Apples or rotten tomatoes?...PO DAY 249

I love Apple. All our computer stuff is Apple equipment. It really is, as they say, intuitive. Technical support is wonderful. Laptop communicates with desktop which talks to iPads. I don't have a smart phone but if I did it would link up too.  Everything always works but...

Lately things don't seem to be going so well. I think it started with Apple maps which were (was) a disaster. iOS 8.0 has gone through several iterations and is now up to iOS 8.1.3, about the sixth version. Each fixes one problem but presents another.

Now there are problems with the much anticipated Apple watch with health monitoring features. It was designed to track stress levels by monitoring skin conductivity. There was an electrocardiogram feature to track the wearer's heart rate. But hairy arms or dry skin created problems and if it was buckled loosely it did not work well. The plan now is to go with a less impressive pulse monitoring system.

Also eliminated for the time being are the blood pressure and blood oxygen level monitoring functions due to inconsistent results. But a blood sugar monitor is still being developed as part oft the product.

It is my understanding that the "Smart Watch" is being developed to facilitate collecting and sharing health data with pilot hospitals. If it were to work as designed it would make the virtual doctor visit a real possibility. Hospitals see it as as way to reduce overhead and are creating the HealthKit program to track patient stats electronically. Linking with Apple offers them tremendous technical resources but it is going to have to work properly and reliably.

What we really need right now is Steve Jobs back in charge.

A little ketchup...PO Day 248

Just to catch everyone up and not to forget the topic of this blog...how am I?

I am happy to report that my hair has stopped falling out. At eight months post op. It started shedding at about six weeks post surgery and kept it up until just the last week or two, maybe lessening over the last month. Also, I think it is back to normal growing again. For a while it just did not seem to get any longer and, since my hair is so short, it is pretty easy to tell if it is not growing. I don't think my doctor ever appreciated how disturbing hair loss is to a female. It just wasn't an issue he addressed.

My chief post operative discomfort complaint has always been muscle pain in the bicep and tricep areas of the arm. The doctor explained that is where the deltoid muscle was reattached to the bone to enable it to lift the arm. He said it would take a long time to stop hurting, if ever. The pain the front forearm, what I am calling the bicep area, mostly disappeared at about seven months post op. I still have some discomfort in the back of the forearm, the tricep area, but it is definitely diminishing. DID I SAY FOREARM?.I MEAN UPPER ARM.

My right arm, the operated shoulder side, is not as strong as I would wish. I still have trouble pushing and pulling with it. Opening or closing the bottom freezer drawer on the freezer is too hard. The push and turn maneuver with childproof medicine bottles defeats me. But I am now able to open and close doors, even our back door that sticks a little. Rotating the car steering wheel is very much easier and only tweaks me on the very tightest turns now.

My range of motion is fabulous. I can stretch and reach with the operated side arm very nearly as good as with the uninvolved left arm. Putting away dishes, hanging up clothes, picking up dropped items, replacing the shower massage head...no problem.

Lifting weight of five pounds or more slows me down. I just don't have the strength yet. It is certainly improving but not where I expect or hope to be. So lifting and pouring a gallon of milk is still a left handed job.

Ah, dressing. The ultimate bugaboo. I get so frustrated. I ought to, need to, be able to dress without help! There is nothing easy about putting on the top half of my clothing. Still. Thank goodness for front closure bras, a real necessity. I do pretty well putting on or removing shirts now but jackets and coats are a struggle. Unless the item is rather loose fitting or stretches a good bit it is a battle. I've even thought about asking to go to occupational physical therapy once or twice to see if a therapist can assess what I am not doing or what I am doing wrong. For one thing, I can't do that little shoulder shrug that lets you drop a jacket off your shoulders to remove it. And once I do get it off shoulder, I can't reach behind my back well enough to let one hand grab the sleeve off the other hand and pull the sleeve down and off. I am just beginning to be able to get my hands to touch behind my back so things may be improving. We'll see. Pulling on tight, stretchy tights, leggings, is doable but a bit of a battle. And pants that zip on the side or in the back are to be avoided. Skirts can be zipped and rotated, thankfully.

About the pneumothorax, the collapsed lung, I had post operatively secondary to the nerve block...I believe I am healed. I recently saw the pulmonologist and had a CT scan. He said everything looked fine. But I am often a bit breathless in a way I never was before. I know it is not my imagination. I can climb stairs and do many times a day. I can walk and chatter away for two to three miles. But those things did not used to make me breathless and they do now. I was never a "mouth breather" but I catch myself doing it commonly now. I have read on the web that folks say it takes a year after a collapsed lung to feel perfectly normal so I am hopeful. Tincture of time.

I last saw my orthopod in December, six months post op. I see him next in June which will be one year after surgery. I think by then I will have very little to complain about. This whole experience has been tough. Not easy to go through or get over. But the result has been all I had hoped for. It is easy to forget how handicapped I was pre surgery and how much pain I was in. Everyone warned me that recovery was a long  and difficult process. It's certainly true. Writing this blog has been a great outlet for all the angst and frustration one goes through dealing with any ongoing medical situation. Thanks for being "out there" listening to me complain!

I said I would do this for one year. Four more months to go! Can we make it?

Rethinking 245...PO Day 247

I got to thinking about my post #245, the one that suggested people who run fast every day don't get the benefit from exercise that slower and less frequent runners do. Maybe there's more to it than just the wear and tear of frequent, full out exercise.

Perhaps there is something different about the person who runs every day, rain or shine. Maybe the person who carries a stop watch and times themselves, always hoping to go faster than they did yesterday, has more going on in their head.

Competing is stressful, even when you have only yourself to race against. The type A person can turn a Sunday afternoon stroll into the Bataan Death March. You can take away their stop watch and they will drive the route and memorize each quarter mile increment. Establishing a daily exercise routine is a good idea but if you can't miss running to attend your best friend's funeral, maybe, that's not so good.

So, the self imposed demands of a high energy, high stress existence may take their cumulative toll on  the health of a person. Stress seems to be the wild card in predicting the future health of someone. And harder to control than diet or exercise. This study is a good example of the narrow interpretation of statistical data. Sometimes there is more to the story than just the obvious conclusion.

The Measles...PO Day 247

With all the talk about the measles, I've been wondering why we "persons of a certain age" aren't being told to get vaccinated. Do I need to worry about getting the measles?

I was pretty sure that there was no MMR (measles, mumps, rubella vaccine) when I was a child. So I obviously wasn't vaccinated then. I do know I had not been vaccinated as an adult. The polio vaccine came along when I was eight or ten and I do remember how frightening polio was before that. Measles didn't carry the same terror but it certainly can be a serious threat to health and life. So why don't I need to worry about it?

The guidelines for getting vaccinated say not to bother if you were born prior to 1957. But why?

Because that's when the vaccine became widely available. That's when children stopped getting the measles. Before that everyone was exposed to the virus and became immune. Even if you never had an overt case of the measles, you had the measles. Once you've had the measles you are immune and won't get them again. Having the measles is kind of like being vaccinated against the measles.

I've written the word measles so many times here it is beginning to look weird. Have I spelled it wrong?

Anyway, glad to understand the how and why of MMR.

Just the facts...PO Day 246

As Joe Friday said, "Just the facts, ma'am." But the facts are often ambivalent. While we all identify that quote with the iconic police show of the 1950s, Joe Friday never said it! It was actually said by Stan Freberg in a comedy parody of the Friday character. Just like Ilsa in Casablanca never said "play it again, Sam." Neither did Bogart say it. But both quotes are now accepted as fact.

So it is with a blog. If you repeat something often enough, it becomes fact. Some of what I post is my opinion or my observation. But often times I quote an article I read, mostly on line.  I subscribe to a number of professional health care websites and Dear Husband gets the daily AMA on line news article which he sends to me if it is interesting.

It seems to me that a lot of research is now statistically driven. That is, for example, 10,000 people agree to fill out questionnaires or be interviewed (usually the former for obvious reasons) for several years. Their every day habits, exercise, diet, drug use, alcohol consumption, work experience, aspects of their personality, things, like that are recorded and become part of a giant computer program that can sort and categorize and spew out statistics that support every kind of conclusion.

The researcher is dependent on the truthfulness of the participant and the consumer of the information is dependent on the researcher to report accurately and to "not have a dog in the fight," as they say in the south.

So if I report a study that conflicts with your life experience or what you have read and believe or what your trusted health care professional has told you, rely on your good judgement and maybe your own Google research. Your good common sense goes a long way toward knowing what is right or wrong. Unfortunately a blog is mostly a one sided discussion with the writer pontificating about some subject. Thank goodness that once in a while someone who disagrees or questions some statement speaks up in "Comments" and gives the flip side of the issue. See "Insomnia Drugs PO Day 242."

I just wish commentary was more visible to the casual reader. Thank you, PB, for making my blog more interesting and conversational!

Don't run so fast...PO Day 245

Combine a Valentine's dinner than was not an early bird special with an uncharged ipad and you get a very tardy blog post on February 14th. I do apologize but dinner was wonderful and my iPad is up and running again.

The Las Angeles Times ran a story about a Danish study of 5000 people over a period of twelve years. They found that runners who jogged fast, seven minute miles or faster, four or more times a week had a mortality rate equal to people who did no exercise at all.

But walker-runners who logged twelve minute miles for only two hours a week had significantly lower death rates.

Apparently there is a growing opinion that too much exercise can stress the cardiovascular system, indeed the whole body. So much exercise may not be necessary, in fact, might be unhealthy.

Boy, am I glad to read this in the recent issue of The Week. Everyone walks faster than me...old ladies with three tippy little dogs walk faster than I do. It's embarrassing. I walk an hour every day only because I walk so slowly. If a twelve minute mile is better than a seven minute mile...does that mean a twenty minute mile is better yet? I sure hope so!

Ads on TV...PO Day 244

Last night, while watching the evening news, I saw a commercial for a company that makes prosthetic knee and hips. It was a first for me. Of course I have seen plenty of ads for drugs, prescription and over the counter. And advertisements for hospital systems are quite common nowadays. Locally highway billboards seem to be the medium of choice for hospitals and medicare advantage plans they offer. When the billboard ads first appeared a few years ago several of them featured physicians who were in the hospital system. But now the ads are more generic and one no longer sees a fifteen foot tall version of their surgeon and his group while hurtling down the highway. I did a double take the first time I saw Dr. Kai and his partners smiling down at traffic. But perhaps highway accident victims are more likely to need a referral to orthopedic surgeons than, say, cardiologists.

It's pretty common to see highway ads for emergency rooms. Some of them feature a live action clock showing how long the patient will have to wait to be seen. The waiting room time is always something like five or ten minutes. I've never seen a wait of an hour or longer on the clock but it's hard to believe it doesn't happen in real life. When I went to the emergency room due to the collapsed lung post surgery I was immediately taken back to an exam room. No waiting. But it was at least a couple hours before a doctor saw me and a couple hours more before any action was taken. Was my "wait time" one minute or two hours? By the way, I've noticed medical literature has begun to refer to  the emergency room as the emergency department, ED instead of ER. Makes sense, actually. And highway ads for emergency "departments" do make sense. Hopefully, one doesn't need such a referral while traveling but it's certainly within the realm of possibilities.

I think it was back in the late seventies or early eighties that either local professional ethics or commercial law changed and advertising by physicians became legal or accepted. I think the practice was already common in big cities. Up until then a doctor was not even permitted to publish more than his name, address, phone number and speciality in the telephone book (that archaic device some of us Luddites still use to contact people and businesses). At first a few renegade doctors began to run newspaper ads and/or television spots. The "gimmick" of the era was a limousine that picked up the
potential surgical patient, transporting them to and from the doctor's office. It was considered terribly unprofessional by the traditionalists. But it worked and within a few years it was common and acceptable practice if a doctor wanted to stay competitive.

I don't remember when drug ads began appearing on television but they are certainly rife today. You cetainly can't watch the evening news without getting a dose of pharmaceutical information about blood thinners, erectile dysfunction meds, or injectable fillers for wrinkly cheeks. Obviously there is a certain age group with fairly common medical complaints that watches the network news programs. Not too many ads for acne medications, prenatal vitamins, or birth control drugs. I guess young people are getting their news - and perhaps their medical advice - on line.

Anyway, I haven't seen an ad for shoulder  replacement prosthetic parts yet. I guess it isn't common enough to make it commercially (literally and figuratively) viable. I'm quite sure there is plenty of advertising directly to the surgeons and hospitals. Actually, I think that is better. I don't feel qualified to sift through the facts and fiction of a well designed commercial campaign. I would be too easily influenced by the youthful seniors playing tennis, dancing the night away, and swinging their grandchildren up in the air.