild side effects to the shot, redness or pain.  Less than 1% develop a fever, muscle aches or more serious local reactions. The risk of a serious reaction is extremely small but does exist.

Having said all that negative, scary stuff, I'm glad I got the vaccine. Just one less thing to worry about in life.


http://www.youtube.com/watch?v=0JRgHol94Xc&sns=em


Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe

Not as the patient...PO Day 146

It is so much easier to go to the doctor's when you are not the patient!  I am accompanying Dear Husband to a couple appointments this week and right now we are waiting to be called back. My palms are not sweaty and my pulse is its usual slow pace. That dread feeling of anxiety I always get has not washed over me.

I used to say that what I imagined was always worse than what turned out to be the case when I finally went to the doctor. Now the doctor's pronouncement is always worse than I imagined! The ravages of time.

The magazines in the waiting room are little help to divert one. My first orthopod, Dr. Kneaval, must have been a movie fan as the magazines were all about actors and cinema. My primary care doctor is into HAM radio and nature. The hospital Women's Center where I go for mammograms is replete with American Baby and Parents Magaine. I've never seen a woman younger than fifty in the waiting area! The reading material is definitely more a reflection of the physician than the patient base.

It's increasingly common to find a TV in the waiting room.  That is a good diversion if it is tuned to a generic news channel. But you certainly don't want any polarizing political chatter starting a dispute among patients. One office we go to plays that channel with all the 50s sitcoms like Gilligan's Island and Mr. Ed. At least they don't start any arguments. Hopefully one doesn't wait long enough to see the end of an episode...but what if you want to know if Gilligan gets off of the island?

Well, I'd better get ready. I am here as "scribe" to make notes for Dear Husband. "Scribe" is one of the solutions proponents of the EHR ( electronic health records) is recommending. Because the EHR data entry has slowed the medical office down so much physicians are being encouraged to hire a scribe who will accompany the doctor from room to room and record what is said and done freeing
the doctor up to focus on the patient rather than the paperwork.

The exam room is going to get pretty crowded... Doctor, doctor's scribe, patient, patient's scribe, and nurse. We're going to need a bigger room and a couple more chairs.

http://youtu.be/AI9oVAHEpJY

Early warning system...PODay 145

It's too bad that my pneumothorax (collasped lung) was not discovered right away, before I was discharged from the hospital soon after my shoulder surgery. There were hints that I would now recognize, having experienced it. I mentioned before, every time the oximeter was used to check my O2 level the tech would tell me it was low and that I should breathe deeper. I would take a couple deep breaths and the number would come up. Also, my temperature was low and my pulse was fast. But no one put it all together and I didn't know.   As it was I went home, things got worse, I didn't complain and it was ten days post op before the problem was discovered.

St. Joseph Mercy Oakland Hospital in Michigan is working to create an early warning system to recognize problems before they escalate to become emergencies. They have created a patient early warning system. A monitor is worn on the patient's wrist to constantly track vital signs monitoring their blood pressure, respiration rate, pulse, oximetry and temperature. The data is linked to the patient's electronic health record. Monitors track the numbers and rank the patient from 0 to 5. Up to 2.9 is good, 3.0 or higher places one in the danger zone and alerts the nurses that the patient needs to be checked out.

The hospital's mortality rate has fallen 35% since the system was put in place four years ago.

It is too easy to overlook small indicators of a potential problem. An impartial system that rates the patient and alerts the nurse to some irregularities is a great idea and obviously works. Yes, people have the ability to recognize and report problems but their "good judgment" can get in the way. Who likes a problem patient! Sometimes an impartial computer program does turn out to be better. Until this idea catches on you are going to have to be your own advocat. Pay attention and speak up. I should have.

This is a great idea and all hospitals should implement it.





Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octobe

Full moon musings...PO day 144 1/2

It's a full moon tonight. Is it true people really act strangely when the moon is in this phase? Is the moon responsible for my arm hurting today? Is the full moon the reason I can't sleep?

The night sky is milky. There's a slight fog that reflects the lunar glow back towards the earth like a dying spotlight. The milky haze obscures all stars and blurs the streetlights into fuzzy balls. Still, it's  bright enough to be able to move around the house as if dawn were breaking. It can't be only 1:00 AM.

Of course the nighttime house is always illuminated in this modern world. With my head on my pillow the red-green-yellow glow of devices in stand by - charge mode brightens the bedroom. The TV "Box" yellow clock glows reassuringly, Dear Husband's electric clock ( battery back up) casts its red light across the room in an arc, my red clock numbers fill the opposite side of the room, from under the bed there's a little red glow from a power strip, a portable telephone in a charging stand glows red and through the open bathroom door the pale yellow-green light from the sonicare toothbrush twinkles. Who needs a nightlight? Who notices a full moon?

But where is the lore of an electronic glow? Does a werewolf emerge from the dark corner of the bedroom. Wow, I hope not, not even in my dreams. Should we plant our garden by the phase of the cable box? Is my mood related to the blinking of the charging toothbrush? Is there any romance in the  joining of our two red clock faces! Can I find a pareidolic image in the shadow cast on the bedroom ceiling?

Tonight is not a super moon nor a harvest moon. It didn't make the nightly news. I didn't even walk outside for a better view.  I didn't see a witch on a broomstick move cacross its face even though halloween is just past. But I'm always mesmerized by its beauty and the predictable appearance of the man in the moon or the woman's profile in the moon. I like the soft glow of the moonlight on the water. And if I would turn off my iPad I might actually discover a little of its romance.

http://youtu.be/FvzNeh4Mq1o

Patient hand washing 101..PODay 144

So, after tattling on hospital staff who don't wash their hands as often as they should, here comes a study by a Canadian group published in Infection Control and Hospital Epidemiology that looks at patients who are in the hospital. The team tracked 279 adults who were patients in an organ transplant ward.  They found only about 30% washed their hands during bathroom visits, 40% at mealtime, 3% while using patient kitchen facilities, 3% on entering their hospital rooms but amazingly, 7% washed their hands when exiting their rooms.

Women were more likely to wash their hands and more likely to use soap than men. For some strange reason all patients were more likely to wash their hands later in the day than in the morning.

It looks like we patients are doing a much poorer job than the hospital staff. But we are the ones paying the price. The U.S. CDC ( Centers for Disease Control and Prevention)  reports that one in twenty-five hospital patients will contract at least one hospital related infection and in 2011 there were 722,000 cases of hospital acquired infection, some serious or life threatening.

Hand washing is very effective in preventing transfer of infections and it is a simple, inexpensive thing to do. We all know we should do it, are we just lazy? Are we rebelling against our mother's voice in our head? Are we in too big a hurry? Whatever the psychological explanation, the physical effects of not washing hands is real and risky. Not only do we need to nag the hospital staff, our guests and even our doctors, we need to look at ourselves as a source of contamination and change our habits! Since infection is a lifelong risk to the total shoulder replacement surgery patient, we need to be especially attentive to the little things like unwashed hands that put us at risk as well as the big things like a purulent wound on a cut foot.

http://www.youtube.com/watch?v=BoHssZ_jBTc&sns=em

On the road again...PO Day 143

                                                                     Gingko Biloba

North Carolina was beautiful. The mountainsides were rich with reds and yellows, it looked like a manic French Impressionist had run amok. Our long pants and sweaters were overkill, temperatures
were in the mid eighties. Thank goodness for air conditioning everywhere. But it cooled off nicely at night and gave us a taste of fall which we were hoping for. Asheville stands out as the downtown streets are lined with ginkgo trees. This time of year their leaves are changing from green to lemon yellow and the streets are lightly littered with scattered leaves. But the Ginkgo tree  puts on a special performance...the day finally comes when all the yellow fall leaves drop in unison and the ground
beneath the tree is a round lush carpet of fan shaped yellow leaves.

We rendez-voused with la belle fille and son in law who are visiting the area for a longer time. They acted as chef and chauffeur and we are now officially spoiled. They treated us like visiting royalty. We dined in and out, shopped till we dropped, and cruised winding, switchback country roads where colored leaves fell like confetti. The little towns like Bat Cave and Lake Lure were bustling with tourists and finding a place to park in antique shop filled Hendersonville was a challenge. But it is nearly the end off the season and soon the cute pubs and chi chi shops will belong to the locals again.

We never stay in one place for long...except for home. So, before we wore out our welcome, we were on the way home. There's mail to sort through and laundry to sort out. And plenty of errands to run tomorrow. Most important, I have to get back to my home physical therapy. Between inactivity and the constrained position of driving  my arm is reminding me that it requires daily attention and exercise. The other thing is our weather is about to change dramatically. The cool fall temperatures we drove 500 mikes to experience is about to come to us here. I wonder if my shoulder is becoming my own personal weather station?

Since I wrote this it has snowed in Ashville!

http://youtu.be/1TD_pSeNelU

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...

Hand Washing 101...P O Day 142

We moms all know how we have to nag the children about washing their hands; after the bathroom, before dinner, when they've cut their finger, after petting the stray cat. Well, apparently someone needs to be nagging our health care workers.

 A survey of 400 hospital staff, by a Charlotte, North Carolina  company Debmed ( a company that sells hand hygiene products)  found many staff members disagreed with the stated compliance rate for hand washing by fellow workers. The facility reported a hand washing compliance rate of at least 81% while the staff members thought the compliance rate was more like 70%. It doesn't sound like much but it makes a big difference ultimately in infection control. The same survey found that less than half, 44%, of the respondents follow CDC (Center for Disease Control) guidelines for hand hygiene on entering or departing patient rooms. In the opinion of the employees the biggest improvement came with recognition that others were aware of your compliance or not.

Worse yet, in a similar survey at the Robert Wood Johnson University Hospital only 13% of 1500 emergency medical providers said they washed their hands before touching a patient. A Cleveland hospital was able to turn such statistics around with a hand washing compliance campaign that raised compliance to 97.6% and lowered hospital acquired infections by 38%. Ventilator associated pneumonia dropped 71% in the four year campaign.

So, if you read all those hospital handouts that come home with you, you will notice that you are advised to ask everyone and anyone who comes in your hospital room to stop and wash their hands. Or use the hand sanitizer in the wall dispenser. It seems a little embarrassing to suggest your doctor might need to wash his hands but maybe we all need the peer pressure.

So be a little compulsive. Be a Mom. Nag a little. It can't hurt and might help.

WHEN SHOULD YOU WASH YOUR HANDS?

• Before, during, and after preparing food
• Before eating food
• Before and after caring for someone who is sick
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal or animal waste
• After handling pet food or pet treats
• After touching garbage

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octob

Medical identity theft...PODay 141

We hear it nearly every night on the news, another big company was hacked and personal information, usually of the financial kind, has been stolen. It's bad enough when this kind of theft impacts our financial well-being but what if it threatens our physical safety?

Community Health System of Tennessee was the victim of cyber attacks in April and June of 2014. The healthcare company operates 206 hospitals in 29 states and the loss of private data affected 4.5 million patients. The company reported to the U.S. Securities and Exchange Commission that they believe the attack originated in China. Only names, addresses, birth dates, and social security numbers were stolen. Only! The information was transferred out of the country, they believe.

Are these attacks little test runs to see if it can be done? Are they tweaking the security systems supposedly protecting our personal information? Is there some nefarious foreign plot afoot?

Perhaps the greatest risk is right here at home. Over fifty percent of identity theft is by a relative or acquaintance who is uninsured and hopes to steal your identity, your insurance coverage, to pay for their treatment or operation. That is why, now, when you show up at a doctor's office or the hospital you must present your insurance cards and a photo ID. Let's hope "your" thief does not look like you! If he does, there is a good chance he will get away with it.

Basic stolen data used to sell for a modest $20.00 per victim. But a fine tuned package of data that includes not only your name, address, SS number and birthdate but also your diagnosis, medications you take, allergies, insurance coverage and more, can sell for upwards of $1500.00 if packaged right. To the computer world you are a customer just waiting to be enticed into buying the newest drug, insurance coverage, or week at a spa retreat. Your identity can create a real person to go with that fake passport or counterfeit insurance card. Or, when coupled with your diagnosis and insurance information, medical supplies can be ordered and charged to your provider, then sold at the weekend flea market. There are as many ways to make money from your exposure as there are victims.

I'm wondering...if they steal my identity, do the get my aches and pains too? Only seems fair.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, Octob

Packing to go...PO Day 140

It's been over four months since my shoulder surgery and the relative isolation of recuperation began. Certainly, there have been a lot of doctor visits and more than usual fast food outings. But not so many social occasions. At first I didn't feel like it and then for a while I couldn't drive so not too many shopping outings. My stamina is still not back to normal so two or three errands locally is enough. A really big event is going to a movie.

But now we are ready to take a little trip. Nothing big, just a three or four day getaway.  We southerners migrate north this time of the year to admire the fall colors and cool temps. When the rest of the civilized world is sporting sweaters and flannel plaid shirts we are still wearing t-shirts and shorts. So as the daylight gets shorter and the reds of the  maple, sweet gum and black Tupelo compete with the yellows of the sassafras, hickory and ash, we pull out our sweaters that faintly reek of moth balls, find some long pants that haven't shrunk hanging in the back of the closet and unearth a pair of closed toe shoes to try to squeeze our flip-flop flattened summer feet into. Of course we take way more than we need. But you never know what weather phenomenon will occur. Once we were unexpectedly snowed in for three days, stranded in a small motel in a small town as the vacation clock ticked down. This time of year a hurricane evacuation plan can morph into a fall foliage foray. "If life gives you lemons, make lemonade."

But, God willing and the creek don't rise, this trip will be routine. Do I take my arm exercise equipment? Dare I take a break? Do I have room for a two pound York weight, the pulley that hooks over a door, the vacuum cleaner tube that I use for flexion exercises, a couple stretchy bands, the Goniometer Dear Husband made for me and the protractor that goes with it, is there anything else? I  think I'd better take a break.  Do I take my iPad, malfunctioning as it is? (iOS 8.1 has solved some problems and created others.) What about the Blog? Will I experience withdrawal if I can't share my angst of the moment? If I take it along, will I have the impetus to disengage and glance up at the scenic beauty of the season occasionally? Or are you always on my mind?

http://youtu.be/R7f189Z0v0Y

Surgery Tips & Tricks...PO Day 139

Either of these links should work...warning: graphic surgical videos, not for the faint of heart.


http://icjr.net/article_34_live_surgery.htm#.VEULraKCOrU


http://icjr.net/article_34_live_surgery.htm#.VEUNnk_CHtU.email 


From the International Congress for Joint Reconstruction comes this video presentation of several joint surgeries, two of which are rTSA and one TSA.

"Watching live surgeries performed by experienced orthopaedic surgeons is a time-honored means of learning about the newest techniques, the latest refinements in procedures, and the tips and tricks the experts use." 

This is easier to watch after the fact. I'm not sure how much I would have enjoyed seeing this with surgery in my future rather than in the past. Seeing the video does answer one nagging question I have had...why were my fingernails orange after surgery? I didn't notice it at first, probably for a couple weeks even, as I was kind of overwhelmed with serious complications. But as I began to recover there came a day when I looked at my right hand and thought, "why are the cuticles of my fingernails orange," and "why do my fingernails look like I have been eating too many carrots."

At first I thought I had stained my fingers with some household product. I did finally decide it had to 
be a leftover souvenir from surgery but was amazed it took me so long to notice it. Still, there is faint evidence of something amiss, the nails have fine lines from nailbed to tip that didn't used to be there and aren't on the left hand. Well, maybe less so on the left hand. I think the striation is common as we get older. Perhaps the Orange just made it more apparent. Also the nails on my right hand have been much more brittle. 

So I don't believe the patients featured in these surgery videos have been spending too much time in the tanning booth, nor using cheap self tanning products. They and I were awash in an iodine or betadine pre surgery scrub. It must clean off of the skin pretty easily but leaves its telltale tinge on the nails. The only solution for the recovering patient is to buy a vintage bottle of Tampico Tangerine nail polish on eBay.

Also, if you do watch the videos and pick up any surgical pearls, I would be a little circumspect in trying to tell my surgeon how to do the procedure.

http://www.youtube.com/watch?v=rBHx0UwMHLc&sns=em


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...