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

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

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

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

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

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





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

Walking...PO Day 157

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

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

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

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

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

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

http://youtu.be/L0wCuwUneSM

EHR=Big brother?...PO Day 156

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

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

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

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


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

How much is too much?..PO Day 155

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

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

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

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

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

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

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



http://youtu.be/8myK93FqbYc

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

Taking the day off...PO Day 154

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

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

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


http://youtu.be/Va29hvaDY10

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

Computers create work...PO Day 153

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

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

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

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

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

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

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

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

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

Shingles vaccine...PO Day 152

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

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

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

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

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