Tag: health care

Literally sick of the topic

I was a believer in the “useful idiot theory” about him, that they’d dump him as soon as they wreaked the havoc to every agency and gotten their murderous health insurance allocation to the rich passed.

A local writer posted about stopping with the no-citations copy and paste stuff on Facebook. “Opinions, OK. Assertions of fact passed along without some source are rumors…Don’t play.”

I replied: “I suppose you’re right, although sometimes I think the info is SO obvious. e.g. someone was complaining about the proposed federal budget cutting EPA, et al, and someone else popped, “Citation, please.” Really? OK, here’s CBS, oh, and here’s WSJ and Common Dreams and… Are there no agreed upon facts anymore?”

Someone else chimed in: “It’s pathetic when Facebook friends have to demand higher standards for reposting than the President of the United States.”

And THAT, I suddenly realized, is one of the reasons it’s been such a tough winter. I wonder if it’s made me literally sick.

My friend Dan Van Riper has been saying for a while now what will bring a country down is “looting by the elites.” The draconian budget that will, among other things, cut medical research 20%, and the awful health plan are going to destroy our country if passed anywhere near their present forms. Why offer such an orgy of unnecessary cruelty?

Yale historian Timothy Snyder warns If We Don’t Act Now, Fascism Will Be on Our Doorstep; comments about fascism always seem to irritate people, but if the regime fits… And who IS running the show?

Most people who have been POTUS have stayed within a fairly wide swath of what one could call “American values.” Not so with this regime, measured by the fact that both GWB and BHO have, uncharacteristically, criticized him. His words before and after the election have inspired a pattern of ugly American behavior.

I won’t even get into his embarrassing behavior with Germany chancellor Angela Merkel or his idiot tweets that required a rare “sort of” apology to the UK’s Theresa May. Some are amused by his behavior, but I’m just horrified.

Last year, I was a believer in the “useful idiot theory”, that they’d dump him as soon as they wreaked the havoc to every agency and gotten their murderous health insurance allocation to the rich passed. But now he’s SO embarrassing on the world stage, and with the “health care” bill in trouble, maybe they need to dump him sooner or later, over some emoluments thing, likely.

(Serious questions that I do not know the answer to: are the tweets on the POTUS accounts buffeted somewhat from libels laws? And is Clarabelle, posting on realClarabelle, more susceptible to libel law?)

In fact, the only thing that makes sense – not “sense” in “that’s a good idea” but some sort of keep himself in power salvo is the Secretary of State’s threat to North Korea. Hey, everybody loves another war, right? Clarabelle will expect the country to rally around their “leader,” and Kim Jung Un is possibly the one head of state even more unhinged.

When does life end, and begin?

An individual is dead when he or she “has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem.

lifeanddeathI had this very good friend in college named Lynn, who I started thinking about recently after I read two disturbing news stories. We met in the autumn of 1975, and within a year of that, she and I had made a pact that if either of us were seriously injured or ill to the point where the quality of life was gone, then the other would pull the plug, literally, if necessary. This was at a time before living wills and health care proxies and the like were common.

I was reading this terrible story about 13-year-old Jahi McMath in Oakland, CA, who has been brain dead since December 12, “three days after she underwent a tonsillectomy and adenoidectomy.” She’s been moved to a facility in New York.

As the article notes:

While laymen tend to use the words “coma” and “brain dead” interchangeably, in medicine they mean very different things.

“Coma” is the broader term used to describe a prolonged state of unconsciousness, according to the Mayo Clinic. Outwardly, it resembles sleep. Doctors may sometimes purposefully put a patient into a coma to give the brain time to heal. Comas rarely last longer than a couple of weeks…; patients can fully regain consciousness or may transition from a coma into a persistent vegetative state.

Someone in a persistent vegetative state has lost most higher cognitive function, but his or her brain shows some activity. The patient may open their eyes or exhibit small movements, but cannot speak or respond to commands, according to the National Institutes of Health. Some patients can recover from this state, according to the NIH.

A persistent vegetative state would describe the infamous case of Terri Schiavo, a “legal struggle involving prolonged life support … that lasted from 1990 to 2005,” and managed to involve Congress and President George W. Bush.

If I were in that state, I’d be OK with my health care proxy pulling the plug on me, thank you.

Both these situations are different from brain death: According to the Uniform Determination of Death Act, an individual is dead when he or she “has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem.”

What that essentially means is that the brain, an extremely complex organ, no longer helps the patient function.

Thus, brain dead, as I understand it, means DEAD. You can keep the organs going for a bit artificially, so that out-of-town family can be by the bedside and ready themselves for the loss. The ventilator, at least in the short term, also makes it possible to harvest organs for transplant.

Yes, I will be an organ donor.

I was talking with a nurse friend of mine, who notes that when the ventilator keeps blood and oxygen pumping around the body artificially to keep the organs functioning, the skin looking pink and warm, even though the person is dead. But it cannot do this for an extended period before organs start to fail.

The other case I read about:

At 33, Marlise Munoz was brain-dead after collapsing on her kitchen floor in November from what appeared to be a blood clot in her lungs.

But as her parents and her husband prepared to say their final goodbyes in the intensive care unit at John Peter Smith Hospital [in Fort Worth, TX] and to honor her wish not to be left on life support, they were stunned when a doctor told them the hospital was not going to comply with their instructions. Mrs. Munoz was 14 weeks pregnant, the doctor said, and Texas is one of more than two dozen states that prohibit, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient.
…
Her case has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion — when life begins and how it should be valued.

In the six weeks and counting, if she is in fact brain dead, one must assume organ deterioration, which certainly must affect a not yet viable fetus.

Two sad stories, to be sure. I was talking to my PCP (doctor) a few months ago, who notes that these extraordinary, “heroic” measures are factors that drive up the cost of health care for everyone.
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Related: How Doctors Die: It’s Not Like the Rest of Us, But It Should Be.

 

The flu shot: new venue

I’m sure that the acquisitions of the offices of my PCP and similar locations involve the hospital wanting to have the right mix of facilities under the Affordable Care Act, a/k/a Obamacare.

I thought, before I had it 7 or 8 years ago, that the flu was like a very bad cold. I was very wrong. The flu made me feel miserable. I mean missing a full week from work miserable.

Since then, I’ve been religiously getting my flu shot every year, usually when I get my annual physical in early autumn. In the past year, though, the practice of my primary care physician (PCP) has been taken over by one of the large hospitals in the area. As a result, my PCP doesn’t know when the flu vaccine would reach the office. I was encouraged to get my shot at Wal-Mart or ShopRite or wherever I could.

For some reason, I found this oddly unsettling. I’m sure that the acquisitions of the offices of my PCP and similar locations involve the hospital wanting to have the right mix of facilities under the Affordable Care Act, a/k/a Obamacare. Presumably, the economies of scale are supposed to make things more efficient, but that wasn’t the case in this situation.

At my local CVS, there were signs encouraging people top get flu shots there, so I inquired. My shot would be covered fully by my insurance, so I for the shot from the pharmacist behind this partition. My wife can go there too, but my daughter cannot because she is under 18.

Getting the shot at the pharmacy rather than the doctor’s office is different, but no less convenient. The new way of doing things, in this case, was not so bad after all.
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H is for Health insurance and History (mine)

The doctor gave a very brief look at my foot and immediately sent me to bed at the infirmary.

When I moved from Schenectady to Albany in 1979, it was, in large part, to go to graduate school at the University at Albany (which may have been called SUNY Albany at the time – I forget) in the School of Public Administration.

A few days before the semester began, I went to a very nice party outdoors at a friend’s house, where I was walking in the grass with bare feet. A few days later, one of my toes on my left foot started to hurt, at first just a bit, but eventually, so badly, I thought I ought to go to a doctor. BUT I didn’t have insurance, and I WOULD in two days when I registered for classes. (Also, at that point, I didn’t even have a primary care physician, so it would have been a function of picking randomly from the phone book Yellow Pages.)

I sucked it up and somehow got through college registration, in tremendous pain. If someone had offered a wheelchair, instead of the single crutch I was using from a previous injury, I surely would have used it. That and/or whiskey. While the pain when sitting was great, the pain when standing/hobbling on one leg was almost unbearable.

Finally, I somehow made it to the college infirmary; it seemed so very far away. The doctor gave a very brief look at my foot and immediately sent me to bed at the infirmary. Seems that I got an infection beneath my toenail, it was going up my foot, and if it made it to my heart, it would have, literally, killed me. I spent the next six days in the infirmary.

This meant I was a week behind in classes, both academically and socially, from the get-go. I never caught up.

This meant two fundamental things in my life:
1) I dropped out of grad school and ended up working at a comic book store for eight and a half years.
2) I became an ardent supporter of universal health care coverage.

It’s interesting how an initially tiny pain in the foot can have life-changing consequences.

ABC Wednesday – Round 13

An American doctor’s life

Not only will the form ask about religion – something the Census can’t ask because of separation of church and state – but whether they are practicing their religion.

I’m very fond of my general practitioner. I’ve been seeing her for only about a decade, though it seems longer. Inevitably, when I have a visit, especially my physical, we talk. Actually, she talks more than I do.

One of the things she’s had to get used to is the conversion of a bunch of medical records from paper form to electronic form. This happened on her own dime a few years back, when she had to acquire the expensive – and not always reliable – software, and hire med students to input the info. Ideally, this meant that all of my current medications would then pop up on the screen, but no, not always if a different doctor prescribed them. One of my allergy medicines was on a different screen, and this required that the patient – me, in this case – tell the doctor one of the items I was taking. Not urgent in this example, but could be problematic if I were an older patient and/or taking more serious meds.

What’s REALLY gotten on her nerves, though, is this demographic data that she’s supposed to collect, starting in 2014. She knows that it isn’t for the personal evaluation of the patient, but so that the National Institutes of Health, or some other governmental agency, can do correlation studies. What bothers her is the government using doctors’ relationships with their patients to do so.

She understands the question about handedness; certain diseases may be more dominant in left- or right-handed people. But not only will the form ask about religion – something the Census can’t ask, BTW, because of separation of church and state – but whether they are practicing their religion, which apparently makes some older lapsed Catholics quite upset. My doctor is supposed to ask whether there is a gun in the house; she might ask this to make sure that grandpa’s gun ought to be locked up because of his dementia, but she doesn’t feel that it ought to be reported to the government.

Worse, NOT getting answers to these questions will mean getting dinged 1% on each of her Medicare patients, which can turn into real money. Moreover, the proprietary software she has does not allow for responses such as “patient refuses to answer.”

Of course, what this REALLY is about is costs. Pronouncements from certain medical boards that proclaim, for instance, that a PSA test for prostate cancer may not be needed for men because the disease is so slow in developing will mean that perhaps the PSA test won’t be reimbursed, UNLESS the doctor specifically notes is such test is being given because the patient has a family history, which, in fact, I do.

My visit to my doctor: always interesting.

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