Too much gratitude...PO Day 230

It may seem this subject has little to do with shoulder replacement surgery but it really does. I have never in my life been grateful to so many people for so many things, big and little. So I have had plenty of opportunity to ponder the problem of saying thanks. It's very complicated.

If someone does something nice for you, you may want to give them a gift. That's when it gets to be a problem. I sent a gift card to the radiologist who diagnosed my collapsed lung. He sent it back! It came home with a nice note that said he was just doing his job, no reward necessary. Now what do I do? Life would have been so much easier if he had accepted the gift.

But I know how he felt. I recently did something for a good friend. I was glad to help her and it was no big deal. She gave me a nice thank you card and a too much gift card. So when her birthday came up, I returned the gift card along with a small birthday present. She sent me a thank you note with the gift card. I am waiting for a " card-worthy event" to return the gift card to her. This could become a tradition.

A friend of Dear Daughter's, who lives very far away, often does helpful things for her, things I would do if I lived nearby. So when, through a serendipitous combination of events, I acquired a new piece of Le Creuset cookware, I sent it to the friend as a thank you gift for helping my daughter and her family. I expected a nice thank you card but received a beautiful blooming orchid with a nice note. Now I owe her a thank you. Where does this end!

If someone gives you a gift in person and you thank them profusely in person, should you send a written thank you? I never knew before how much it meant to receive "get well" cards. Should I send thank you notes? The cards were greatly appreciated. And what if someone does something really nice for you, I mean really thoughtful, and you fail to write them a thank you note in a timely period...when does the acceptable "thank you" window close? The longer time passes the harder it is to do or say the proper thing. It is complicated.

Twice in my life I have sent a small "gift" anonymously. I wanted to do something and I really did not want any thanks or gratitude. Both times it caused such a fuss, a ruckus, an unpleasant aura of suspicion, that I finally had to confess I was the one who had sent the gift. Wow, did those good intentions backfire! I guess it is okay to make an anonymous donation to a charity, even noble, but don't try it with family. It will only get you in trouble.

I confess, I am not good at saying or writing the right thing. It is all there in my heart. I just have a hard time putting my gratitude into words on paper. And yet I know how much I appreciate a sincere thank you note. I think I am going to close out this post and go write a couple thank you notes for Christmas presents. Is it too late?

Exercise...PO Day 229

Our company leaves today and life will settle down into the post holidays-winter routine. Maybe I will be able to get back to my walking exercise routine which is what always suffers if there is any disrupting influence in life. Between Christmas, New Years, and guests we have continued to eat too richly. It's time to exert some discipline in the kitchen.

I also need to develop a strength building exercise program for my operated arm. I've postponed expecting strength in that arm since I read the 6–12 month time span was when power would increase. But I suppose it won't increase if I don't do something to help it. There is certainly some wasting of muscle in that arm. And the tricep part of the upper arm has a definite crinkly appearance, from reduced use I suppose.

Prior to breaking my right shoulder and the subsequent surgery, I walked with two hiking polls. While the activity is pretty passive, I suppose it is the repetitive motion that has such a beneficial effect on upper arm musculature. I had tried using weights and modified push ups without noticeable improvement but when I switched to the walking sticks I really could see a difference,

It seems a bit shallow to worry about appearance when I have struggled so with function. Maybe it is sign that function is becoming less of an issue. I find that my use of the operated arm is very nearly equal to what I normally do with the other arm. I no longer have to remind myself to use my right arm, it happens automatically. The only limitation remains strength. Possibly the heaviest thing I lift is a gallon of milk which weighs about eight pounds, I can carry it, preferably with arm extended , not bent. But when it comes to lifting it to put it in the fridge I have to let the unaffected arm take over. I think Dear Husband has some eight pound weights but that doesn't seem like a good starting place.

I have the exercise bands given to me right at the end of my official course of physical therapy. I think that will be my starting point. I don't want to go back to physical therapy now. Surely I can create my own exercise program. First step is just to get back to walking regularly and using two walking sticks. Even when l have walked since surgery I have only carried one stick and switched back and forth between which hand held it. Not enough, I think.

So if you see one of those kind of funny looking walkers, the ones with the Euro style sticks that are meant to be hiking rough paths in the alps, it might be me. My walking course is pretty tame, flat and mostly asphalt or concrete. The roughest thing I encounter is a neighborhood dog. Even the most passive, friendly canine acquaintance does not like the walking sticks. I don't know if it is the tap-tap of the sticks as they strike the paved ground or if the sticks look too much like weapons. But while dogs, and even cats, are a little intimidated by the sticks, my real walking nemesises are unimpressed, the vultures!

A neighbor, well intentioned no doubt, is dedicated to feeding the feral cats, in spite of City advice not to. Unfortunately, the cat food placed in vacant wooded lots attracts vultures who roost in tree canopies and supplement their diets by tearing up garbage bags looking for food scraps. Waving a walking stick threateningly or clanking them together has little affect on the urbanized scavengers. Under extreme threat they will grudgingly hop out of range, only to return to the buffet table as soon as I pass. I guess they know my right arm isn't strong enough to be a danger. Well, just wait... I am about to turn that around!

Video conference...PO Day 228

Thinking about video conference type visits to your doctor reminded me of an article I read about interviewing for a job by video conference. There were some suggestions that had not occurred to me.

For instance:

Try to position yourself where there is not a lot of distracting home decor behind you. You want to be the focus of the screen shot, not your bookcase or your living room background.

Don't assume your chat partner will only see you from the waist up. Be sure you are dressed on the lower half appropriately so if you have to stand up they're not getting a peek at your pajama bottoms.

Shut pets out of the room while you are on screen. Cats, especially, have a habit of jumping up onto the table or desk and becoming a huge distraction.

Try to enlist someone to entertain small children during your e-visit. Even an off- screen crying baby makes it difficult to focus on your problem.

Plan ahead to have things you might need at hand. Current medications, even over the counter, beside you will prevent wasted time getting up to retrieve them if the doctor asks about them.

Don't allow yourself to be distracted by a ringing phone or a knock on the door. Either Turn down the ringer or arrange for someone else to answer it.

Alert fsmily members to what is going on so they don't barge into the room in the room in the middle of your appointment.

Have a note pad and pen available to make written notes.

Finally, don't position yourself with a window behind you. If you are backlit the doctor won't be able to see you clearly.

I would wrap this up by saying something about saving money at your e-visit but...I just read that CME has proposed reimbursing for e-visits at the same rate as in-office visits. I thought the whole point of on-line appointments was to save money. I guess it is very difficult to keep medical costs down.

Expectations....PO Day 227

I read a brief article about happiness recently. It purported that the lower your expectations the happier you were if something went well. It made me think of my post 121 "Judging Success." While objective postoperative tests did not show great improvement in a group of shoulder replacement patients, subjectively they were generally quite satisfied with the results of their surgery. Their surgeons were rather disappointed that the results were not better and conversely the patients thought they were doing very well all things considered.

It's that "all things considered" part that makes such a big difference. Maybe the older we get the more realistic we are in what we expect out of life. When I consider the fact that I could not raise my arm more than about 15 degrees prior to surgery, I am quite happy with a full range of motion at the price of some discomfort. When I look around and see the serious illness that afflicts one friend or another, I am not so sorry for what I have to deal with. There's that parable in which everyone puts their troubles in a pile and is permitted to take out the troubles they would rather have. In the end, everyone chooses to take back their own troubles, the ones they came with, the ones they know.

But...

Is expecting less a cop out? It hardly seems the American way. Aren't we supposed to shoot for the moon, aim for the stars, something like that. What if Steve Jobs had settled for a less innovative computer, had not taken the gui and run with it? What if Bill  Gates had agreed that his software should be shareware because that was the way it had always been before? Is it that only geniuses like them can get away with aiming too high? That the rest of us have to be realistic?

Is realistic expectations the equivalent of lowering your expectations? Or does lowering your  expectations imply that you had lofty dreams and you gave up on them? As a mother none of us is ever going to tell our child to aim lower, although we may discourage the idea of a pro sports career, for instance. Realistic expectations allow for less stellar accomplishments while not ruling out the possibility of pulling off an heroic, game winning shot at the basket.

So, expect less and you'll be happier? I don't think so. I want it all. It's okay to be surprised, even astonished by events but I want to reach for the stars and perhaps surprise everyone else when I catch one but I knew I could do it! I accept the occasional disappointment for the rare thrill of total shocking success.

No post...PO Day 226

Can I blame the snow storm (is it Juno?) for not writing a post for today? Hardly. It is the usual winter day here, sunny and high in the mid 60s to low 70s.

Is it due to the funk I am in because Dear Son and his family have moved to a very north central state and it makes me every sad? Maybe, but that has been an ongoing situation and I have managed to crank out something for my blog along and along.

Perhaps it is because we have company, relatives from Oklahoma, and being social has used up all of my chatter and gossip and goodwill so I am left with nothing intelligent to say.

Maybe it is because I have been awake most of the night, when I would normally be writing my daily post, watching the Weather Channel or CNN to see what is happening with the storm. Being a southerner it is as hard for me to imagine coping with a blizzard as it is for northerners to think about living with hurricanes.

Am I just disappointed that the pork loin roast last night was over cooked and tough? The rice and green beans were good, at least. Good food is an important part of life and I don't like to churn out something less than good. Doesn't have to be great, just good satisfies.

Am I out of sorts that, due to guests, my routine is messed up and I am not walking? It's true, we get addicted to our exercise program and don't like it when it gets interrupted. Maybe I can walk today?

Or, after 225 days, have I run out of things to talk about? I hope not as I would miss you all. I've loved the writing and the reading that sometimes goes into the writing. Anyway, we'll see what happens today.

Will Willet survive or won't she?

Can't prevent everything..PO Day 225

Even if we are attentive and proactive, we can't prevent everything.

In 2012 there was a "superbug outbreak" that infected dozens of people in Pittsburgh, Seattle and Chicago. If everyone involved had washed their hands a hundred times it would have made no difference. The dangerous infection, Carbapenem-resistant Enterobacteriaceae (CRE) is one of the superbugs that have developed because of the overuse of antibiotics.

The infection was spread through the use of duodenoscopes used in gastrointestinal scopes of patients with gallstones, cancers and other digestive system problems. It was spread from patient to patient because the. CRE can survive traditional cleaning methods.

A Seattle investigation revealed 35 infected patients and eleven deaths, although it is difficult to rule out death from other problems as many of the patients were critically ill already.

In spite of this this, the FDA has not issued a recall for the devices saying it remains important to have the procedure available for use. One approach has been to culture and isolate the equipment for forty eight hours after use to be sure it is safe to use again. Hospitals and clinicians are having to think outside the box in designing protocols for infection control. Studies have shown, for instance, that wiping equipment down with chlorhexidine every day is not as effective as doing it every other day. Now how does that make sense?

All you can do is express concern and hope your doctor and hospital are tuned in to the problem. Sometimes merely asking a question is enough to ensure people do the right thing. Now if we just knew what that is!

Childhood Memories..PO Day 224

I know this is off topic but I found it fascinating. Dear husband was reading an article in The Week magazine by Kristin Ohlson and I happened to see it. The subject is what Sigmund Freud called Childhood Ammesia.

What is your earliest memory?  Not the story the family has told so many times that you think you remember, your earliest independent memory. For most of us, we may have sketchy memories, more like impressions, from age three or four, but not full memory of events until about age seven. It's not that young children aren't remembering things at a young age. It's that they don't form permanent memories. Ask a two and a half year old about something that happened when he was two, a trip or a birthday party - something memorable - and he remembers it and can talk about it. Fast forward to age  four or five and he has no recall of the event at all.

Whatever is going on as to development in the brain, the memory thing doesn't fully happen until we are about seven. Before that, while we do have some memories, they are small vignettes filled more with emotion than with details. As a parent we may be trying to create these perfect movie moments for our child but, in spite of our best efforts, they may not remember the family vacation to Disney World at all but can vividly recall the popcorn machine in the lobby of the hotel where you stayed traveling to the theme park on I-95.

That's not to say all those wonderful bonding moments were a waste of time and energy. While they are not remembered, impressions and emotions are created and become part of the equation of who we become, who we are.

Reading the article caused me to call my sister. I remembered an epic snow fall and walking, with her, through shoveled paths where the walls of the paths were much higher than my head. It had the effect of being in a frozen maze. I wanted to know what year that might have been. Since she is four years older than I, was sure she would remember it perfectly. Well, my memories are not her memories, she did not recall the snow, the paths, the events at all. A little internet searching revealed the record snowfall in November the year I had just turned four. Obviously the whole experience made a much greater impression on me than on her.

Anyway, when the family conversation around the dinner table lags next big holiday, ask the question, "What is your earliest memory?" It may totally surprise and amaze you.

http://youtu.be/78Ruh0ewBVo

Virtual appointments...PO Day 223

I found this very interesting.

I had read about telehealth services but I really didn't understand the concept. A poll by a telehealth company brought the idea to life for me. American Well is a developer of the video chat doctor visit. It is promoted as a way to make doctor visits less expensive and more accessible. Harris Poll interviewed over 2000 people who generally found the idea acceptable. Many found the idea of lower cost combined with no waiting for an appointment very desirable. With the growing use of personal health monitors that measure blood pressure, temperature, heart rate, etc, the doctor has the basic data available. It is projected that an evisit would save over $100. for an appointment.

The concept is attractive to parents who find it hard to bring an ill child in to the office. Or if you were sick in the night it would be so much easier to "see" the doctor. While you might expect the idea to appeal more to young tech savvy people, it is actually more attractive to the senior set who may find it more difficult to get to the office in person. A quick visit required to refill a prescription is a pain unless you could do it via Skype.

The idea has been around for a while but there are several reasons it is getting serious consideration now.

Better and faster internet connections make video conferencing more feasible.

Using a mobile device, people would be able to connect with the doctor from anywhere.

Electronic Health Records provide the doctor online history on the patient.

Patients are getting comfortable with forms of instant messaging.

Finally, states like New York, are recognizing video doctoring as a legitimate form of medical care.

Since it is my current opinion and experience that modern doctors never touch you anymore, I can't see any reason a video visit would not be just as good as an in person visit. I'm for it!

Coffee....PO Day 222

Continuing the subject of diet and what is good for you or bad for you...

It turns out there is evidence that coffee does more than keep you awake. According to the Journal of the National Cancer Institute's article published January 20, 2015, a study done by Yale university's Erica Loftfield supports the theory that coffee works to prevent malignant melanoma.

"Previous research has shown  that coffee drinking could protect against less deadly forms of skin cancer, apparently by mitigating the damage to skin cells caused by the sun's ultraviolet rays."

Malignant melanoma is the fifth most common cancer in the US. There were 77,000 new cases of melanoma in 2013 and 6500 deaths from this cancer. 

The study was done by surveying 3.5 million AARP members from six states,; California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania. 447,400 members responded to the survey which began in 1995 and continued for ten years. 

Statistical analysis of the data collected showed that people who drank the most coffee had the lowest rate in malignant melanoma. Also increasing consumption appeared to lower risk. People who drank one to three cups of coffee a day had about a ten percent reduction in risk. Increasing consumption to four or more cups a day had a twenty percent reduced risk.

The important ingredient here is caffeine. Those drinking decaffeinated coffee did not have the same benefit. One cannot rule out possible other ingredients that offer the protective qualities.

Sounds really good. But this is not a controlled study, it is a statistical analysis. According to the chief  medical officer of the American Cancer Society, there have been many similar studies of the effect of coffee on health both favorable and unfavorable. 

So I guess, if you drink coffee, you can feel smug that you are doing something good to protect yourself and if you don't drink coffee, you can consider the study unscientific. But whatever, stay out of the sun, wear a hat, and/or use sunscreen. We know that helps.

Exercise...PO Day 221

The Christmas season really interrupted my exercise program. But a January doctor visit, not with my orthopod, has gotten me back on the road.  Well, his urging coupled with the accumulated pounds from holiday overindulgence backing him up.

I am now walking two to two and a half miles a day but possibly only five days a week. You know how it is, there is always something interfering with your schedule -weather, appointments, sloth. At least, for now, it is not hot and I don't come home dripping wet. The best thing that can happen is to come upon an unexpected garage sale. It combines two favorite activities, walking and shopping.

You get to know all the neighborhood dogs. I know more doggie names than people's. And, while you might get a brief nod from the  human, the dogs are usually so excited to see you. It can't help but boost your spirits.

 Walking reduces your risk of heart disease and diabetes. It lowers the bad cholesterol and raise the good cholesterol. It increases your vitamin D level and lowers the risk of osteoporosis. It helps control your weight, although it won't take the place of diet. It helps tones muscle, especially abdomen and legs. A recent study shows a walk a day increases your longevity. If you use walking sticks it adds some upper body toning. Sounds like the perfect activity. It can be a little rough on feet and toes. The best technique is alternating shoes so the same spot is not rubbing or irritated every day. It permits social interaction without having to be very social. A brief hello and a smile as you pass neighbors keeps you in touch with the world around you without much demand. And the best thing about walking is that it can be tailored to your individual athletic prowess. You can be a power walker or a stroller, a bird watcher or a neighborhood gadfly.

Okay, I've convinced you. And myself. I'd better get to sleep or I won't feel like stepping out tomorrow morning.

Diet advice...PO DAy 220

We are constantly being advised what to eat and what not to eat. And the rules keep changing. Remember the food pie chart from the 1950s? Red meat was the base! In the 1960s we were told to eat margarine instead of butter. Now butter is better.  Fish was and is recommended but not fresh water fish that is tainted by Mercury in the waters. And not big salt water fish that eat smaller fish that eat smaller fish building up more and more toxins. Fruits and vegetables can be contaminated with insecticides. Chicken has arsenic. Milk is radioactive at worst, too fatty at best. No soda, too much sugar. No diet soda, artificial sweetener is bad. No juice, the sugar thing again. 

Now research says salt is not as bad as we thought.

TIME (1/20, Sifferlin) reports that while “it’s currently recommended that adults aged 51 and older consume less than 1,500 mg of sodium a day for better heart health,” research published in JAMA Internal Medicine suggests that “consuming up to 2,300 mg of salt isn’t associated with greater mortality, cardiovascular disease, or heart failure in older adults.”

        Forbes (1/20) contributor Larry Husten writes that investigators “analyzed 10-year followup data from 2,642 adults between 71 and 80 years of age who participated in an observational study and who had their sodium intake assessed based on a food frequency questionnaire filled out in the second year.” Husten writes, “No significant relationship was found between sodium intake and mortality or the development of cardiovascular disease or heart failure.”

I'm glad to learn this but I don't know who or what to trust anymore. I guess we just have to eat everything in moderation. What's bad today will be good tomorrow and what's good today will be bad tomorrow! At least ice cream remains a healthy choice. :)

Can do - Can't do...PO Day 219

I feel like I have turned a corner in my recovery but it has happened so gradually that I can't pin down a date. I am right at seven months post op and it has happened in the last couple weeks. No bells went off, no fireworks lit up the sky, no one noticed, not even me. But things have certainly improved.

I've mentioned that the pain on the front side of my upper arm is all but gone. I don't know when that happened. The sharp pain On the back of my upper arm associated with position is still there but now I have hope it, too, will eventually resolve. I have been sleeping very much better and I attribute it to less discomfort in the night. I'm glad for the better sleep but I was enjoying being an early riser for the first time in my life.

Gradually my operated arm-shoulder is getting stronger but I still can't lift heavy items with it. A gallon of milk is a challenge. I can carry weight with that arm hanging down to my side but cannot lift it higher than my waist.

I can sleep on my right side! I probably wouldn't stay on the operated shoulder all night but I can shift back and forth. I do still sleep with several pillows which pad and support the shoulder.

I can wash, comb, brush, curling iron, and color my hair! Now I am trying to decide if I will keep it cut as short as I have had it. It has been a blessing to not have to worry with it. I missed my last hair appointment so my very short hair is now normal short and I can see it requires more attention. Have to make up my mind by the 29th.


The door that sticks still gives my right arm a little trouble. Pulling or pushing with the operated limb hurts and isn't very effective still. Even pulling out the top drawer of the bottom freezer, the one with the ice tray, has to be done with the unoperated arm. 

Driving is going well. But tight turns still tweak my arm. I've found that rotating my hand and grasping the inside of the wheel is easier than grabbing the outside of the steering wheel. Don't know why but it works better. Otherwise, eveyrthing is pretty much normal.

Kitchen work is great. I did have a lot of trouble cutting with a knife. No strength and it hurt. But I would say I am pretty normal now. Dipping ice cream is still difficult but where there's a will there's a way. And I am motivated. Putting up dishes on the second cabinet shelf is easy. I don't favor my 
operated arm any more. Stirring stiff cookie dough can be too hard but I use the mixer more for jobs like that.

I use my unoperated arm-hand to grasp the railing going up or down stairs. I wouldn't trust my operated side to be strong enough to stop a fall. 

My range of motion is great! Except for being able to reach behind my back I really don't have much limitation. 

Except ... When putting on or taking off a jacket. That still drives me crazy. I can't get my right arm back to facilitate putting the left arm into the sleeve and I can't do that little shoulder roll that helps to drop the jacket off your shoulder when removing it. I'm getting better though. Practicing. I will wear out my suede jacket without ever leaving the house.

I avoid putting weight on that arm getting into bed or rising from the floor. The bed thing creates the "flop" but lots of pillows and an uncomplaining bed partner help. Getting up off of the floor is not pretty-hope no one is watching.

I'm sure there are other things to mention but you get the picture. Things are better. I won't dissemble, this has been very difficult. It was difficult before surgery and difficult since surgery. Maybe the toughest thing I have gone through. Definitely not for the faint hearted. But there seems to be a p dim light at the end of the tunnel. I just hope it's not a train. 




                                                       












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.  2015 January-current events.

Prescription Addiction...PODay 218

The first time I had an appointment with my orthopod there was a whole sheaf of papers to read and fill out and sign. One document asked the patient to sign that they (me) understood that their office would not prescribe pain medication for longer than three months. After that, if the patient had unrelenting pain they would be referred to a pain management clinic for treatment. This applied to both medically managed patients as well as surgical patients.

Wow, I thought, that sounds a bit harsh. I was not on any pain medication so wasn't thinking about myself. That's not to say I wouldn't have taken a pain pill for my shoulder  pain. They just didn't help at all so it was not an issue with me. But I know of lots of folks with orthopedic pain who might want some pain pills longer than that. I didn't understand the problem.

According to an  article in the New England Journal of Medicine, prescription drug abuse is a big problem. In 2012 clinicians wrote about 259 million prescriptions for opioids, enough for every American to have one bottle. And to make it sound even worse, opioid use declined from 2009 thru 2010 when it rose again.

According to the Center for Disease Control, narcotic painkiller sales rose 300% between 1999 and 2008. In 2010 prescription overdoses with opioids resulted in 100,000 emergency room visits. Two thirds of ER visits for overdoses were for prescription overdoses. Increased opiate drug sales matched an increase in theft and abuse.

So that explains why physicians are reluctant to write an RX for pain medication. But solving the drug problem is not that simple.

Unfortunately, as the prescribing of opiate  pain medication went down, there was an increase in heroin abuse and illegal drug overdoses. As ordinary middle class people find they are unable to acquire pain meds legally, some turn to seeking out illegal sources of heroin. Adam Bisaga, MD, an addiction specialist in New York reports, " the solution to addiction must involve treatment rather than just simply trying to restrict legal access...You see drug cartels expanding into smaller towns. Heroin is reaching rural areas where it was never seen before."

Hopefully pain management clinics are waging war against drug addiction on two fronts, reducing opiate RXs and getting addicted patients into treatment.  This certainly gives me a better understanding of the difficult position a physician is in.

Scrubs as apparel...PO Day 217

Until I was hospitalized for my rTSA surgery and subsequent collapsed lung I wasn't exposed to hospital couture. If I thought about doctors and nurses I visualized the docs in white lab coats and the nurses in white dresses with little white hats and white stockings. I know, boy was I behind the times. Now everyone wears "scrubs." The pajama looking ensemble used to come in one color., forest green and was strictly worn by surgical personnel. It was accessorized with a skull cap and sometimes a face mask. Oh, and matching booties.

What I know now is that everyone in the hospital wears scrubs. In my hospital you could identify the person approaching you by the color of their outfit. Blue scrubs were respiratory, pale blue was food service, forest green kept the traditional surgical area, etc. Nurses seemed to have a bit more freedom, their scrubs could have patterns like themed holidays or cute little animals or polka dots. But scrubs were ubiquitous.

Now, with everyone working to lower the risk of hospital caused infection ( see yesterday's post ) scrubs have come under scrutiny as a source of germ transportation. Research by germaholic, actually he's a biologist, Jonathon Eisen of UC Davis has shown the "uniform" is a source of transporting hospital born germs from in hospital to home or wherever the scrubs travel.

Hospitals like Children's Hospital of Philadelphia, for instance, have a standing order that scrubs used in surgery or in areas where sterilization takes place (instruments), those scrubs are not to be worn outside of the hospital. I'm not sure if the intent is to protect the scrubs from outside contamination or to protect the outside from being contaminated by the scrubs. But Eisen says the scrubs tend to become contaminated with the very germs we are trying to eliminate, MRSA and C. Diff, which are prevalent in the hospitals and less in the real world. So wearing hospital scrubs at work and then off
work spreads the bad germs, according to Eisen.

Also, watches and wedding rings harbor germs between the metal and the skin. Neckties and sweaters    can be a problem since they are not frequently laundered. And that doctor's white lab coat? A veritable smorgasbord of bacteria!

The article I read did not really offer a solution, just pointed out the problem. Would the germ transportation be any different if nurses went back to starched white dresses? Is the idea that hospital work clothing would be left at work to be laundered there? Is there some innate reason scrubs attract more germs than other apparel? Is the family of  the hospital workers exposed to a greater number and variety of germs because they are brought home on the employees' clothes?

Maybe the doctor IS better and safer in those green scrubs. But lose the skull cap and mask for lunch, please!

Hospital infections...PO Day 216

Five years ago the Department of Health and Human Services looked at the rates of hospital caused infections and found them intolerable. 600,000  patients a year are sickened by infections acquired while hospitalized and 75,000 die of the infections. A five year plan was established to eliminate hospital acquired infections. The time is up and Consumers Union, a division of Consumers Report, has looked at the results of the program.

3000 hospitals reported their infection rates over the five year time period. While there was improvement in most areas the improvement rate was small and the industry did not meet the goal of eliminating hospital acquired infection.

In summary:

Most states significantly reduced "central line associated bloodstream infections but it appears that most of that improvement occurred in the first couple years of the program and by 2013 most states did not show continuing improvement.

Except for abdominal hysterectomies, surgical infections rates were somewhat improved. Other surgical procedures showed good reduction in infection rates, especially hip and knee replacements surgery.

The rate of Catheter-associated infections actually rose 6% and proved to be the biggest challenge of the study.

MRSA AND C.difficile infections cause more than 25,000 deaths each year. In regards to MRSA,  24 states did significantly reduce their rate of this dangerous infection,  seven states actually had higher rates and the rest showed no change. Most states showed an improvment in dealing with C.difficile. This data is not really complete as it only identifies infections that showed up while the patient was in hospital and most infections aren't identified until after the patient is released.

So, there have been small strides. Some hospitals have shown more improvement than others, as you would expect. 

"The CDC does not disclose hospital-specific rates for the infections covered by this report, but these can be found on the federal Hospital Compare web site.  Many states provide hospital-specific 
reports also, some covering more infection measures than are reported nationally. Go to the Safe 
Patient Project for links to these state reports."

Having a catheter may be a necessary part of your hospitalization but it remains a stubborn risk for infection. Removing it as soon as feasible is a good idea. 

Doctor at the mall...PO Day 215

Back in the early 1990s I went to work part time for a doctor who was going to open a satillite office in our small town. He was looking for just the right location, one that presented the right professional atmosphere. I remember him saying they wanted to find someplace in a professional office park, definitely not a commercial site like a storefront setting in a plaza or mall. Image was everything.

The times have certainly changed. There are 9,400 walk in clinics in the U.S. and fully one third of them are in a mall! It's the perfect marriage of commerce and health care. The mall management is happy as medical tenants tend to pay higher rent, have better credit and stay longer with a good lease. The patient is often a person without a regular physician who is trying to avoid the emergency room. When they discover the mall located walk in clinic they aren't thinking it is less professional than the stand alone doctor's office. The clinic in the mall has high visibility and offers the convenience of one stop shopping. They are thinking, " how convenient."

These walk in clinics often mirror the hours that  the retail mall businesses adhere to. And not just hours which can be 10:00 AM to 9:00 PM, but days too, to include the weekend days. These are family friendly enterprises and are very well staffed. Illness is not the only reason patients go to them. School physicals for sports, routine vaccinations, medical permission slips and insurance health exams are just a few of the services a well-patient facility can perform.

With many new people enjoying health care due to the Affordsble Healthcare Act, these clinics can become very busy. Right now they tend to be staffed by board certified doctors and RNs. As nurses with advanced training gain greater responsibility it may be that we see more clinics operating with nurse practitioners. Either way, the bill for being seen in a walk in clinic is often one fourth of the bill for the same care at an emergency room. Many new health care owners, due to Obamacare, have high ER deductibles and are happy to embrace the less costly walk-clinic often retired to as the "Doc in a Box."

Right now this type of medical facility is expanding all over the country. There is still pent -up demand for the in-and-out health care facility. The industry is growing so fast that it is possible that
supply will out distance demand and not every walk in clinic  will be a commercial success. But right now the majority of clinics are in the right place at the right time.

Just keep in mind that these clinics are relatively new. If you need to visit one, be patient. They are still working out the kinks. And allow time for a little retail therapy and a soft pretzel.

Technology...PO Day 214

Yesterday we had a new air conditioning/heating system installed. Living close to the ocean means you replace your equipment more frequently due to rust caused by the salt spray. The new compressor's ID ends with the letter C which stands for Coastal and implies it will hold up longer. We'll see. But one thing we asked for and got was a thermostat that is not smarter then we are. Our ten year old thermostat always thought it knew more about heating and cooling than we did. It was programmed to conserve energy. If we were cold and tried to raise the temperature it would only allow the warmer temp for four hours, then it would revert to the chilly environment sure to save the planet but freeze us.  Ditto if we were hot. You could tell it to make it cooler but first thing you knew it was back up to 80 degrees. Thank goodness for ceiling fans.

It's not just us. Our neighbor confessed that they had changed their Netflix membership to streaming from DVDs in the mail. Problem is that they had not been able to watch a single movie since as they can't figure the new system out.

It took us a while to give in and agree that our car knew when the doors should be locked or not. When our mechanic could not get the flat tire warning light to go off I had to google the question. We've learned to thwart the garage door opener by setting a rake in front of the electronic eye. Before that the garage door had a bad habit of closing while we were unloading the trunk of groceries. Actually that may have been operator error.

Our new dryer resembles the controls of a Boeing 747. Dear husband used to occasionally move wet laundry from the washer to the dryer and start it. Not anymore. There is a way to override the preprogrammed settings but I think the dryer and our old thermostat have the same environmental goals in mind.

My iRobot vacuum is sending a message that sounds like  the tune from Close Encounters of the Third Kind. Problem is that it is nothing like the messages described in the manual. I don't know what it is trying to tell me but it won't run until I decipher the code. I hope it is not a message from extraterrestrials.

A few years ago while at Dear Daughter's house I decided to use her washer. I managed to figure everything out except where to add the detergent. It is futile to ask a four old how to operate the washing machine or where the soap goes. They are only good at solving  computer problems.

My husband marvels at my ability to remember phone numbers. What he doesn't know is that I can't figure out how to save phone numbers on my new cell phone. So it is easier to just remember the numbers.

Right now I am going downstairs and change the thermostat and dare it to argue with me!

Repeat flu warning...PO Day 213

Gallup, best known to me for political polls, turned its attention to the flu in December, just past. With four percent of the population reporting they were sick with the flu, this was the highest incidence of flu in the years they have been covering the subject, since 2008.

The ordinary flu was not getting much attention. At that time we were pretty obsessed with Ebola which was really only an issue if you had been to Africa or worked with patients infected with Ebola. So while we were worrying about a disease that was quite unlikely to infect us, the ordinary flu was doing its damage. Especially at risk are small children and people over age 65. Already this flu season 21 children have died from the flu. Such statistics are not collected for adults.

How can you tell if it's the flu? Flu symptoms include: • A 100oF or higher fever or feeling feverish (not everyone with the flu has a fever) • A cough and/or sore throat • A runny or stuffy nose • Headaches and/or body aches • Chills • Fatigue • Nausea, vomiting, and/or diarrhea (most common in children).

We're not out of the woods yet. Historically, January and February have been the worst months. Unfortunately, the variety of flu for which the vaccine was developed is not the specific variety that is most prevalent thus year. Still, being vaccinated does some good. Also seeking medical help early in the illness is a good idea. Even if it means enduring the ER experience!

According to the government web site "Antiviral drugs are prescription drugs that can be used to treat the flu or to prevent infection with flu viruses. Treatment with antivirals works best when begun within 48 hours of getting sick, but can still be beneficial when given later in the course of illness. 
Treatment with flu antiviral drugs can make your illness milder and shorter. Treatment with antivirals also can lessen serious flu complications that can result in hospitalization or death. Antiviral drugs are effective across all age-and risk groups. Studies show that antiviral drugs are under-prescribed for people who are at high risk of complications who get flu."



 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.  2015 January-current events.

When did it happen....PO DAy 212

Have I not been paying attention? I thought I was a good observer but apparently not.

Sometime this afternoon I realized that one of the two painful areas in my operated arm did not hurt. Was it a momentary relief? When did it stop hurting? I stretched, raising and extending my arm...no, it did not hurt in the front bicep area which was one of the two spots that had been exquisitely tender. I've pointed this tenderness out to the orthopod every time I've seen him. His standard response is "it's where the deltoid muscle is now attached to the bone and hopefully with time the pain will ease off." At nearly seven months post op, I have to admit, I had pretty much resigned myself to it not easing off.

That was okay. I accepted the discomfort as a trade off for having a good functioning arm. The pain was sharp and was an instant reminder to stop moving one's arm in the manner that was causing the pain. But it also hurt in a low grade chronic kind of way and was at least partially to blame for my poor sleep. Positioning oneself to go to sleep brought out the worst of the discomfort. Interestingly, I have been sleeping better the past few nights. Could it be because some of the pain has disappeared? And I didn't even know it!

Did I do something to alleviate the pain? Perhaps. I still have a problem putting on and taking off a shirt and especially, a jacket. It is really annoying. So I have been practicing putting on and removing a suede jacket. I chose the suede jacket since it does not stretch and that usually increases the frustration factor. Anyway, I have been struggling into and out of the jacket six or eight times a day for the past few days. And it's been getting easier! Not perfect, but easier. I'm still at the point that the procedure isn't pretty. If I were wearing the jacket out in public I would leave it on or leave it off and not submit others to the spectacle. But at least I can now do it! Could this manipulation be the explanation?

I think it's the only explanation. None of my exercises cause me to maneuver my operated arm behind my back. When I was given the exercises putting my arm behind me was totally forbidden. I am now allowed that position so long as I don't force it. Well, whatever the reason, I am very pleased  to realize the pain has abated, changed in a positive way.

Is this an example of occupational therapy? Therapy designed to help one do the ordinary things in life? Or should I call it fashion therapy? I love this little suede jacket and it doesn't look as if the weather here is going to get cool enough to wear it! So I get a little thrill every time I put it on.

Whatever. I am just so glad to recognize the progress I have made!




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.  2015 January-current events.

Money for drugs...PO Day 211:

If I say "consulting payments" in the same sentence as my doctor's name, most would conjure up an image of him looking at an x-ray, shaking his head, and conferring with other physicians about what to do for this complicated  case he's been called in on. Or if I am not happy with the treatment I am receiving for my poor shoulder I might ask for a second opinion and be seen in consultation. Medicare would gladly pay for the tests and the visit, "consulting payments" would be a good name for that service.

But the modern use of the phrase does not come across as so noble. Pharmaceutical companies aggressively market their products, drugs. The market is competitive and profit driven. Companies have spent small fortunes developing new drugs and it is understandable that they want and need to recoup those costs. One approach is to make the new product interesting or attractive to the physician or hospital.

Under the Affordable Care Act, all drug makers are now required to disclose payments they make to doctors, those payments we're calling consulting payments. A company that is sponsoring a drug research program may pay out hundreds of thousands of dollars in speaking and consulting fees, spread out affecting dozens of doctors wallets. While these payments are not tied to any contract requiring the doctor to endorse their drug, they do influence which drugs the physician prescribes.

This data is now available on line at http://cms.gov/openpayments/

ProPublica, a business research reporting entity, compiled a list of the top twenty drugs  being promoted by drug companies paying the most in consulting fees. They are:

Victoza (diabetes), Eliquis (anti-clotting), Brillinta (a blood thinner), Invokana (diabetes), Latuda (schizophrenia), Xarelto (anti-clotting), Humira (arthritis), Tudorza (COPD), Daliresp (COPD), Abilify Maintena (schizophrenia), Abilify (schizophrenia), Linzess (IB Syndrome), Pradaxa (anti clotting), Tradjenta ( diabetes), Belviq ( weight loss), Copaxone (multiple sclerosis), Samsca (hypo atremia), H. P. Acthar (infantile spasms), Symbicort (asthma), and Aubagio ( multiple sclerosis).

Interesting how we are familiar with many of these new drugs because they are prominently featured in TV ads during the news hour every night. I'm not sure how effective the ad campaigns are. Most of the ad time us taken up with describing the fearsome side effects of the drugs. I love when they wrap it up listing "even death" as a possible complication of the drug. It doesn't make me want to rush into my doctor's office for the latest new treatment!

By the way, possibly because of advocacy groups pushing drug makers to disclose payments to doctors, consulting payments have gone down a little. Perhaps the addition of the Affordable Care Act scrutiny will have more of a good effect.









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.  2015 January-current events.

Doctor shortage?...PO Day 210

There is lots of talk about a looming shortage of physicians. The aging of America is the main reason. With baby boomers entering the era of medical high usage the demand on the medical industry will be felt primarily by over extended medical doctors.

But, according to a piece on National Public Radio in November 2014, many health care experts and economists think the potential problem is exaggerated. Oh, everyone agrees that the demand will increase. The disagreement is over how to deal with it.

The Association of American Medical Colleges predicts that the country will need more than 90,000 more physicians by 2020. But health economists like Gail Wilensky believe they don't all need to be medical doctors. She believes expanding the scope-of-practice laws for nurses, pharmacists and other ancillary medical personnel would eliminate the problem.

The issue is being publicly debated by doctors and the Veterans Health Administration. The VHA has proposed to allow nurses with advanced training practice medicine without physician supervision. 6135 advance practice registered nurses, nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists within the VA Health Care System would be allowed to care for patients.

Doctors argue that this move would hurt a health care system struggling to care for an influx of veterans dealing with serious physical and mental issues. Nurses say it would deliver high-quality
care in a more timely manner. The American Society of Anesthesiologists said allowing nurse anesthetists to work without supervision would decrease quality of care. They believe a physician is better equipped to handle emergencies. Nurse organizations believe physicians are concerned about protecting their jobs.

Physicians contend doctors provide  a higher quality of examination and consultation than nurse practitioners, who naturally disagreed, and believe their expanded role would reduce costs of medical care.

How this issue is decided within the VA system will certainly have a trickle down influence across the entire medical industry. It bears watching. I'm not sure whose position I lean toward. I have had exposure to several nurse practitioners and have found them all professional and competent. On the
other hand, I have never seen any cost saving benefit from being seen by a nurse practitioner. The "doctor bill" has never demonstrated the purported savings suggested using an ancillary medical professional would provide.



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.  2015 January-current events.

Male nurses...PO Day 209

Between 1970 and 2011 the percentage of male registered nurses went from 2.7% to 9.6%. It's not a huge change but enough that we are seeing male nurses commonly now. Similar increases have occurred among licensed practical nurses and licensed vocational nurses. Even in an industry dominated by women, male nurses tend to earn more. Schools are actively working to recruit male students for nursing programs.

During my hospitalization post rTSA there came a day when my nurse de jour was a young man.  If you had asked me years before, two months before, even two days prior, I would have declared my neutrality and endorsed the idea of male nurses soundly. But reality is different from theory. I just couldn't see having the same intimate relationship with this young man. I'm not crazy about asking Nurse Mary to help me go to the bathroom or get dressed but it can happen. But get Nurse Gary to take me to the bathroom? I don't think so.

How to explain it? Of course I have had my share of male doctors, even gynecologists. But the patient-doctor relationship is totally different from the patient-nurse situation. The doctor is clinical, detached, authoritative. The nurse is intimate, attentive, personal...the ultimate example of the caregiver. No Nurse Ratchet for me, my nurse is Florence Nightingale, Clara Barton and Mom rolled into one. Perhaps the next generation can see Nurse Gary in that role. 

The fact is male enrollment in nursing school is increasing. Just as women are expanding into traditional male dominated careers, so are men looking at fields that used to be female only. Retraining or second career choices are drawing men to nursing in ever greater numbers. Certainly 

there is a niche for male nurses to work with male patients. Men have been putting up with the gender awkwardness forever, having only female nurses to rely on historically. It's only fair that we women now face the same sensitive situation. 

But having a male nurse definitely encouraged me to figure out how to manage a few personal tasks on my own.

Enough seriousness...PODay 208

OK, I've been serious for several days in a row. If I didn't quite stick to topics regarding shoulder surgery, I did stay in the medical realm. But what is really on my mind is making a list of New Year's Resolutions. I don't think, for one moment, that I will be able to stick to them all but it doesn't hurt to have goals and aspirations for the coming year.

There are the tired and trite resolutions to exercise more, lose weight, clean out clutter, etc. Of course I need to do all of those things but I've been promising to do them for decades. I think it is time to take a new approach to doing a better job with my life.

Does that mean I have to befriend the neighbor I don't speak to? Has Hades iced over? Must I really eat less chocolate? It is a main staple in my diet. Cut back on TV watching? It's true, it's constantly on but I'm not really watching ALL the time. Quit procrastinating? Maybe next week. I don't smoke or drink (much) so it would not be much of a sacrifice to give up. Be kind to old people and small children?  There are no small children around here, just annoying old people. Spend less time on the computer? Then I would just spend more time watching TV. Shall I go to bed earlier? Any earlier and it would still be light outside! Should I get up earlier? Any earlier and you couldn't call it morning! I could swear I'd go to doctors less but once they get a grip on you, you lose control.

Maybe I'll just muddle along, try to exercise more and lose a few pounds. I could clean out some closets, that would be good. Sounds like a plan.

Happy New Year!













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. 

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.