Monthly summary...PO Day 288

It's the last day of the month and I usually try to sum up my medical situation then. Well, not my whole medical situation...unfortunately post rTSA surgery is not my only health issue, but the only thing I talk about here. Medically, I mean.

I think I am doing great. I use my right arm, the operated side, almost normally now. The bedroom redo really put it to the test. Even a little hammering was required. I absolutely could not strike a small nail with the hammer in my left hand. I am still more ambidextrous than I used to be but I think that is largely due to habit.

Lifting weight is still a bit of a problem. The gallon of milk is my bellwether. I think, full, it weighs eight pounds. I've developed an interesting pouring technique, letting the weight rest on the counter and just tipping the container to allow the milk to flow into the glass. I might have to hold the glass below the counter height to allow it to fill. Haven't poured milk all over the floor yet!

Even stretching to reach the socks that hang out in the back of the dryer drum is possible. I may have to give the cute and functional "grabber-picker upper" to the grandchild who found it at Cracker Barrel and insisted I needed it. He was right!

I have pretty much full range of motion now. There remains some sharp pain if I move my arm behind my back. But even that is improving. I can tie an apron behind my back with difficulty. I would not be able to hook a bra in the usual manner and still wear my converted front closure bras. I think I'll probably always have do that. I am not doing range of motion exercises anymore. But I do stretch several times a day.

Reaching up to get somethings off of the third kitchen cupboard shelf is no problem, or at least it wouldn't be if I hadn't shrunk. I am just shorter than I was. Can't blame that on rTSA surgery. I don't have any excuse for not hanging up clothes in the closet now. I am truly  surprised at how well my shoulder allows my arm to move.

Scrubbing something, a dirty pan or a shower wall, is a little difficult. It requires both strength and coordination. I can do it but it's a little hard. I bought some rinse off tile cleaner to use for the interim. I just have to tough it out when faced with a dirty pan. The day is coming when I am going to have to spend the day really cleaning pots and pans. They have been a bit ignored this past nine months. At least I don't have any copper bottom pans.

I haven't taken any pain medication for my right shoulder in months. Just don't need it. I did apply ice  and heat in the first weeks, even months, after surgery. And took the occasional ibuprofen in the early days.

I can roll over in bed and even use my right arm to push myself around in bed. It's minimally uncomfortable to   lie on the shoulder for any length of time. And I still have five (!) pillows to help pad and support elbows, knees and heads.

So yes, I   do have some limitations but I am doing great. It's been nine months and I can honestly now say that things are pretty much normal. But it has taken a full nine months. I think of myself as a fast healer and pretty tolerant of medical adversity so I would predict  that recovery period for most people.

Oh, likewise the residual breathing problems following the pneumothorax are gone. I am no longer breathless so much of the time. That did take a long time to resolve. But I feel like my lung capacity is back to normal.

I don't see my surgeon again until June, one year post surgery. I should be 101% by then. Looking forward to it!

no exercise but...PO Day 287

I have not been exercising but I have had tons of energy. Is there any relationship?

Normally I walk every morning, two and a half  to maybe three miles. I don't walk fast so I am not exhausted when I finish but I am a little tired. My friend with whom I normally walk has had company and committments so she has not been the incentive I obviously need. I feel guilty but wow, I have been full of energy for projects around the house. Is it just because I am not exercising? I've always  heard that exercise gives us more energy

It started with the plan to change our bedroom. New curtains had that trickle down effect which meant cleaning, as much rearranging as possible, touch up painting, a new (albeit old) bedspread, new pillow cases, some wall things removed and replaced.

Sewing the curtains caused me to sort out fabric and trims. I found material I bought about seven years ago to make a dress for a granddaughter. Now she is too old for green frogs on lily pads and peach polka dots so it became a cute apron. One apron turned into three and now I can outift visiting chefs.

I cleaned out my craft closet. Well, maybe not "out," more "up." I can't seem to throw anything away. If I do, I almost immediately need it. I'm not a hoarder but admit to owning a bit of clutter. We've added on to our house twice and both times included extra storage. It didn't help a bit. My house keeping operational mantra is "clutter rises to meet available space." The only way to  have less stuff is to move to a smaller house.


Next project is to get outside and rake some oak leaves. Unlike the rest of the world, our oak trees lose their leaves in the spring as the new growth pushes the old growth out of the way. Leaves are mixed with catkins and thick yellow pollen.When it rains overlapping rings of yellow pollen line the borders of  where puddles stood but have evaporated It looks as if the street is decorated with chaotic olympic circles.

So, am I only so productive because I am skipping the all important formal exercise? As we all know, house work or yard work do not count as exercise. Instead of burning more calrories I think house work just makes us hungry and we eat more. Well, my walking partner's company is about to leave, a short respite before the next wave arrives. So we'll see if my mood prevails or if I revert to my old lazy self.

air pollution...PO Day 286

Recently in The Week magazine there were  two different articles two weeks apart about air pollution due to car exhaust pollutants called nanoparticles which have been linked to heart and lung disesase.  I was surprised and hope things are different in the US but maybe not.

The first study was by researchers in Surrey, England. Sounds like a pretty civilized and forward thinking part of the world. Surely their cars are properly equipped to protect the public from pollutants. The researchers analysed the driver's exposure all along their route in their daily commute. Drivers were exposed to 29 times more pollutants when stopped at red lights than when their car was moving. The conclusion or solution was that one should keep their windows closed and not pull up close to the car in front of you which is emitting the hazardous fumes. Pedestrians shoould be aware of the exposure they receive when at such intersections. One suggestion was to change your route to avoid busy intersections. No mention was made of bicyclists but they must really be at risk.

The second study was in Barcelona, Spain and was reported in The Week separately. Researchers tracked the developmental progress of over 2000 school children between the ages of 7 and 10 years old. The chldren were distributed at 39 different schools in the city. They learned that children who attended schools near congested roads, where air pollution was measurably higher. developed cognitive skills at slower rates than children who were exposed to less pollutants. For working memory, such as being able to recall items on a list, chldren exposed to greater polluted air improved their memory score by 7.4%, while children breathing cleaner air improved by 11.5%. It doesn't sound like much but which group would you want your child in? Their solution? Install particle filters on school buses and keep windows on the road side of the buildings closed. Ideally traffic in and around schools should be kept to a minimum.

Are things better in this country? Are the emission controls that our auto manufacturers implement mote strict? Maybe in California. All over? I don't know. Does being in an air conditioned school help? I would think so. Of course that does not change the exposure at the stop lights. Most, maybe all, American cars are now equipped with air conditioning but that really doesn't keep the bad air out of your car. There's that little button you can push to recirculate air or bring in outside air but I am never sure which is which when you push it.

Neither article described, in lay terms, the state of pollution in the cities that were studied. I'm just hoping that all the fuss raised by the EPA over the last 20-25 years has actually worked for the good and our intersections and especially our schools are swathed in cleaner air than in Surrey and Barcelona...not wishing them ill. I wonder if Englamd and Spain have crusaders who hold the government accountable for things like air pollution. I hope so.   

More About Tor...PO Day 285

Following up on yesterday's entry...I went to torproject.org and learned a lot about Tor as a web browser, how it works and who can use it. I'm thinking about it but haven't done it yet. I'm a little nervous installing new software on my equipment. Experience has taught me that things can go wrong. If I was smart I would install something new on one device and wait a while but I usually jump in with both feet, or I should say two iPads and one laptop.

In this case I will be limited by circumstances as Tor requires OSX which my older equipment does not have. Fate is looking out for me.

Here's what the Tor homepage says:

"The Tor software protects you by bouncing your communications around a distributed network of relays run by volunteers all around the world: it prevents somebody watching your Internet connection from learning what sites you visit, it prevents the sites you visit from learning your physical location, and it lets you access sites which are blocked.

The Tor Browser lets you use Tor on Windows, Mac OS X, or Linux without needing to install any software. It can run off a USB flash drive, comes with a pre-configured web browser to protect your anonymity, and is self-contained."

I wonder if the Clintons' private server used Tor. That would be a really great endorsement and, given the state of affairs, would have been very wise. Has everyone else always known about this? Finally, how great they provide this for free. The website does suggest a donation, much like Wikipedia does, which seems quite reasonable. 

On line identity...PO Day 284

I just read about a father who was teaching his little daughter to make up things about herself when asked for information on line. While he didn't want to encourage lying, he didn't want her to reveal too much about herself. It's not a bad idea.

We are all building an on line identity every time we place an order, fill out a survey, do a google search or send an email. Even though we are wise enough to not answer the most invasive questions, like what is your annual income (!), the great computer in the sky knows. Dare we give fictitious answers when asked irrelevant questions in our doctor's office? Will a glib, somewhat smart aleck, answer follow us to our grave?

Google, Bing and Yahoo all track our activity, not for nefarious reasons, but to create personsl data banks to use for commercial reasons. Facebook encourages sharing personal details of our daily lives, including the activities and whereabouts of our children. Ebay knows what we buy and what we sell and what we window shop for.

Is it possible to live a modern life and maintain some level of privacy? Yes, but it isn't easy and definitely requires more knowledge and dedication than I have. A starting place to anonymize your on line self is Tor, according to Wired magazine.

"Though it’s hardly the sole means of achieving online anonymity, the software known as Tor has become the most vouchsafed and developer-friendly method for using the Internet incognito. The free and open source program triple-encrypts your traffic and bounces it through computers around the globe, making tracing it vastly more difficult. Most Tor users know the program as a way to anonymously browse the Web. But it’s much more. In fact, Tor’s software runs in the background of your operating system and creates a proxy connection that links with the Tor network. A growing 
number of apps and even operating systems provide the option to route data over that connection, allowing you to obscure your identity for practically any kind of online service."

I haven't tried it and don't know anything about it so this is not a recommendation, just a discussion.  I don't even know what operating systems it is compatible with. I certainly have as little as anyone to hide. But the day my real name and identity appeared on my blog ( through my fault changing my google account ) I was absolutely panicked until I could reestsblish my Willet persona again.  Of course it only protects me from persons as inexperienced as myself.

Value based care...PO Day 283

Healthcare in the USA is undergoing a sea change. The move is from a "Fee for service" System to a "Value based Purchasing" plan. Part of the motivation is to reduce costs, part is to improve the outcome of treatment. Most insurance plans are making the shift. Certainly Medicare is embracing the new healthcare model.

Under the old Fee for Service system each visit or test was billed and paid for individually. Some think this incentivized the medical industry to order more medical encounters without regard for results. Value Based Purchasing, on the other hand, pays for service based on outcome and penalizes providers for excessive visits, tests, and poor results. A huge component of value based purchasing is analyzing data to establish protocols of care that save money and ensure positive results for the patient when all is said and done.

A big part of Value Based Purchasing care is patient satisfaction. If you have had much medical treatment lately you have probably been solicited to complete questionnaires with detailed inqueries about every aspect of your treatment from how long you had to wait to see the doctor to how responsive the nursing staff was if you were hospitalized.

The reason there is so much importance placed on readmission rates is that this is one area where financial penalties are pretty stiff. If hospitals can demonstrate a savings in what it costs to treat, say.
a rTSA surgery they are rewarded by sharing a portion of the money saved. If the hospital's cost is higher than Value Based Purchasing thinks it should be, then the facility is penalized.

I know I am not doing a good job of explaining how value based purchasing works. It is very complicated and we are just beginning to make the shift from pay for service healthcare. Certainly time will demonstrate if it is good medicine and cost effective. Let's hope it proves to be both.

brain exercise...PO Day 282

For complicated reasons I am unable to correct the typos in today's post. Please forgive the errors.

Not too long ago I was looking for some small entertainment for Dear Husband and me to do together. Card games were boring with just two participants, ditto board games. Scrabble was too competitive and had too many rules.By chance California daughter sent us a puzzle for Christmas and it was a hit. We can wile away an entire afternoon sorting through colorful pieces of perplexing puzzles.

At first the puzzles were well behaved and followed the rules, restricting themselves to the library/breakfast table. But, as the number of puzzzle pieces grew from 500 to 1000 to 1500, they began to take over every flat horizontal surface. Laminated place mats were no longer for plates and glasses, colorful puzzle pieces competed with flower and bird patterns. We learned to turn them over and let the puzzle pieces stand out on the plain cork background. But the puzzle demanded more room. A trip to the home improvemnt store produced thin plywood sheets cut to puzzle size dimensions, felt backing had to be ordered and glued in place. Finally the puzzle found a home on  a litttle used tea caart that can be rolled about. That's the puzzle in process of being assembled...the pieces awating selection are still spread out on breakfast table, placemats and plywood sheets. 

A vintage floor lamp was recruited to illuminate the "work" surface. With an extension cord connected the lamp can be moved about as the need arises with only minimal danger of tripping someone intent on locating a puzzle piece with "two innies, two outies and a red line on a yellowbackground.

There's got to be a name for the semi-hunched over stance of a person looking for a particular puzzle piece. Something like the Sanabel crawl performed by shell seekers on the west coast of Florida. Whatever one calls it, it is a back killer. Maybe rolling chairs were the solution! First one Ethan Allen General Bradford maple chair was replaced with a modern leather office desk chair that rolls. It was so popular with the puzzle piecers that a second such chair became a necessity. The old boring wood chairs had to be stored away to make room for the new mobile, pseudo-bumper car conveyances, that let you roll and spin and search. The only thing they lack is a motor.

Quickly an assortment of magnifying tools appeared. A lighted Sherlock Holmes magnifying glass equipped with a built in light was a gift. A vintage Bausch and Lomb leather cased magnfier like your dad used to have showed up. The ultimate tool, the jeweler's loop, made child's play of picking out that little detail that ruled in or out a particular puzzle piece. A couple flashlights joined the armementatium and a hunt ensued for old bifocal glasses that might have the right Rx for the
distance.

So, is all of this just to entertain us? Are we wasting quiet afternnons hunting puzzle pieces when we could be expanding out brains in some other more worthwhile activity? Not Necessarily.

Research shows that there is some good mental stimulation going on when one is working a jigsaw puzzle. Heaven knows, we can use some of that!

1. Memory Development: Doing jigsaw puzzles greases the synapess of the brain and is especially conducive to improving short term memory as you try to remember the details of the particular piece
for which you search.

2. Thought Development: You literally have to "think outside the (puzzle) box."  Your mind has to experiment, make choices, correct errors and reconsider. This is the kind of thought process that leads to invention and discovery.

3. Whole Brain Activity. Doing puzzles encourages whole brain acitvity, the combination of logic and creativity which is so useful in problem solving.

4. Dopamine production. in releases dopamine in response to small and large breakthroughs. Benefits of dopamine include a positive mood, better concentration, improved memory, and good motor skills.

5. Meditation. Working a puzzzle is a little like meditating. While it challengges the brain, it also relaxes the mind and reduces stress.

So, we are not wasting an afternoon. We are exercising our brains. And the total mess of puzzle pieces taking over the house is justifiable when you consider what it is doing for our intellect.

That's my story and I am sticking to it.

Wearables....P O Day 281

Athos, a start up Silicon Valley tech company, is taking exercise clothing to the next level.

Wearables is the new term for computer-tech devices that one wears that communicate with our smart phones, tablets, laptops, or computers to report our physical activity. They help us keep track of distance walked, calories expended, time spent - stuff like that. Ultimately the plan is that they will monitor blood pressure, heart ratae, O2 saturation, etc and facilitate virtual doctor visits. The upcoming iwatch is an example of the future wearable.

Athos has upped the game. They are introducing a line of exercise clothing and a "core" device designed to read each muscle's activity and report it. The clothing communicates with the core and the core reports to your device. Are you doing your crunches right? Is your left leg letting your right leg support too much of the weight when doing lunges? There is even a head band apparatus that analyses your brain waves to see if you are meditating properly!

The "core" costs about $199, the shirt is $99 and the pants are $99. If you look on it as having a personal trainer standing beside you critiquing your technique it is a bargain. I don't think the equipment is available yet.You can "reserve" your order right now.

This type of wearable device  is the next wave of computer driven personal IT equipment. The industry is expected to double its business in the next few years. It's the future. And it is here!

3-D printing...PO Day 280

I don't get 3-D printing. Oh, I guess I can visualize pouring some polypropylene beads into a hopper and duplicating a little toy soldier or cowboy. Apparently that is possible and even cost effective with the price dropping machines available to the home hobbiest.

But living tissue?

According to WebMD, it is now possible to replicate human tissue. The example they cited was a cancerous tumor. A sample of a patient's tumor can be used to create the actual tumor in the lab. Then different treatments can be tried on the tumor to see how they would work in the real case. Customizing treatment for the specific needs of the individual.

An example of creating an ear was used although I don't know if that is already possible. I have read about growing replacement body parts in the lab. Is a heart or a kidney far away?

What about a new humerus for rTSA surgery patients? Instead of a stainless steel rod inserted into a reamed out bone, there would just be your real lab-grown bone grafted onto the old. Would that be better? My " hardware" has never hurt. That just amazes me when I think about it. Does bone not have nerve sensation in it? According to Dr. Google, "The periosteal layer of bone tissue is highly pain-sensitive and an important cause of pain in several disease conditions causing bone pain, like fractures, osteoarthritis, etc." So, yes, bone feels pain. Wouldn't you think cutting the bone off, reaming it out and inserting a metal rod into the shaft would be eternally painful? Thank goodness, it appears not. The only ongoing discomfort I have had is from the muscle attachments and that is getting better and better, less and less, I should say.


Anyway, 3-D printing is moving from the factory setting to the laboratory and the possibilities are staggering. It's exciting and amazing what possibilities the future holds. But, for now, I am thankful for the medical advances that gave me the function and freedom from pain that my old-fashioned (!) surgery provided. 

sore shoulder...PO Day 279

I have a better understanding of why reverse total shoulder replacement surgery is for older people. The bionic arm or, should I say the new hardware, does not like hard work.

You know how one projects begets another, even before you have finishsed the first? Frustrated with the curtain progress, I looked at the family photos on the wall. There has been a photo of les deux belle filles (2 step-daughters) hanging there that isn't good of either of them. Time for it to come down. Replace one frame and the whole grouping is disturbed. More hole patch and touch up paint is needed.  There was minimal hammering involved. Just little picture hangers into dry wall but it taught me that roofing was not a career choice for post TSRA patients.

The only admonition my surgeon had was "don't fall."  But I have read that hammering is really tough on replaced shoulder joints. I can see it. The jarring motion, a forceful blow sudddenly stopped, distributes all that energy within the joint.

It does still amaze me how basically physical many jobs are. I guess I imagine there is a robot or a machine to do anything. But drive by a construction site, from a new house to a high bridge, and you will see workers climbing scaffolding, digging ditches, or scurrying up ladders to heights I would not consider safe. And more and more often, the worker is female. The other day, while stopped at a red light, there was a worker down on knees removing the form boards from a new cement sidewalk pour. "She" was struggling to get  a board loose and, as I watched her, the thought quickly passed through my mind that, while I admired her for doing such physical work, a guy would not be having such a difficult time. As the light changed, the girl stood up and turned around. It was a guy! His full, curly, long pony tail had fooled me. I had to laugh at myself.

Anyway, rTSA is not for young people, people who do strenuous jobs, or older folks who hope to continue playing singles tennis. I think you can get away with hanging a picture or two. Maybe even repotting some plants. But don't expect to dig up the "north forty" anytime soon.

What's up...P O Day 278

Perhaps twenty years ago I bought some lace curtain panels from a German women. I don't know lace but thought these were truly beautiful.. They are just panels about 60" long. I always thought that someday I would use them as curtains.

Well, if not now, when? So when the redecorate the bedroom urge came over me, I decided now was the time. Two small windows were easy to plan out. A lining with a lace overlay on rings on a an existing dowel rod. Simple enough. The rod and rings had to be painted and the first lining material was not a success but finally it worked.

But the sliding glass door? What to do? The lace panels were not long enough so they had to be added to a longer panel,then attached to the lining. Three attempts did not solve the problem of getting the joining seam level and even. It's getting better but there is still a definite wave to the line where the two meet. The three parts, lace panel - sheer panel to make lace appear longer - and lining, are heavy and cumbersome. The bracket had to be moved, more holes in the wall! Where is the leftover paint to touch up the wall? Where is the hole patch stuff? Oh dear, the cover on the ironing board is falling apart, that teflon stuff might come off on the lace. So it's off to buy a new cover. The two cans of spray paint barely covered the wooden rods and rings so I need more paint to touch up. And thread! I thought I had plenty but better buy sone more while I am out. One can't sew the rings to the curtain; how would you wash them when the time came? So it's back to the store to buy ribbon to sew to the finished panel - which isn't finished yet - to tie the panel to the ring to slip onto the rod to hang the panels. And it is up and down the ladder to hang the panel, then unhang the panel, over and over as that is the only way to accurately measure the length. the lack of doing was what got me in trouble with that seam in the first place.  Oops, need new finials for the rod ends. A trip to Home Depot should do. Yes, they had one style, only one, but it was acceptable and didn't require painting. The box they came in was a marvel in cardboard engineering. The one sheet of cardboard folded and tabbed and locked in a perfect design to display and protect the finials. But even when you thought you had released the last possible road block to removing the finial, it would not pull out of the box. What was holding it in? Further dismantling revealed there was a big plastic washer anchoring the screw fitting of the finial in place. You'd think they were made of glass.  Honestly. I could write an entire post on the subject of packaging that will not allow you to access the toy or cosmetic, phone or
food item that you purchased.

Wow, I have a new appreciation for anyone who makes curtains or sews lace. Or climbs ladders or installs "anchors" in drywall. I wonder what problem will arise today? How many trips to the store, how many trips up and down the ladder? And am I going to love these curtains when they are finished? Definitely! They are "over the top," ultimately girly, and totally impractical. Fortunately, dear husband can stand the feminization of the boudoir...the fact is, he would be hard pressed to know what was on the windows before and likely will not notice that each window now appears to wear a wedding gown.

Too much to do...PO Day 277

Willet is alive, just overhwhelmed wiht her projects. The curtain thing is really too much. Forgive me.I'll be back soon.

Going Out of business...PO Day 276

Rural hospitals are struggling to survive in the new business environment called medicine. It's not just cuts in payment but that surely has not helped.

Medicare payments have been reduced by two points a year, a significant amount for a small hospital to absorb.  Other problems, mostly involving money, include declining populations; disproportionate numbers of elderly and uninsured patients; the frequent need to pay doctors better than top dollar to get them to work in the hinterlands; the cost of expensive equipment that is necessary but frequently underused; the inability to provide lucrative specialty services and treatments; and an emphasis on emergency and urgent care, chronic money-losers are at play.

Losing its hospital is kind of like losing its heart in a small town. Life revolves around the hospital, it's always open. The "lunch crowd" spills out of the cafeteria  and heads for the fast food places out by the "four lane." The wives of the local city officials makeup the volunteer corps who help the patient navigate the maze of hospital hallways. Smokers Anonymous, AA, Weight Watchers, and Parents Without Partners hold their weekly meetings in one of the classrooms. The night shift police officer can often be found in the ER just before dawn sipping coffee and trying to stay awake during those difficult pre-dawn hours. And, of course, everyone goes there for minor injuries, lab work, scans, and consults. 

But it's not enough to keep the small town hospital alive. Across the country since 2010 over forty rural hospitals have closed and nearly three hundred are in trouble. A similar situation occurred in the late 1990s and was only resolved when the federal government changed rules to help the small hospitals stay in operation. Community hospitals in Texas have been particularly hard hit. 

There's little the community or the individual can do. Supporting your local hospital is a given and not enough. The long arm of the federal health care system has a choke hold on these small facilities, really all hospitals. For hospitals on the edge of economic viability to survive the government will have to offer some financial assistance. Given current conditions and sympathies, that's not likely.

It's a shame.

Even in the ICU...PO Day 275

Hospitals are reaching out to us even in the ICU, according to the Wall Street Journal. There's even an   APP for that.

Hospitals have begun to consider " disrespectful treatment" of the patient as important as infection control in the ICU, according to Peter Pronovost, M.D., Ph.D., medical director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore. Lack of compassion or patient care is now considered a form of harm to the patient. Patients and families are provided tools for communicating with staff to facilitate better care.

"Hopkins' Project Emerge, one of four ICU redesign initiatives underway at various hospitals to improve patient safety, collects and analyzes data from monitoring equipment and medical records, and incorporates the information into a "harms monitor" for use in the ICU. The monitor tracks incomplete tasks to remind staff which preventive measures to perform and alert them to high-risk scenarios. It also tracks how well the ICU team complies with patient and family care preferences. The monitor also includes an app that allows family members to select which tasks they want to help staff with, such as washing the patient's hair or helping their loved one walk down the hall, according to the article."

"Similarly, Boston's Brigham and Women's Hospital has developed the Patient-Centered Toolkit, a web-based portal that allows patients and their families to access their plan of care as well as information on lab results, medications and their conditions. It also allows them to address specific questions to the ICU staff, the Wall Street Journal reported. "

The desire to communicate with the patient and family has certainly come a long way. Is this a result of the Health Care Reform Act? Or a necessy step in satisfying the patient to compete for their business? Whatever, it is surely accruing to our benefit as health care receivers. If our hospital does not have such a program already in place, we should ask. They will definitely have heard about the concept and be ready to get on board.

Friend your hospital...PO Day 274

Are you friends with your hospital on Facebook?

The Journal of General Internal Medicine reported on a study comparing facebook's system of rating one's hospital with the hospital's 30-day readmission rate.  The latter is an important test of how good a job the hospital is doing. I suppose the theory is that if they are doing things right, monitoring the patient closely to catch issues before they turn into problems, that patients won't be showing back up in a week or three with post release problems that require re hospitalization.

In reviewing 4800 hospitals they found that in general the higher a hospital's Facebook rating the lower their readmission rates.

I am one if those bad patients who had to be re admitted following reverse total shoulder replacement surgery. After a smooth surgery and quick discharge, I was back a week later with a collapsed lung, a rare side effect of the nerve block administered at the time of surgery. I don't hold the hospital responsible, not even the anesthesiologist who did the block. I feel that I was one of the statistically doomed unfortunate few who experience the problem. I guess that means I won't be un-friending
my hospital.

Will we be sharing vacation photos and craft ideas on our Facebook pages? Probably not. We're not really on a first name basis. But I won't be giving them a black mark if asked to rate them.

The power of social media is growing exponentially. A negative word to my paltry thirty Facebook friends can reach their 900 Facebook friends (30x30=900) only to spread to their 27000 friends (900x30=27000). Wow, even as I write that, it is hard to believe. Did I do the math right? The ability to communicate on such a huge scale carries with it a tremendous responsibility to be factual and fair.

Would I want my hospital to be using their facebook site to report that I had not been the ideal patient? That I complained a lot, wouldn't call for help getting out of the bed, had Dear Husband smuggle in McDonald's? Fortunately research shows that, for now, hospitals are using social media more for communicating with employees. Heaven help us if Facebook starts asking the hospitals to rate we patients on a five star basis.

Would I be a ***** or, horrors, a **?

Feeling good,,,PO😂Day273

I'm feeling better, I must be . I have been tackling all kinds of little projects. I've been sewing, totally an extra curricular activity. I cleaned up the pantry floor, a great place to store all kinds of stuff. I am even less breathless, a chronic sensation since the collapsed lung post op. Does it really take nine months to get back to normal?

I did see the one year recovery time period repeatedly suggested for pneumothrorax on the web.

I was talking to a friend who is picking up the result report for a cat scan today. Interestingly, the hospital will let her have a copy of the report before she sees the referring doctor. But she suspects she will not know all the language in the report enough to understand it. We agreed that in times gone by she would have to go to the library to translate it. Now, with the WEB, she can figure it out in her nightgown.

Another project I'm tackling is changing bed covers and curtains from heavy winter to light summer. It's going to require a shopping trip today but will look so fresh when finished. When I was a child my aunts would cover the living room furniture with slip covers and roll up the area rugs for the summer. What a lot of work.

And does anyone else remember the clear plastic slip covers from the sixties? They were very effective in protecting the upholstery...in Florida, without air conditioning, no one dared sit on them at all!

Well, all my intellectual energy is being consumed by the projets de jour (projects of the day) so I've nothing great to say. But I'll be back tonight. Stay well..

The right question...PO Day 272

The last time I was with my primary care doctor he asked, I thought, a strange question. He said, " what can I do for you?" But having just read the article I hope to hyperlink here, it is the perfect question. The physician sees us a compilation of all our serious medical problems, most of which cannot be fixed. But sometimes we are just there for sympathy or reassurance. Often the patient accepts the futility of treatment long before the doctor does. After all, the physician is trained to heal, to fix what is wrong. Not fixing things is failure.

But if the doctor can get past the desire to be the miracle worker, if he can open a dialogue with the patient, he (or she) might be surprised at how realistic we patients can be. Of course this article addresses the problem of meeting the needs of an elderly, seriously  sick person. We don't all have such a serious situation going on. 

Next time I see my doctor I'm going to be prepared. Why am I there? Is it just routine? What do I want? Do I just want my RX refilled? Am I just after a little TLC? Do I expect a cure or am I willing to accept the inevitability of the insoluble problems of age? 

I wish I could copy the article here but it is too long. This appeared in the Washington Post March 9. I don't know how long it will be available. Here's an introduction:

"A doctor discovers an important question patients should be asked."

By Mitch Kaminski March 9

This patient isn’t usually mine, but today I’m covering for my partner in our family-practice office, so he has been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath...http://wapo.st/1Mny00x

Inappropriate screening...PO Day 271

I just read an article that addresses a complicated problem.

The title of the article is Regional culture impacts inappropriate imaging for prostate, breast cancer. It's a summary of a study reported in JAMA Oncology this week. Records of prostate and breast cancer testing on medicare patients were dissected and correlated. It's important to note that there is no relationship between the two conditions. And yet, the incidence or rate of what was determined to be inappropriate (read: unnecessary) screening (read:tests) was almost identical. In approximately 40% of patients being screened for prostate cancer and approximately 40% of patients being screened for breast cancer the tests were determined  to be unnecessary. 

Why, then, were the patients subjected to the "imaging" and the healthcare system burdened with the expense? 

The primary cause was the practice of defensive medicine, meaning the doctor orders tests to protect himself from a lawsuit claiming he failed to diagnose a serious condition. Too, patients are worried and request unnecessary tests. Less common, doctors are not familiar with test protocol. The "regional culture" factor comes into the equation when the medical network encourages tests to increase revenue or doctors feel pressure to order tests to keep up with the Dr. Joneses. Either way, it is estimated that unnecessary screening can run up bills as much as $12 billion dollars. A year!

The article suggests that steps must be taken to get things under control. What steps are not addressed. I am all for saving money within the healthcare system. There is absolutely too much waste. Until someone starts to cut back on my benefits. Then, being a normal human being, I want my inappropriate screening and I want it now. ;)


Actually, I try hard to resist " inappropriate screenings." To no avail. I should copy this article and carry it with me to my appointments. But in the end, I am a vulnerable human who wants the reassurance even if it costs $12,000,000,000.

Spring is here...PO Day 270

Around the country the sounds of nature are heralding in spring. In New Hampshire the plaintive wail of the loon, silent in the winter, echoes across Lake Winnipeauskee as he searches for a mate. In Ohio, as the ground thaws, the Northern Spring Peeper comes to life and fills the night with repetitive chirps creating a cacophony of love songs, discernible only to other miniature frogs. The sweet song of the solitary robin drifts into a Maryland window to delight the late sleeper and alert them that spring is at hand.

In northeast Florida spring comes suddenly in early March with a low, throaty rumble. The sound is faint at first as the day awakens. Slowly it builds as the harbingers of spring gather, singles, then couples, in the annual pilgrimage. They buzz about, nearly deafening the casual observer as they flit  ahead, then beside, then behind you, like a swarm of bees relocating their hive.

It is Bike Week in Daytona Beach.

The rumble of the motors fills even the sleepy little beach towns. It drowns out the sound of the waves on the beach and obscures the song of the mockingbird. Even the red headed woodpecker's drumming on the metal roof flashing cannot compete with the pulsing combustion engines. The sound carries on the breeze and faintly fills the quiet bedroom, the bikers cruise late into the night. The hardiest of the breed are up at dawn, drawn to the sight of the sun rising over the ocean, and offering a wake up call to locals.

Having announced the advent of spring,  the flurry of activity fades and the motorcycles are loaded into trailers, silenced for their trip home. But they will be back next year, like all of Mother Nature's alarm clocks, to let us know winter is over and to usher in the new season.

Know the future...PO Day 269

There's an article in The Week magazine about researchers in Mexico developing a test to predict the odds of getting Alzheimer's in the future. It uses skin tissue to look for certain proteins that are present in people with neuro degenerative diseases. So far it looks very promising.

But what kind of promise are we looking for? Does seeing into the future offer a promise of a cure? Is there an implied promise that knowing what is going to happen down the road somehow will make it less tragic when the inevitable finally strikes? Would you, would I live life differently?

I'd like to think I'd save more money. Be a better person. Do all those exciting things that we think we have all the time in the world to do and end up not doing because we run out of time or energy. But knowing myself as I think I do, I'd probably be frozen in indecision. I don't think I'd be depressed, it's not in my nature. But I can have a hard time deciding between a bagel and a biscuit for breakfast. I can't imagine dealing with life altering decisions for events twenty, thirty years in the future.

Would I choose to not have children, fearful of passing along some defective genetic trait? And miss the joy of babies or the agony of teenagers? Never! Would the love of my life be foolish enough to commit to a life together knowing what might be ahead? I hope so but...  Would I write the great american novel or invent some clever device or found a great institution of knowledge? Probably not. Actually, definitely not.

I'd just muddle along like I'm already doing. Like most for us are doing. The fact is that knowing the future doesn't mean we'll ever have to face the future. It really isn't "written" like Jamal said in
Slumdog Millionaire. Bad things could thwart the inevitable. A fatal skydiving accident, getting shot while trying to rob a bank. :)  Good things could derail the prediction. A cure for the disease would be the best possible outcome and certainly within the realm of possibilities.

So knowing the possible future isn't knowing the future. Plan for the worst, hope for the best. Seize the moment. Smell the roses. Are there any other platitudes that cover such a dire prediction for the future? Oh yeah, "Any idiot can face a crisis – it’s day to day living that wears you out. " –Anton Chekhov.

Tax return...PO Day 268

We are working on our income tax return. Somehow the folder where all the documents that show income, like interest or dividends or social security, has disappeared. I'm sure it will show up as soon as we recreate everything in it. In the meantime though we have to collect all that information. Well, I thought that we would have to wait for duplicate forms to be mailed to us. But not so!

Everyone, every company, provided a website where you can register and have access to your data. I knew that! But I didn't realize copies of 1099s were available and printable. How convenient.  Of course that's the private sector. What about the federal government system?

I registered both of us with socialsecurity.com and immediately could see previous social security payments, future payments, and the forms that report what one is paid, what was deducted for medicare and drug plans if signed up for those. If you are not yet receiving social security and are still working, you can see your credits and quarters worked. Very useful information.

I am able to go into my hospital account and recreate my charges and payments as well as treatment including dates and doctors. I can go to my account with medicare.com and see if and when I met my deductible. I can see all charges from doctors, hospitals, therapists, etc.

I am as quick as anyone to be suspicious of on line information and the loss of privacy we all experience. But, wow, when you need quick access to the information it is great that it is available. The only thing that could be better would be if we didn't have to file a tax return at all. How about a flat tax? Think of the time and effort and expense that would be saved. I'm for it!

Grocery shopping....PO Day 267

We went to the grocery store this morning. I know it's not shoulder surgery or even medical related but it consumes a big part of our energy and budget. And it's essential to life. I try to shop just once a week but there is often the quick stop for milk or bread or a forgotten item. I go to a "full service" grocery store, not a super center or a "club." I'm not opposed to them, just don't live close enough to one. Anyway, I got to thinking about the logistics of grocery shopping.

 A lot of literature about grocery shopping says the best day to shop is Wednesday. That's because the stores often change their ads mid week. I asked the check out person when the store is the least busy. She said, "definitely Monday morning." It was certainly true this morning.  No waiting in line for a cashier. Just zipped right through. I was told weekends were the most busy. You'd have guessed that. And, while lots of websites suggest shopping at the dinner hour, around here that can be a very busy time. So early Monday morning it is. Only problem with that is that the store and the staff are not in full gear very early. Rotisserie chickens aren't done yet and the fish are still chilling out in the freezer. But there are few customers and checking out is simple and fast.

Don't shop when you're hungry. It leads to too many impulse buys. Shop with a list. (I never do!) That helps avoid being tempted by displays and you'll be less likely to forget things. If you're going to my grocery store, take a sweater. The store is absolutely freezing! It's funny to watch customers in the summer when it's 95 F in the shade donning sweaters in the parking lot. Carry the ad with you so you can prove stouffer's pizza is 2 for $5.00. And organize your coupons the best you can.

I always wonder how our grocery bill compares with others'. Am I extravagant? Am I too frugal? A
Google search reveals a lot about other people's grocery bills. For 2014 the USDA projects a male-female couple over the age of 51 will spend the following: if they are thrifty, $370.00 a month; on a low cost budget $476.00; moderate spending $593.00; and liberally budgeted $715.00. This accounts for all meals at home, plus snacks. Wow. I think we eat well, good food and plenty of it, and compare very favorably with these figures. As I said, we're not close enough to shop at the all-in-one discount centers, we don't even split our shopping trip between two or three grocery stores to get the different  bargains each week. But we don't eat a lot of pre-prepared foods, mostly "from scratch" menus. I wonder if that keeps the cost down a little?

This new information makes me want to go back and buy that small eye round roast for $18.00!

Pre op procedure...PO Day 266

My hospital requires joint replacement surgery patients to attend a class prior to surgery. There's lots of information to prepare you and everyone is given chlorhexidine solution and told to scrub with it the night before surgery. Also, at a pre-op visit you are given a nasal swab test for MRSA, methicillin resistant staph aureus, one of the dangerous and antibiotic resistant bugs that frequent hospitals. Apparently the regimen is successful in preventing serious post op infection.

A study was done at the veterans hospital in Houston, Texas beginning in May, 2013. Patients were provided chlorhexidine cloths and nasal and mouth rinses prior to surgery. They also watched a video about MRSA and the danger it poses. Approximately 350 patients went through the course and they were compared to about 350 patients who had, as they put it, "hardware" implanted surgically prior to the new protocol and did not receive chlorhexidine nor the related instruction.

The patients in the study had a SSI, surgical site infection, rate of 1.1%. The control group, those operated before the new protocol was instituted, had a SSI rate of almost 4%. This was considered significant.

Their conclusion: "Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50% among patients undergoing elective orthopedic surgery with hardware implantation. Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study."

There are three points to stress here:

This is such a simple, inexpensive step to take to prevent infection. My group was also advised to not shave the area to be operated as little cuts could introduce bacteria. I don't know if, in the case of knees, the area was shaved at the time of surgery. I think not.

I'm sorry I did not get the identity of the people who did the study so to give them credit.

I haven't known a simple way to express what happened to me surgically. Now I know...I had new hardware installed. Would you say I was up-graded?

Spring forward...PO Day 265

If you're reading this Sunday morning, you have already sprung forward or you are an hour late...if you live in the USA. Every spring we reset our clocks ahead one hour and in the fall we set them back one hour; spring forward, fall back. The "fall back" time is the real time, the "spring forward" time is the manipulated time.

Businesses often like daylight savings time as it promotes evening activities like shopping, socializing, and entertainment like athletic events. It's simple, it stays light later so we are out doing things more. When we were more of an agrarian society farmers were not such fans of changing the clocks to extend the daylight hours into the night. For those early risers on the farm it was suddenly darker when they arose to milk the cows or plow the fields.

For those who do not live by a Timex but, rather, by their internal clock, it can cause some problems. The one year old baby may not understand why she is being put to bed when the sun is still lighting the nursery. The ten year old cocker spaniel may not be so keen on dragging out for his morning constitution at 7:00 AM when, to him, it is really only 6:00 AM. 

And for all of us it can be a bit difficult to make the adjustment. WebMD has published ten sleep tips to make the transition a little smoother. Here they are:

1. Gradually adjust the time, say in fifteen minute increments starting a few days before.

2. Take a nap if you feel tired that day. Not too long nor too late. Maybe at work? 😄

3. Know how much sleep you really need and schedule for it.

4. Keep regular sleep hours. Even on weekends.

5. Get some exercise during the day. Thirty minutes three times a week is good.

6. Avoid stimulating substances: alcohol, caffeine, even some pain relievers.

7. Eat lightly at night. Avoid too much liquid before bed.

8. Relax before bed. No scary TV, don't think about problems at work. (Not so easy)

9. Create a sleep friendly environment. Cool room, no noise, no toys, no snoring pets.

10. If you can't sleep, get up. Find a quiet activity for 20 minutes or so, then try again to sleep.

I think step 1 is really the only tip that addresses the problem of the changed clock. The other tips are generally good but aren't specific to the time change. And step 1 will probably only fool your one year old and then, only if you also install room darkening shades on her bedroom windows.

Bye, bye Birdie...PO Day 264

The robins appear to have left. Thank goodness.

 Yes, I remember my second grade reader picturing the cute little robin in a tug of war with a fat worm. He was all alone in a green lawn. It's true...If you live north of the Mason Dixon Line you probably know the robin as a single guy, kind of a loner, staid and dignified, half hopping-half strutting across the grassy lawn. His red chest is plump and he wears a dignified grey brown coat, dressed to attract a like-minded young female with a full red bosom and a dove grey-brown gown.

But when they come south for the winter they are like rowdy college kids on spring break. They arrive en masse, hungry and thirsty, loud and boisterous. They gather at every conceivable watering hole, bowl, fountain or puddle. They dine on the purple berries on the palm trees, which by January have fermented enough to raise the question of underage drinking. The inebriated birds soar and dive in gay abandon, chattering loudly, dipping down to earth to sip from a flower pot, then climbing up into the palm fronds to munch on more berries. Purple berries in - purple berries out. The ground, driveway, sidewalks and patios are covered with berry bits that stick to shoes and track indoors and stain all horizontal surfaces. The party flits from tree to tree, house to house, neighborhood to neighborhood.

Then, suddenly, someone must pass the word that spring break is over. There's no formal announcement, no alarm goes off. As quickly as they invaded the bushes and trees and every nook and cranny around the neighborhood, they are gone. They slip off unseen, unnoticed, as if to avoid being presented with a bill for room and board. Or at least for pressure cleaning the sidewalks.

By the time they make it back to Ohio or Massachusetts or New York they have resumed their roles as the harbingers of spring. No more the fun guys or the party girls, they settle back into their solitary lives, no hint of their wild spring break. And the word goes around,  "What happens in Florida, stays in Florida."

http://youtu.be/UOn-uIDk-oE

Rare complication...PO Day 263

In a July 2013 issue of the Washington Post there was an article about a woman, Jan Harrod,who had  undergone  shoulder   replacement surgery following unsuccessful conservative treatment for damage to her shoulder in a fall. While the patient had a good mechanical result, she could move her arm well, she continued to suffer unrelenting pain.

Visits to her surgeon and consultations with other specialists had not solved the problem. She underwent invasive procedures to look for and fix possible reasons for the pain. Nothing helped. Infection of the surgical site was suspected but ruled out.

In a casual conversation with a distant relative, her brother was reminded of her lifelong allergy to nickel, a metal often found in inexpensive jewelry. Since childhood she would react to exposure as if she had been around poison ivy. The brother mentiond it to his sister but she assured him the implant was made of titanium. Actually, there had not been much discussion about the material the implant was made of, she has just read it was titanium. No problem.

But at her next consultation with an orthopedic specialist she mentioned her allergy to nickel. He revealed that, while the implant was mostly titanium, there were some other metals involved, nickel among them. Lots of tests confirmed her allergy to the metal and the extreme solution of replacing the prosthesis with a custom one, totally made of titanium, was decided on.

At the time of the article appearing, she was doing very well. Her surgery was successful and she was finally pain free. It's natural to assume the lifelong allergy was causing the trouble. It's impossible to know for sure. But hers is a cautionary tale to anyone anticipating joint replacement surgery. If you have had any severe allergy be sure to mention it to your surgeon.

You can google the article by By Sandra G. Boodman July 22, 2013 in the Washington Post.

St. Somebody...PO Day 262

The culmination of the closet chaos was to take things to the local thrift shop. I love that it is here. I find it difficult to throw away useful items but have no problem donating or giving them away. And shopping there is fun and inexpensive. It is totally staffed by volunteers so it's a true charity operation. When they first opened I could not remrmber the name of the saint after which the catholic charity that runs it is called. So I started referring to it as St. Somebody's and the name has stuck. I really didn't mean it irreverently, more just smart aleck, I guess.

Anyway, I was there to donate. The volunteer ladies were engaged with a shopper, helping her
pick out clothes and shoes. It was as if they were helping Michele Obama shop. It turns out the fortyish woman is homeless and has been living in a tent in the woods. Someone stole all her belongings so she only had the things she was wearing. The local police had brought her to the thrift shop to see if they could help her.

I was so sad to realize homelessness is so close to my home. I was so moved by the care and attention the volunteers were giving her. I was impressed by how grateful the recipient of the help was. And I was pleased to see how helpful the local police were rather than just trying to move her along.

I don't know what will become of her. We don't have a local homeless shelter. What small assistance our community has is for women with young children. I hope she's not back sleeping in the woods but she probably is. Bless her heart, I hope she is safe. The volunteers took up a small collection from  workers and customers to help her a little. It's a drop in the bucket.

But the problem is bigger than just that one person. I fear she is the tip of the iceberg. We are told that most people are one paycheck from being homeless. Are there dozens of such people, unseen but moving on the edge of our community? Our little thrift shop supports only local people who are in need. Sometimes they supply clothing, often gasoline gift cards, food items, and occasionly rent money. But the need is always greater than the resources available.

I will keep donating and shopping. That's a small contribution. We also make a donation occasionally.  Mainly I think I will show a little respect and start calling them by their proper name, Society of St. Vincent de Paul.

Fish for dinner...PO Day 261

We all seem to have gotten the message to eat more fish but we aren't getting the follow up message about the dangers of fish laced with Mercury. Maybe the "powers that be" aren't getting the message out to us.

Factories and power plants are spewing fumes loaded with mercury. The air-borne contaminated air settles and the Mercury concentrates in bodies of warer, streams, lakes and  oceans. The fish absorb the Mercury and the fish at the top of the food chain have the highest levels of mercury. These include tilefish, shark, swordfish, King mackerel and tuna.

Consumer Reports has criticized the FDA for failing to alert people to the danger of Mercury in a diet. It has long been recommended that pregnant women and children should avoid the suspect fish but Consumer  Reports advises no one should be eating canned tuna or tuna sushi. And if you are eating more than 24 ounces of fish a week you should be avoiding the fish high in Mercury.

You can read about the problem in the February 20 issue if The Week. In the meantime, skip the tuna sub for lunch.

Where is Willet? PO Day 260

It all started about three days ago when the closet chaos caught up with the clothes horse and she couldn't stand it anymore. Now clutter doesn't usually bother her. In fact, clutter can be kind of comforting...all your favorite stuff tucked around you. But even Willet began to feel oppressed by the disorganization. Unworn clothing, out of style shoes and purses, unreachable sweaters, jackets that aspire to vintage but really are just old, suits that boast linebacker style shoulder pads, too small slacks- too large dresses, a sequined jacket from the 80, a favorite coat but too much for florida, etc., etc., etc.

Sorting begat  trying on. Shoes had to be worn, tried to see if they pinched toes. Bags filled with rejects, perfectly wearable relics of past parties, previous pastimes, and prior peccadilloes.  A small stack of sewing projects, repairs or remodels, grew. Long pajama bottoms became short. An ankle length dress became more practical at knee length. Shoulder pads were snipped out and discarded. Bell bottom jeans ... Now we get to the point of the story.

It's no small project to convert boot cut or bell bottom jeans to the new ankle length skinny leg jeans. The flat felled seam, double stitched, has to be picked loose. The hem, also double stitched, is ripped out. A new side seam is marked and stitched. Double check to be sure the legs are the same width at the bottom. The raw edges have to be edge stitched to prevent fraying. Finally, the narrow hem is resewn. Almost finished but Disaster!!! It's hard to explain what happened. Forcefully cutting a thick tab of doubled denim, the tip of the left index finger met the fulcrum of the strong sewing shears as they burst through the fabric obstacle. Unfortunately flesh yielded more readily to the scissors than did the denim.

So now the two fingered ipad typist is a one fingered iPad typist. It's a temporary handicap but it totally chills enthusiasm for creating the written word. Dear husband has offered to be the chief cook and bottle washer but no offers of being a ghost writer are forthcoming. All this just when its time to do the taxes...is there any chance for an extension?

Under construction

Today's blog will be a little late. It should be up by noon.

Loss of muscle tone...PO Day 259

How have I been so unobservant? This didn't happen yesterday. My right arm is the operated shoulder side. And my right upper arm looks like a raisin, an old shriveled up raisin. I guess the muscle has withered enough to allow, even encourage, the skin to sag. I haven't been remiss in using the arm but there was a long period of forced inactivity.

I guess the lack of strength should have been a clue that the muscle was out of order. It's been a year and a half since I broke the shoulder and eight months since rTSA surgery. So that arm has been just hanging around all that time. Muscles atrophy without use. I knew that. I just didn't realize it would happen to my muscles!

But I looked in the mirror today and there was no denying it...My right arm looks a hundred years old. I admit my arms are old lady arms already. But I didn't use to be embarrassed by them. I wore sleeveless shirts without a second thought. But now....well, thank goodness it is winter and long sleeves or jackets are de rigueur.

The only thing to do is put that arm to work even more. We'll see if I am able to build some muscle again. I guess this reveals my true priorities...I could ignore the weakened arm but the saggy look demands drastic action. 

Peanut allergy....PO Day 258

You hear a lot about children and peanut allergies these days. Schools have peanut free tables in the lunch room. I was on a flight one time when the flight attendant announced there would be no packets of nuts dispensed as there was a child with an allergy on board. Product labels warn if the factory also processed foods containing peanuts. No wonder. The possible risk of exposure is frightening, possibly deadly.

But...recent news questions the current belief that one should prevent exposure to the nuts. I am just copying and pasting here recent news.

A study suggesting that exposing kids at risk for peanut allergy to peanuts may actually help prevent an allergy was covered by all three of last night’s national news broadcasts for a total of more than four minutes. The study also received extensive coverage online and in print. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which provided funding for the trial, is quoted in nearly every article. Most sources tout the study, with some calling the findings a “landmark” or “ground-breaking.”

        The CBS Evening News (2/23, story 5, 1:56, Pelley) reported, “A new medical study...could transform the way doctors prevent peanut allergies. Turns out keeping kids away from peanuts may be the wrong thing to do.” ABC World News (2/23, story 6, 1:42, Muir) and NBC Nightly News (2/23, story 4, 0:31, Holt) also discussed the study during their respective broadcasts.

        The AP (2/24, Marchione) reports that the research, published in the New England Journal of Medicine, “involved more than 600 children ages 4 months to 11 months old,” all of whom “were thought to be at risk for peanut allergy because they were allergic to eggs or had eczema.”

        The New York Times (2/24, Pollack) “Well” blog reports that these children “were randomly assigned either to be regularly fed food that contained peanuts or to be denied such food.” Those “feeding patterns continued until the children were 5 years old.”
   USA Today (2/24, Szabo) reports that “babies regularly given peanuts for at least four years cut their risk of peanut allergy by an average of 81%, compared with children who avoided peanuts.” 
These “results are ‘without precedent,’ said” Dr. Fauci, who added that “the results have the potential to transform how we approach food allergy prevention.”

        The Washington Post (2/24, Bernstein) “To Your Health” blog reports, “An accompanying editorial described the research as a ‘landmark study,’ called for quick issuance of new guidelines on peanut consumption by children and recommended that some infants between the ages of four and eight months who are at risk for the allergy be started on small amounts of peanut protein.”

I WOULDN'T FOLLOW THIS ADVICE WITHOUT TALKING TO MY DOCTOR!