Upcoming doctor visit...PO Day 314

I have an appointment with my favorite physician this coming Monday. No matter what is going on, he always makes me feel like everything will be fine. When I see him I don't have that feeling of dread that usually accompanies me to a doctor visit.

But I am a little nervous this time. I went for my blood work today. I thought I could see little fat droplets mixed in with the blood as the technician filled the vial. Perhaps I exaggerate a little but I just know the Lipid panel part is going to be bad news. The numbers are usually fine amd I feel as if I have aced my SATs.

What is different this time? Since Christmas I have been baking and eating everything bad for you. Cookies are practically a food group all on their own, as if they belong right there beside fruits and vegetables. And I have not been exercising, the only way to reduce  one's bad cholesterol and raise the good cholesterol numbers. My "walking buddy" has been tied up with her own medical visits and tests, on top of which she has had house guests. Normally we walk two to three miles every morning.

At first, when I had no one encouraging me to "just do it," I felt guilty that I was being a slug. But I quickly realized that eliminating an hour of moderate exercise left me with more energy for home projects like gardening or cleaning. Why can't mopping floors or polishing wood furniture do the same thing for your health as traditional forms of exercise? But it doesn't and I fear the tale will be told when we see my lab results Monday.


My only hope is that the cookies I take to the doctor and staff help him understand my total lack of self control.

Value Based Purchasing.. PO Day 313

It has been very hard for me to wrap my brain around the new  health care concept, Value Based Purchasing, VBP for short.

This isn't going to be a good explanation but if we're going to understand what is happening in the hospital treatment we receive we need to grasp the concept.

The Affordable Healthcare Act looked at the way healthcare is meted out in this country and said it was inefficient. There has been no accountability for outcome and the old "Pay For Service" model encouraged more visiits, tests and procedures. Value Based Purchasing would standardize care, create protocals of efficiency and ensure better overall healthcare.

A greater emphasis would be placed on prevention. Hospitals would be financially rewarded for improving results and reducing costs. They would be penalized for not meeting goals. A big part of making this new system work is analyzing patient experience which is done through post inpatient surveys and the electronic health record system. A satisfied, happy, and healed patient is worth more than a disgruntled, carping healed patient in the greater picture.

This isn't just all about being in the hospital. In fact, keeping the patient out of the hospital is a big goal. Faster turn around, releasing the patient sooner after procedures, is desirable. Shorter hospitalization time exposes the patient to fewer hospital infection sources and cuts costs. Alternatives to inpatient care are being created. Pilot programs for in home health care are in operation in some big cities. Shifting elder care from hospitals to nursing homes is being investigated.  Virtual office visits, using Skype or Facetime, are likely to become part of healthcare.

CMS, Centers for Medicare and Medicaid, is the biggest force in instituting VBP right now but many employer sponsored healthcare prograns are following suit. The idea of healthier participants at a lower overhead appeals to not just government healthcare administrators but to private industry.  VBP is not a proven system. It is a theory being brought into practice since the implementation of the Affordable Health Care Act of 2012. It is in response to the out of control increases in medical costs in this country over the past ten to twenty years. How  well it works, whether it works at all, will determine what happens in the future.

I believe I am seeing the influence of VBP in my medical care in a small way. It seems to me that the frequency of seeing my doctors in routine follow up is changing. Doctors who used to ask me to return in four months now suggest that I come back in six months. A specialist I have been seeing for the past five years just told me I could be followed by my primary care physician and did not have to see her anymore. As a reverse total shoulder arthroplasty post surgical patient I was released from the hospital as quickly as I could have imagined possible, almost too fast. But as a readmitted sickie with a pneumothorax, to their credit, the hospital and staff went all out and there was no question of sending me home until I was totally ready and able.


Maybe this will work.

Price of privacy...PO Day 312

John Hancock was the first to sign the Declaration of Independence. His signature is bold and daring and announces to the world that he supports a new way for the future. So goes his namesake, The John Hancock Insurance Company.

In an unprecedented move, the insurance company is offering a financial discount to members in return for personal information. Not a survey asking the member's opinion or history, rather a way to monitor the subscriber's activities that affect their health and well being, John Hancock has partnered with Vitality, an employee wellness company, that will help them monitor and process personal information of members.

In addition to the discount, which can add up to thousands of dollars over a lifetime membershio, participants will be given a Fitbit. Wearing the fitbit will link the member with the company who can thentrack exercise activiity, blood pressure, doctor visits and  on line educational courses taken to add points to the members profitle. Personal goals can be set and members can succeed or fail.

On the surface it sounds like a good idea, Don't we all need a little help keeping our New Year's resolutions to exercise more, eat better, live a healthier liefstyle? But should it really be our  medical insurer doing it?

What if we don't hit our benchmark goals? Can they cancel our policy? Will they have access to our Electronic Health Record? Can they share the information with other companies, cancel our life insurance because we are living life in the fast lane? Willl there be a black list of names of people who are not good condidates for coverage?

Is this a great way to save 15% on our insurance and get a free Fitbit or is it an intrusive foray into our personal lives by a big brother who has a vested interest in our health and welllbeing?

The Other Shoe!...PO Day 311

It has beeen ten months since my rTSA surgery. It took several months for the bills to trickle in which did not surprise me. Being a medicare patient who had met her deductible, my interest was purely academic. I had read a lot about how much joint replacement surgery cost and I was curioius how much my procedure would be adding to the national debt.

Even though I have had a lot of experience with insurance EOBs (Explanation of Benefits) both personally and when I worked for a living, I was totally confused by the statements that arrived in the mail. I was embarrassed by how little Medicare approved for many of the procedures and there were several "items" that I never could find listed, like the cost of the artificial joint. I decided the latter must be included in some global charge and not priced individually. I wondered how my readmission would be handled, would Medicare pay for the iatrogenic incident? I couldn't tell what happened.

So, ten months and six days after my surgery a new This is not a Bill Statement arrived in the mail. All those surgical fees that I couldn't locate on previous statements magically appeared. Good thing I was sitting down when I opened it. I assume the item listed as Supply/Implants translates to "new metal shoulder hardware." Priced at a mere $34,168.67, the charge was denied for reasons DEandF (information was missing, I should not be billed for this (thank heavens!), and Medicare does not pay for this service).  The other bigggie was Prosthetic repair of a shoulder joint at $26,167.01. This, too, was denied for reasons EF and H (I should not be billed for this service -hooray-, Medicare does not pay for this service and this service cannot be paid when performed in this facility!).

Other lesser procedures run the bill up to a total of  $72,575.69.  What "cloud" have these charges been floating around on? Will these claims be refiled, corrections made, information filled in, amounts proportionately reduced, and ultimately some Medicare and some Medigap payments will be made? How can "this service cannot be paid when performed in this facility" be resolved? Is there more to come?

And finally, if a person was not insured they would be expectted to pay these charges in full! 

New Pet Peeve...PO Day 310s

Is it just me or has anyone else noticed how heavy doors are getting? I don't think it is just my post operative arm situation. Fortunately many entrance doors operate automatically. They don't single out anyone,  opening for the frail customer as well as the construction worker. The ones that are power operated but only if you push the big button on the wall work great but require you admit you are a wimp and  create that little side  detour to reach the button.

But the problem is the non power door and they are everywhere. The "Medical Screening" department at my local hospital has a door that requires a two handed pull to give way. My first orthopod's office door should have a security camera aimed at it. The footage would separate the genuinely handicapped from the malingerers. One fast food restaurant is designed with the double door air lock arrangement so you can't avoid having to use first your right arm, then you left, to get inside. Our local dollar store's doors look like they are powered but aren't. A good Candid Camera epiosode could feature all the customers who almost collide with the glass expecting the doors to part like the Red Sea for Moses.The double jeopardy situation is trying to exit a heavy door with a shopping cart. Only the moms with strollers can manuver with any skill.

I'm a kind of do-it-yourself person. I'm as likely to open the door for someone else as I am to let someone else open the door for me. But I am obviously sending out vibes or visual hints or have a virtual "Help Me" sign on my back because people seem to go out of their way to open doors for me. And, the fact is, I really appreciate it. It's just too bad that there isn't a burley roofer standing by as I give our sticky back door three tugs to get out.

According to the ADA (American Disabilities Act) there are all kinds of rules for door accessibilty. But of particular interest is their description of the Force required to open the door. They state:

"Interior accessible doors should require no more than 5 lbs. of force to open. This applies to interior hinged doors and gates, as well as sliding and folding doors.  The ADA Standards do not specify the opening force for exterior doors, though some state and local building codes may have requirements. Typical maximum opening force for exterior doors ranges from 8.5 to 10 lbs. Doors designated as fire doors must have the minimum opening force allowed by the local authority." 

These standards apply to construction post 1992 and corrective measures are limited by the economics of the business involved. I don't foresee any changes in the doors I encounter in life, not even my own back door. But it's nice to be able to complain!

Who's been busy?...PO Day 309

What in the world is keeping Willet from writing her blog? Has she lost interest in communicating? Is she too wrapped up in other projects? Gone back to regular employment, has a houseful of visitors, taken a lover? I don't know, no, maybe, no, no and no!

For one thing, I am sleeping better. Finally! I do still wake up at 1:00 or 2:00 (as evidenced by this writing) but I now am quite sleepy and go back to sleep easily. And I am not waking up at 4:00 AM, alert and ready to set the world on fire. I do miss the head start I got on the day but I am glad to be able to sleep until six or seven. My body and soul function better with a couple more hours of sleep.

That countdown clock has definitely gotten inside my head. I now feel the pressure of time like I never have before. All those projects that I was going to get to some day are annoyingly lining up and crying out, "me first." Today I tackled the job of altering a blouse, collecting clothes I don't wear to donate to the thrift shop, and cleaning my silver jewelry. Boy, do I sparkle now!

It's true, I don't have a lot to say about reverse total shoulder replacement surgery. After ten months I feel like I am pretty much over it. At nine months post op it seemed like everything just began to click into place. Oh, I do still have some discomfort, in some positions, doing some heavy work, but I think I have reached optimum improvement. I am very satisfied with the results. My right arm lifts and stretches as fully and well as the left. It is still not as strong as the left but I am making progress there too. Tincture of time. I will have a good report for my surgeon when I see him at twelve months
post op.

I am loving my artsy painting project. Please don't get the impression that I am an artist. I am a dabbler, a rank amateur, a graduate of the school of "art for the elementary school teacher." But this project is a true labor of love and I can spend a couple hours in painting rapture, easily ignoring life's real obligations. In an extreme display of self control I have put my paint and brushes away, temporarily, so as to not finish the job too quickly. Unusual restraint for me.

And finally, since you asked :) ... Computer problems! If I am going to write much on my iPad mini I enlist my wireless keyboard. It's easier typing, has key functions to move around that the iPad's screen keyboard does not have, and encourages proper typing form. I had to replace the batteries in the keyboard, no problem. But when I turned on the duo again the keyboard and my iPad mini did not "pair" up. For two days my iPad mini stubbornly refused to tell me why it was not talking to the keyboard. The keyboard would only say I should be sure it was turned on and within range (30'). I did, it was! Long story short, the keyboard had decided to take up with a previous partner (my old iPad) and Apple will only permit monogamous relationships. If the keyboard, for whatever nostalgic romantic reasons, was going to "pair" with my old iPad, nothing I did was going to restore everyone to their rightful stations. A hardware divorce was in order! That done, the keyboard snuggled up to the iPad mini and marital harmony was restored. And I am a ten finger typist again!

So, I'm sure that is more than anyone wanted to know but that's where I've been and where I am.

Montezuma's revenge...PO Day 308

We've all known someone who ignored the warnings to not drink the local water when in another country. There's usually a high price to pay. But here, at home,  we can drink the water in New York or las Angeles or Houston. No risk.

But the latest news is not good. According to The Washington Post and retold in The Week, shigella, the food borne bacterium responsible for Montezuma's revenge is spreading across the United States.
The United States! Normally responsive to cipro (an antibiotic), a new mutant strain resistant to cipro has appeared. At least 243 people have been infected, 20% required hospitalization.

Half the cases are related to travel but half are home grown. Groan. Something new to worry about.

The CDC is concerned. Shigella is easily spread. Symptoms include severe diarrhea, muscle cramps, nausea and vomiting. It could easily be misdiagnosed as food poisoning. I don't know how one protects oneself from exposure. Hand washing is always a good thing, of course. But is this spread through the water supply in this country as in Mexico? Or restaurant food? Does it pass from person to person through hand contact? A little guidance here, please!

This is going to require a little Google search...

Iatrogenic...PO Day 307

Iatrogenic:  of or relating to illness caused by medical examination or treatment.

In an effort to reduce hospital acquired infections and complications of treatment, CMS (centers for Medicare and Medicaid) made the decision that they would not pay for HACs ( hospital acquired conditions) when fourteen different situations occurred. This had the added benefit of reducing the cost of care since previously CMS had covered such events. Now they are implementing the next phase in which hospitals will be scored for adverse events resulting in HACs and poorly performing hospitals will not only not be paid, they will be penalized financially. 

In a related analysis of patients, statistics show that you are much more likely to acquire an HAC if you are admitted to the hospital on a weekend rather than.a week day. Weekend admission is linked to worse outcomes for several life threatening conditions such as myocardial infarction, pulmonary embolism, and intracerebral hemorrhage.

Why would that be? One could argue that weekend admission patients tend to be more seriously sick.  But it could also be that staffing problems leave hospitals short handed. Perhaps doctors
are less available on weekends? Do lab reports get processed as quickly on weekends?  I do know that when my collapsed lung was discovered on a Friday afternoon a thoracic surgeon was not available and the ER doctor had to treat me. It was a less than ideal situation.

So, if you develop an HAC know that your hospital isn't going to be paid for taking care of you. Will that have any effect on your treatment? It certainly seems reasonable to believe cost will be a consideration.  And try to avoid dealing with the problem on the weekend if possible. But we all know that things are always worse at night and on the weekend. 

Old is new again...PO Day 306

Most of us do not remember a doctor making a house call. Surely modern medicine and the essential equipment of a modern medical office would make seeing a patient out of the office impossible. Or maybe not.

Generally when I see the doctor I sit on the edge of the exam table, a new length of the paper roll sticking to the backs of my legs. The nurse has already weighed me and checked my blood pressure, pulse and temperature. We talk about why I am there and review whatever medications I take. Rarely, and depending on the specialty of the doctor, he/she might listen to my heart and lungs with a stethoscope. That's usually it. We could do that in my living room!

The idea of recreating the medical  house call is the subject of a new PBS special, RX, The Quiet Revolution. "Created by 10-time Emmy Award winner David Grubin, the AMA-sponsored film showcases physicians and care teams across the nation who are changing how people receive medical care by lowering costs and making patients the central focus of their practices."

If you google "Doctors making house calls" you might be surprised by the number of medical practices specializing in seeing patients in the home setting. From big cities to rural communities, the practice of practicing medicine the old fashioned way is coming back.  In the few sites that quote fees there is no indication that a house call is less expensive, it may be slightly more expensive. One example quoted a fee of $99.00. It's also unclear how medical insurance would treat such a visit.

But, goodness, if you were sick as a dog, or had small children who would have to go to the office visit with you, or if you were without transportation...it might be worth the premium. Furthermore, there is some evidence that the physician who sees you in the home setting may gain a greater insight into the patient's lifestyle resulting in better counseling for diet, exercise, hygiene, etc.

There's already the future virtual doctor visit via Skype or   FaceTime. And pretty soon we can be monitored by our doctor's office monitoring our smart watch or the latest wearable.

It sounds too good to be true. I hope we are all here to see the future of health care.
.

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One track mind...PO Day 305

Yesterday was Dear Husband's birthday. I don't know how that justifies bailing on my blog but it's my only excuse. Any ripple in our quiet routine moves through the household like a Sunami crashing ashore a day or two later totally disrupting our lives. Combine our little trip. Saturday through Monday with the festive day yesterday and I am absolutely nackered.

Not that I had to do a thing. Les belles filles (Rhymes with belfry) arrived looking like the advance party for a catering company. They brought decorations, hardware like plates, cups and utensils, wine and beer, appetizers, hamburgers and hot dogs, enough produce for a salad bar, condiments,  potato salad and twice baked potatoes and a fabulous ice cream birthday cake. The only contribution I made was to occasionally tell one or the other where to find a pierced spoon or a tomato knife.

Gifts were appropriately of the disposable ilk, like gift cards to favorite eateries. He loved an original poem by a "significant other." The girls cleaned up and packed up and by six PM the party was over and we were cat napping in the quiet again living room. I'd guess it was his best ever birthday.

But all this makes me wonder, when did I acquire a one-track brain? I used to be the consummate multi-tasker. I could juggle work, teenagers, aging parents, a non-live-in relationship, social engagements, housework and occasionally home maintenance. Where did that ball of fire go? Perhaps I used her up and wore her out. It appears she passed the torch to the younger generation, thank goodness.

I guess that is the natural course and I am grateful to have such capable inheritors. But I can't help being a little sad to not be the "one." I love the chaos of putting together a big family meal. I like the challenge of having both hot mashed potatoes and hot gravy on the table as people sit down. I enjoy the banter as bowls are passed clockwise, or is it counter clockwise. I like the suspense as everyone bites into the never-had-before casserole and I really like it when the dish gets a thumbs up. Ah me, maybe next holiday.

expiration date...PO Day 304

I don't know when it began. No one gave me one of those clocks that counts down the time you have left based on life expectancy. I think Sharper Image sold them. I wonder if they had one that foresaw their demise and rebirth in 2008.

I think the lace curtain project solidified the feeling but it had been brewing inside of me for some time before that. I looked at the lace one day and thought if I didn't do it now it probably wasn't going to get done. There's no morose feeling, no depressing dread. Just a quiet realization that that count down click is ticking and I probably will not live forever.

Actually, it is having a very good affect on my life. I'm looking at things much more realistically. I've thrown away some "future project" clutter that just wasn't going to happen. The "stencil vines on your kitchen walls" is a good example. I did keep all of the acrylic paint that came in the box. Can always use it before it dries out and shrivels up. Is there an an analogy there?

I'm working on an art project that I started about ten years ago. It has been languishing in a corner gathering dust all this time. I don't feel the burden of completing it. Rather, I am excited to see how it comes out. I've cut off some long pants that were waiting to be made into summer (year round for us) shorts. And I threw away a couple dresses that I'm not going to have occasion to wear. And this afternoon I cleaned out my knife drawer which had way too many knives in it.

I never believed in time travel or the Dorian Grey deal with the devil. I would never have wanted to live it all over again like in Damn Yankees. I just didn't think about it. Procrastination was easy for me, kind of second nature. Where was this paradigm for punctuality when I was working and could have used it?

I haven't looked...I don't think an expiration date has appeared on the bottom of my foot...like the woman in the American Cancer Center ad jokes about. But if a date has appeared, I hope it is just a suggested Best if Used By date, rather than a formal Expires on ... date like a short term CVS coupon.

Playing oppossum...PODay 303

Hopefully none of us will ever benefit from the latest  discovery from opossum research. But researcher Claire Komives had great news to share with NationalGeographic.com.

For years opossum aficionados have known that the opossum is virtually immune to snake venom. Even a bite from a diamondback rattlesnake is no threat. Now researchers have learned that the blood of opossum contains a peptide that not only protects them but, when extracted, can provide the same  protection to mice in the laboratory.

The understanding is that the peptide binds to a toxic protein in the venom and renders it harmless. The discovery promises an effective and inexpensive treatment for snake bite victims. And, not only does the protection extend to other snake venoms, it also works against toxic scorpions and some toxic plants.

Who knew the pesky opossum that roots around in our lawns could be the foundation of a major treatment for snake bite victims? I didn't even know they were immune to snake bite venom! How do researchers come up with such obscure information that leads to huge advances in science, health and life in general?

Not that this has anything to do with reverse total shoulder arthroplasty. I just thought it was interesting. And it helped me remember that it's "opossum," not oppossum and definitely not possum. But now I need to know...is it pronounced o-possum or, as we say in the south, possum?

The price of cheap wine...PO Day 302

Instead of the adage "life's too short to drink cheap wine," the new mantra should be "life's too health conscious to drink cheap wine." According to CBSNews.com, a class action lawsuit has been filed against two dozen California wine makers claiming their wine has high levels of arsenic. Cheaper wines from grapes grown in the Central Valley of California are the issue. The vines have been irrigated with water containing arsenic which passes through the plant to the grapes and ends up in the wine like Trader Joe's Two Buck Chuck.

Kevin Hicks, attorney for the "class," claims some inexpensive wines contain up to five times the arsenic level the Environmental Protection Agency permits in drinking water. In testing over 1300 bottles of wine of all types and price ranges, only 83 demonstrated high levels of arsenic. Of course if your wine happens to be in that cache of 83 bottles your level of concern is higher, isn't it?

The brands being sued respond that the claims are misleading and that Hicks has a conflict of interest. His company is involved in wine testing for quality. The Wine Group suggest permissible arsenic levels in water reflect the greater quantity of water we drink, ergo wine can have higher levels of arsenic since we drink less wine.

I don't think that argument "holds water." How do they know how much wine I drink? How little water I consume? How much chicken I eat with my wine, which also is said to contain high levels of arsenic. Even rice and it's by-products add to my arsenic consumption. I don't want to have to buy more expensive Napa Valley wine but I don't want arsenic in my two dollar (now three dollars) bottle of Zinfandel. Why not? It's not enough arsenic to kill you... But arsenic is a carcinogen. You don't smoke, use sunscreens, avoid air pollution...now you can't even have a glass of wine without worrying about cancer!

Life's too short to drink wine laced with arsenic.

Coulda-woulda-shoulda...PO Day 301

Talking to someone who is facing rTSA surgery in a month or so made me think of things I would have done differently. I don't think there is anything big on the list, just little things that could have made life easier. Hind sight is always better than foresight.

Number one: I would have moved a recliner into the bedroom and created a temporary sleep site there. Between the recliner and the couch, I slept in the living room for six months as I was unable to get comfortable in a bed lying flat. It just would have been better to have a real sleep spot in the bedroom. I did not realize how long it would be before I could sleep in a bed properly.

Two: neither the hospital nor the surgeon provided the recommended style sling for post rTSA patients. I should have ordered one on the web instead of making do with my inadequate "broken shoulder" sling. Ask about a "shoulder immobilizer."

Three: easy to put on clothing was a big problem. I anticipated the "tops" issues and had a supply of large, loose men's shirts to wear around the house. But I didn't realize the Problems I would have with "bottoms" . It is very hard to pull up pants - underwear, bike shorts, zip up shorts or slacks,  exercise pull ons - with one hand. I don't have a good solution, just want to make you aware of the problem.

Four: skin problems: wearing a sling 24/7 keeps your skin folded against itself in several places. Your underarm and the inside fold of your elbow, for instance, get very irritated. A soft cloth between the folds of skin helps. Ask your therapist about a cream or ointment.

Five: more skin irritation. The sling itself eventually irritated my forearm. I cut the toe out of a sport sock and slid it onto my forearm to keep the sling from rubbing.

Six: ice. I personally did not like drippy ice packs. I found the freezer insert for a refrigerator bowl, the kind you take to a covered dish supper, worked very well. It was icy cold, lasted a long time, and did not drip or sweat.

Seven: lounge wear. Not Las Vegas lounge wear...lounge around the house clothing. :) There were a handful of nights that I could not face undressing and redressing for bed. I just slept in my clothes. The ideal solution was comfortable, loose fitting clothing that could do double duty as "at home" and "overnight". The ubiquitous pajama bottoms you see young people wear out in public with a big BIG shirt worked well. T-shirts don't work for a while as you can't pull them over your head.

Eight: shoes: slip ons or Velcro closures. But not athletic shoes that require socks ( hard to pull on) and fit snuggly ( hard to pull on).

Nine: hair. Unless you are a better one armed paper hanger than I am, fixing your hair is difficult. Curlers, curling irons, straightening irons, and blow dryers usually require two hands. My solution was a really short "do". It required only a tossle to look fairly good. If your significant other has had a secret ambition to be a hairdresser you might enlist their help. Forget rubber bands or scrunchies.

Ten: purses. I could not manage a regular purse. Too heavy and too awkward. I bought three or four very small woven bags on long cords or straps that I could wear cross body and that would hold the bare essentials - drivers license, debit card, a few dollar bills.

These worked for me after I eliminated what did not work for me. Everyone is different and will find their own solutions. 

Love this study!....PO Day 300

I just love this study!

Published in the British diabetes and endocrinology journal, The Lancet, a study of some two million people showed a direct relationship between weight and dementia development. The study contradicts conventional wisdom and other smaller scientific studies which showed obesity as a contributing factor in dementia. This study demonstrated the exact opposite!

Underweight people had a 34% greater risk of developing dementia than people of normal weight. And the obese had a 29% lower risk of demonstrating memory loss and confusion.

A 2008 study of 6000 people found that people with big bellies while in their 40s were more likely to develop Alzheimer's and other forms of dementia. But a study involving 6000 is no rebuttal for a study of two million and current popular opinion is siding with the modern survey involving the higher numbers. Lead scientist, Nawab Qizilbash of Oxon Epdemiology admitted his results were completely  opposite. While the science used in the old study can not be disputed the  Times of Patienrs said the patients  in the new study were an average of 55 years and over 45,000 of them developed dementia over an average of nine years. The risk of dementia fell steadily  as their weight rose.

Qizilbash, as quoted in the Times, said the findings held despite attempts to adjust it for other causes of dementia and the tendency of obese people to die earlier.“We did a lot of analysis to see if we could explain it but it just seems to persist. We couldn’t get rid of it, so we’re left with this apparent protective effect,” the scientest was quoted as saying. 

The co-author of the paper said the results suggested “that doctors, public health scientists and policymakers need to re-think how to best identify who is at high risk of dementia. If we can understand why people with a high body mass index have a reduced risk of dementia, it’s possible that further down the line, researchers might be able to use these insights to develop new treatments,” Stuart Pocock of the London School of Hygiene and Tropical Medicine was quoted as saying by the London newspaper.

Qizilbash warned, however, that being overweight or obese brings with it a much higher risk of death from any cause and a higher risk of stroke and other diseases.

I suppose the last statement had to be said but it was nice, for a moment, to think that a little excess belly fat could have some beneficial quality.

Traveling....PO Day 299

What is it about traveling that just wears you out? You're just sitting there, whether it is in a car or airplane or whatever. We're not on horseback or walking behind a covered wagon. There's no rowing or hoisting sails involved. We've lounged on padded Seats in air conditioned comfort with customary drinks and food readily available. At day's end we are settled in a comfortable room with familiar television stations like the weather channel to soothe our frazzled psychics.

Where would this country, this world be if we had been the ones who had to cross the Rockies or ford the raging Mississippi or hike the Appalachian trail to start a new life?

I'd like to think we could have done it. Not as a challenge on our life's bucket list, but just because it was what was expected of us. Thank goodness for our ancestors who were brave and stalwart and forged all these new trails that we take for granted today. Are there still adventurers taming the wild and creating new frontiers? I don't know...some of those shows about life in Alaska look pretty challenging.

Well. on to our project of the day. Instead of hip boots and a machete to carve out a trail, I will be clad in my hot pink blazer and dear husband will even sport a pink shirt! We're not claiming to be the Donner Party but we do have a mission today. I hope we bring a little smile to someone. It's the best we can do right now.

I didn't say that! PO Day 298

Cave site! Too tall and you didn't fit through the opening to the CAVE SITE!

If you read yesterday's post you must have wondered why I was suggesting being too tall could keep early human from getting into his grave! Apple's word processor is great at anticipating what you are going to say and filling it in for you. But not infrequently it takes liberties with one's prose and inserts a word that totally changes the meaning. If you're not paying close attention weird things come out of your mouth, or fingers as it were.

The program is wonderfully smart. It even learns names and unusual words that the writer tends to use over and over and anticipates them. But if you are a messy two finger typist at 3:00 in the morning like I am you may teach the program to substitute words that are incorrect. I have typo'd the word shoulder so much that the program thinks it is spelled "shoukder" .  And "this" is frequently spelled "thus."

Not rarely the program will insert the strangest word, a really esoteric word, for the word I intended to use, like parabola for paradigm. I don't know what a parabola is! But if I am not watching closely that's what I get.

I could rave on about a writing "editor" who changes one's meaning but we are off to see our friends today. So even though it is unbelievably early I am up and out of here.

Good buy and sea ewe later.

Risksof being short...PO day 297

There are all kinds of risks attached to being shorter thsn average but none can be answered in a simple manner. Of greatest surprise is the report that being short increases the chance of heart disease.

The New York Times reports that research published in the New England Journal of Medicine suggests that “shorter stature increases the risk of heart disease.”

  The AP reports that researchers “collected information from researchers around the world on 65,000 people with known risk for heart disease (two-thirds had already had a heart attack) and a comparison group of about 128,000 others.” The investigators “first...verified that stature played a role: The risk of coronary artery disease – clogged arteries – rose 13.5 percent with each 6.5 centimeter (about 2.5 inches) decrease in height.” Then, “studying 12 risk factors, they found two were related to genes regulating height: LDL or bad cholesterol, and triglycerides, another type of fat in the blood.”

        The NPR “Shots” blog reports that “for someone 2.5 inches shorter than average, the risk of coronary artery disease increases by about 13.5 percent.

There's such a burden to being outside of the normal range in any aspect of life that it's hard to move on. Does knowing you are at greater risk in any way reduce that risk? If not, why tell us? Does all this mean that being taller, say 2.5 inches taller than average, reduce the risk of heart disease? Or is it possible that being taller, outside the normal range, has the same dangerous effect as being shorter? 

Did being taller create an evolutionary Darwinism in which being just the right height enhances your survival rights? Too short and you can't reach the high fruit. Too tall...what possible bad effect there? Too tall and you did not fit through the opening to the grave site? Too tall and you were more exposed to predatory animals? The words "stand out in a crowd" come to mind.

Don't!

Everyone is ailing...PO Day 296

Gosh, everyone I know is getting sick. Some minor things but mostly big stuff. Is it just the demographics of the people I hang out with? Do I have some multi symptom contagious disease that I am spreading around? I could imagine up some bizarre theories, it's the water or a government run medical care plot to drum up business.

My relatives on my mother's side always blamed illness or death on the medical establishment. It was the doctor's malpractice or the nurse's misfeasance. I guess that was the twentieth century version of witches at Salem. Now we are more inclined to blame exposure to environmental toxin or bad life style choices.

Maybe it is more basic than that. If you live you are going to die. Of course we all want to live to be 100, but sound of body and mind. That is a rare happening. The human body is a rare and delicate thing. When you think about all the possible things that can go amiss it's amazing any of us make it out of childhood.

I don't have anywhere to go with this. Nothing smart or pithy to say. It's the middle of the night and all I can do is pray for good things for everyone who is suffering. And suggest my healthy friends stay away from me!

The midnight rule again...PO Day 295

In October post op day 110 was about the two midnight rule that had been postponed for the umpteenth time as CMS (center for medicare and Medicaid services) and congress haggled over its institution. Apparently the haggling continues and nothing has happened.

Hospitals have been retroactively penalized for treating patients as inpatient when CMS felt that was overkill ( poor choice of words) and the patient was only admitted to the hospital in order to justify higher reimbursement. CMS wanted to require the patient to have been an inpatient for two consecutive midnights to qualify for the inpatient status. Congress felt the interpretation of the rule was confusing. The fight was on.

And is still ongoing.

The American Hospital Association is suing the government over the bill. CMS has offered to reimburse disputed claims at 68 cents on the dollar. Hospitals are still struggling over how to properly treat the patient with the threat of financial penalties hanging over their heads if they err on the side of over action. And patients are still ultimately responsible for disputed charges.

So...be sure it is clear if you are being held in the hospital for treatment or observation. Even if your stay does span two midnights, unless you are classified as under treatment, you are not considered an inpatient. Treatment as an outpatient can make your charges higher, can disqualify you for post hospitalization nursing home care. The most recent deadline for implementation is the end of this month but why think it will happen then.

The bottom line is:

"In order to qualify for Medicare reimbursement under inpatient rates, the two-midnight rule requires that physicians deem the patient's condition as serious enough to require at least two overnight stays. Patients who aren't formally admitted may remain under outpatient or observation status--an action that may leave patients with high out-of-pocket expenses."

A little trip...PO Day 294

We are going to visit a dear friend this weekend. She is very ill with a progressive disease that she has had for many years. In spite of that she has always been a fashionista and loves pink and purple. The "hotter" the pink the better. Gradually through the years pink has crept into her closet, her ephemera, even her home decor.

So, by chance, I came upon a real bargain in a silk jacket in a fairly hot pink.if I can figure out what to wear with it, I know it will be a hit. I thought about a black shirt and pants but that tones it down too much. I want to make a Statement! Grey T and skirt looks oddly oxymoronic. I'll probably go traditional and wear white shirt and pants. That's the only thing that lets the color pop.

I really am not being frivolous here. You never know what will lift the spirits of a suffering person. I took a hospitalized friend a huge stack of catalogs recently. It was better than a flower bouquet. She was throughly distracted by virtual shopping and could throw each away as she finished looking at  it. Another friend loved it that I brought Milky Way candy bars. Moisturizing lotion and lip balm are good as hospitals are so dry.

The only rule is "nothing that is hard to transport." You don't want to be juggling potted plants with real dirt room to room or house to car. How did the idea of flowers or plants get started? Must have been the florist industry's idea, Food is always good but you never know if the patient has diet restrictions. Plus hospital food service has really improved. Now there is often "grill" service and you can order special items.

Cards are always nice to receive. I can stand in front of a card display for twenty minutes looking for the perfect card. Not too sappy, not so serious but can't be smart aleck, light hearted with just the right combination of sincerity and humor. Amazingly, there always seems to be the perfect card. Hard to imagine the job of creating greeting card poetry over and over, True of any creative endeavor.

Well, I hope my attempt at a sartorial salutation goes well. I don't foresee wearing a hot pink silk blazer style jacket a lot otherwise. I'm thinking it will bring a smile to her face. I hope so.

A very bad sign...PO Day 293

It sounds as if there are workers on our roof. Not Santa and eight huge reindeer in early April, I don't think. A burglar who is going to come down the chimney? Not likely, no chimney. I know who it is...they've been there before.

It's vultures! There is nothing graceful about their landing.  They pitch in like stumbling, somewhat inebriated longshoremen. The incoming displace the already settled and the scrambling and jockeying for a good spot starts all over again. The highest peak is the most desirable real estate, of course.

Why have they chosen our house this evening? Do they know something I don't know? It does no good to yell or whistle at them. They know a fake feint when they see one. The stream from the water hose will not reach that high. My aim with a rock is not accurate. I'd probably just break a window. Dear Husband has a BB gun...you can imagine the rest of that story. Leave it to say, vultures have thick feathers and a tough hide.

So, why are they here tonight? Because tomorrow morning is garbage collection day. The cat food distributed by a well meaning but wrong headed neighbor is poor pickings compared to household kitchen leavings. White trash bags either let aromas seep out or allow visualization of the contents as they are most vulnerable. One, two, or three vultures can spread the contents of a garbage bag up and down the street a block or more.

Don't compare these birds on the dole with the noble buzzards of disney's Dumbo. Those guys work for a living, cleaning up carrion like diligent funeral home employees on commission. Our vultures line up for a free meal twice a week on garbage day and make do the other five days of the week on dry cat food left for the thriving feral cat population. Sadly there is nothing to be done. Vultures fall under the protection of the Migratory Bird Treaty Act of 1918. "The statute makes it unlawful without a waiver to pursue, hunt, take, capture, kill or sell birds listed therein ("migratory birds")" 

I have a greater appreciation for the father in "Steel Magnolias," he was shooting into the trees to scare off the crows. Well, it could have been worse, it might have been vultures!

Look Alive.

PO Day 292

I'd rather draw and paint all day
Or sew a seam about to fray
I don't mind days when it is grey
If I can find a place to stay
Dry and warm, a hideaway,
With milk and cookies on a tray
I guess I'm saying,  if I.may,
The blog will return, give me a day...

Or two.

Always a worry...PO Day 291

There's always something to worry about even if there's nothing to worry about and things are great.

I've been really busy recently. Lots of  projects. I am so pleased to be able to do the different things and especially glad to have the energy and strength. It's almost like I have awakened from a long virtual coma in which I could see and hear everything going on around me but just could not get very involved. It was all I could do to perform the basic necessary tasks of life. But there was no room for any of the extras that make life interesting and fulfilled.

I guess it started with the desire to "summer up" the bedroom. It turned into more than I had expected but I am so pleased with the result. Then an idea for sewing project has been in the back of my mind for a long time and I finally did it. Now it's spring and the garden calls to me. So a couple days ago I spent the morning raking leaves, pulling weeds and tidying up. Yesterday the little recirculating fountain had quit recirculating and I spent a long time emptying it, refilling if, and reading the instruction manual. It turned out it was as simple as some of those annoying purple berries from the palm trees had gotten inside the motor case and were doing a very good job of stopping up the water flow. Problem solved.

The human hand is a marvel of engineering and that opposable thumb element is invaluable. But wearing gloves to protect those hands is just not my thing. I have a couple small, healing cuts on my hands from minor accidents and many little pin pricks from sewing.  No one wound is enough to talk about but the combined effect is that my hands are a little sore. So all of a sudden I am wondering how much risk of infection there is and how much danger of an infection spreading to my "hardware" exists.

From what I have read the metal parts of the artificial joint are a very good host for growing bacteria that is otherwise killed off in living tissue and circulating blood. Does this happen rarely? Only in immune suppressed people? Do my white blood cells have what it takes to beat back infection? Do I need to worry about this new wrinkle? I guess I'll take a few days off and let the little nicks heal up. But I hate to lose the momentum of this moment of enthusiasm. And the lingering question remains...Am I turning into a hypochondriac?

Opposites attract...PO Day 290

We've all heard the saying "opposites attract" and it certainly seems true. I can't think of a single couple where the two people have the same personality. If one is outgoing, the other is shy. If the husbsnd is frugal, the wife is a spendthrift. At least it starts out that way. After years together couples do tend to take on each other's characteristics. They even start to look like each other. But those similarities tend to be superficial or cosmetic. Maybe it's just easier to assume a mutual "couple" identity than to constantly be swimming upstream.

But the basic two position union has its advantages. The "pessimist" keeps the family grounded somewhere near reality while the "optimist" allows hope to survive in dire situations. It's certainly true of  Dear Husband and me. He hears the doctor say "this surgery has only a small chance of relieving your pain and restoring use of your arm," while I hear "this procedure is your best hope for getting back to normal function and being pain free." Of course the surgeon made both statements and they are not mutually exclusive. But what each of us takes away from the encounter is a totally different outlook for the surgical prognosis.

What I, the family Pollyanna, have come to accept is that reality is going to be somewhere in the middle. It's not going to be as good as I expect nor as bad as Dear Husband foresees. I need someone to bring me to reasonable expectations and he really wants someone to assuage his worst fears and instill hope.

But what is it that draws us to a person of such polar opposite thinking? I think we are aware of the irrationality of our way of facing life, even if we don't or can't verbalize it. We're careless and we are impressed by the person who is careful. We're not very social and we admire someone who finds it easy to make and have friends. My laissez-faire attitude needs a let's-not-try-that balancing element even if my conscious brain doesn't know it.

It's wonderful how fate looks out for us. Of course, those very opposite qualities that unconsciously attracted us to our partner all those years ago are the very things that drive us crazy about them as time goes by. Not to say we don't  still need them.

Internet of things..,PO Day 289

I have been reading the words "the Internet of things" recently but had no idea what was meant by it. I wish I could come up with some clever definition but I was just clueless as to what was meant by the phrase. More recently I have been seeing the term IoT which meaning nothing to me my brain immediately went to iOS which is the abbreviation for any i device's operating system.But it simply means internet of things.

So back to...what does it mean?

The internet of things is the interconnection between all things, animate or inanimate, that have the ability to connect to the Web. It could be your home air conditioner, your car, your scale, your phone of course, even you! Almost everything that can be powered on or off can connect and share information.

Your phone can know that you are running late for work and tell your coffee machine not to bother making coffee this morning. Your phone can then  tell your car which can reroute you to McDonald's for a drive thru breakfast. Your scale informs your car that you have gained five pounds so to pass on the sausage biscuit. When you get to work your standing lunch order is changed to a healthy salad and your twice a week gym appointment is rescheduled to every day. Your after lunch workout makes you late for your appointment with your primary care doctor who has already printed out a diet worksheet for you and a prescription for a statin drug is at the checkout counter as you leave. Your spouse knows to drop by the pharmacy to pick up the new Rx on the way home since it is right on their way. When you reach in the freezer to take out the steak you were planning for dinner the fridge
beeps and the display screen suggests fish instead. After a light dinner your TV powers on and the documentary on Birds of the Amazon begins to play, recorded last night while you were at a concert. Before the Spix's Macaw has arrived on the screen your alarm clock has reminded you that you overslept last night and you need to get to bed a little early tonight. The TV automatically shuts off, the lights dim, the door locks click and, before your know it, you are tucked into bed.  

The Internet of Things sounds a bit 1984ish. Wait, "1984" is 31 years ago! Instead of a government run Orwellian society do we face a well ordered life managed by "things" talking to each other in the "clouds?" Will we no longer miss an appointment, fail to meet a deadline, or overlook paying a bill? What if we don't want to be on time but prefer fashionably late? Can our computer understand withholding payment because we were dissatisfied with the job done? Is there room in the Intenet of Things for the flawed, forgetful, disorganized, but very human, being?