Medical Complications: A Doctor Finds Herself On The Other Side

A dear girlfriend recently experienced what Dr. Rubin writes in her post. What would I do were the unthinkable to happen to my husband, or my daughter as a result of a mishap at the hands of a medical provider? Remaining calm under life-threatening situations is incomprehensible. Nonetheless, what Dr. Rubin suggests makes a lot of sense. I can only hope I’ll remember her advice should I ever need it.

………hugmamma.

Carrie Rubin

Nothing in medicine is without risk. As a physician, I’ve always known this. As a layperson, I’ve just experienced it.

surgical instruments Image credit: Microsoft Clip Art

Last week my mother suffered a severe complication during routine surgery. As a result, what she went in for was not at all what she came out with. A long road to recovery lies ahead, one with the unfortunate road block of another surgery along the way.

As a medical doctor, I understand complications happen. Nothing is one-hundred percent, and believe me, no healthcare provider wants a patient to have a bad outcome. But as a daughter, I also understand the anger and frustration that result from a medical mishap.

Out of respect for my mother and her medical team, I won’t share specifics about the incident, but I thought a general post on the topic might help others in a similar situation. Who knows…

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details…little known facts

Secret Service agents in response at the assas...

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In summing up what I’ve learned about President Ronald Reagan and First Lady Nancy Reagan from reading I Love You, Ronnie, a couple of details came to light which I’d not known before. And according to Mrs. Reagan, only those close to what occurred at the time, knew. The first dealt with the assassination attempt on the President’s life 3 months after he took office. The second was an incident that probably caused the premature onset of his Alzheimer’s. Only a handful, it seems, were privvy to both occurrences.

Waiting for news, Nancy Reagan sat with Sarah Brady, whose husband Jim had also been shot in the attempt on the President’s life.

As we waited, I looked out the window and saw how, in the buildings all around the hospital, people had thrown sheets out the window saying things like GET WELL, MR. PRESIDENT and WE LOVE YOU, MR. PRESIDENT. Every now and then, a nurse would come and report to me on Ronnie’s progress. At first, the doctors were having trouble finding the bullet, which was a devastator bullet, the kind that explodes inside. One time, the nurse came and said, “We just can’t seem to get it out. We may just have to leave it in.” Well, that didn’t sound so good to me. And then another time, she said, “They’ve found it, but the doctor is having a hard time removing it–it keeps slipping from his fingers.” Finally, she came back and told me that the doctor had gotten it out, but I almost lost him then. The bullet had been lodged an inch from Ronnie’s heart.

We were lucky–we didn’t realize how lucky, in fact–because when Ronnie had arrived, all the doctors were in the hospital for a meeting. No one had to be called in. Everyone Ronnie needed was right on hand, and there was no waiting. …

I wanted to stay there all night, but the feeling was that it would be better for the country if I left and went back to sleep at the White House. Otherwise, people would have assumed the worst and there would have been panic. As it was, Ronnie’s aides had to do all they could to calm the country down. The briefings made to the press were partial, to say the least. The assassination attempt was really a much closer call than people were led to believe at the time. Everyone was trying not to frighten the people in the country, but the fact was, Ronnie almost died. It was a miracle that he didn’t. And I knew all along how serious things really were. …

Needless to say, I was terrified. After the shooting, every time Ronnie walked out the door to make a public appearance, my heart would stop–and it wouldn’t start again until he came back home safely. Ronnie knew how scared I was. But if he was frightened too, he never let me know it. As always, he was cheerful and optimistic. God had spared him, he believed; there had to be a reason why. By making jokes…he tried to take the edge off my fear.

The Reagans wave from the White House after Pr...

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Who could fault the First Lady’s hovering over the President thereafter? No wonder her seeming control of his life, personal and public, for which the media liked to criticize her. I know because they had me convinced she was running the country with her husband, an unofficial cabinet member, as was constantly written and spoken of in the news. How the spinmeisters love to slant the facts. Readers, beware!

Fast forward to July 1989, after the Reagans had left the White House. Visiting with friends Betty and Bill Wilson at their ranch in Mexico, the President went riding. An accident occurred.

Ronnie had been thrown off his horse. He was riding with some other men, going up an incline, when one of the ranch hands had hit something that made a loud noise and spooked Ronnie’s horse.

The horse reared once, and Ronnie stayed on. It reared a second time, and Ronnie stayed on again. Two Secret Service men tried to move in and calm the horse, but they couldn’t do it. The horse reared a third time, bucking so hard that Ronnie fell off and hit his head on the ground, miraculously missing the jagged rocks all around.

President Ronald Reagan

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We got him on a plane and immediately took him to a hospital in Tucson, Arizona. He should really have stayed there, but it was my birthday and the Wilsons had planned a celebration, and Ronnie was determined to go back to the ranch. We went back–but at my insistence, we took a doctor with me.

The day after…we flew home. I was very uneasy and kept at Ronnie until he agreed to get his head X-rayed. We went to the Mayo Clinic, where we’d gone every year for checkups. It turned out that Ronnie had a concussion and a subdural hematoma. He needed to be operated on right away. It all happened so quickly that I think, once again, I was in shock. …

I’ve always had the feeling that the severe blow to his head in 1989 hastened the onset of Ronnie’s Alzheimer’s. The doctors think so, too. In the years leading up to the diagnosis of the disease, in August 1994, he had not shown symptoms of the illness. I didn’t suspect that Ronnie was ill when we went back to the Mayo Clinic that summer for our regular checkup. When the doctors told us they’d found symptoms of Alzheimer’s, I was dumbfounded. Ronnie’s fall from the horse had worried me terribly, of course, and I’d had to urge him to take time out to recover after his operation. But I had seen no signs of anything else.

There’s no telling if President Reagan would have enjoyed more years of retirement, free from the debilitating symptoms of Alzheimer’s. How fragile the brain, with only the skull as protection from the hazards of everyday life…like horse back riding. Spared from the assassin’s bullet, Reagan succumbed to no less a devastating end. As his devoted wife, and true witness to her husband’s last 50 years on earth, Nancy Reagan suffered Alzheimer’s alongside him.

Senator Corker greets former First Lady Nancy ...

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…First of all, there is a feeling of loneliness when you’re in this situation. Not that your friends aren’t supportive of you; they are. But no one can really know what it’s like unless they’ve traveled this path–and there are many right now traveling the same path I am. You know that it’s a progressive disease and that there’s no place to go but down, no light at the end of the tunnel. You get tired and frustrated, because you have no control and you feel helpless. We’ve had an extraordinary life, and I’ve been blessed to have been married for almost fifty years to a man I deeply love–but the other side of the coin is that it makes it harder. There are so many memories that I can no longer share, which makes it very difficult. When it comes right down to it, you’re in it alone. Each day is different, and you get up, put one foot in front of the other, and go–and love; just love.

I try to remember Ronnie telling me so many times that God has a plan for us which we don’t understand now but one day will, or my mother saying that you play the hand that’s dealt you. It’s hard, but even now there are moments Ronnie has given me that I wouldn’t trade for anything. Alzheimer’s is a truly long, long good-bye. But it’s the living out of love.

Photograph of Newlyweds Ronald Reagan and Nanc...

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…blest by true love…even in the face of adversity…hugmamma. 

 

where were you…

…when Diana, the Princess of Wales died? I can only think of one other person for whom that question has been asked…John F. Kennedy, our President. I know I was in school when he died, because classes were suspended. Instead we all walked to church to pray for him. In Diana’s case I think I was asleep, and learned with disbelief, about her death early the next morning.

Unlike President Kennedy‘s death of which so much has been written, documented, and analyzed in books and on TV shows, Diana’s death has been treated more gingerly it seems, at least here in the U.S. Either that, or I didn’t bother to read about it in the tabloid magazines because of their tendency to sensationalize the facts to make a profit. I didn’t set out to learn about them even now, they just fell into my lap, by way of Sarah Bradford’s Diana – Finally, The Complete Story

I chose to share this with you because as in life, in death Diana’s beauty remained intact. Her serene appearance belied the inner damage that resulted from the horrific car accident.

It took almost an hour to free Diana from the wrecked car. She appeared to her rescuers to be the least injured of the four: only a slight trickle of blood from mouth and nose indicated that anything was wrong. Yet her internal injuries were life- threatening. After the initial impact the Mercedes had spun away, rotating at high speed before crashing into the tunnel wall on the right. At the first impact Dodi and Diana had been thrown violently forward against the backs of the front seats (not having worn their seat belts), then the rotation of the car had flung them around against the interior. When the Mercedes finally stopped, pointing back towards the mouth of the tunnel, Diana was slumped on the floor, against the back of Rees-Jones‘s seat, facing down the tunnel. Her legs were twisted, one under her, the other on the seat. With her eyes closed and her face undamaged apart from a cut on her forehead, she looked beautiful and as if she were asleep. But the shock of the impact and deceleration on her body had displaced her heart from the left to the right side, severing the pulmonary vein and rupturing the pericardium (the protective sac round the heart), flooding her chest cavity with blood. …

Photo of the Chapel at the Pitié-Salpêtrière H...

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Yet to the first doctor on the scene, Frederic Mailliez, who had been driving through the tunnel in the opposite direction, she ‘looked pretty fine…I thought this woman had a chance.’ He put an oxygen mask over her face while attempting to clear her air passages. When the ambulance arrived, Dr. Jan-Marc Martino, a surgical anesthetist and resuscitation specialist, worked on Diana. Before they could transfer her to the ambulance, she suffered a heart attack. She was given cardiac massage and a respiratory tube was inserted into her mouth. Then she was lifted on to a stretcher and placed in the ambulance which crawled its way with a police escort to La Pitie-Salpetriere Hospital, stopping once on the way as Diana’s blood pressure dropped to a dangerous level. She was put on a ventilator. ‘She was unconscious and under artificial respiration. Her arterial blood pressure was very low but her heart was still beating. X-rays revealed the horrific state of her internal injuries and afterwards she suffered a second heart attack. An incision in her chest revealed that bleeding was coming through a hole in the membrane round her heart and later that her superior left pulmonary vein was torn. Adrenalin was administered and cardiac massage kept her heart going but only just; there was no independent rhythm. Diana was to all intents and purposes already beyond help. Electric-shock therapy was administered, to no effect. At 4 a.m. (3 a.m. British time) on the morning of 31 August, she was pronounced dead.

Charles, Prince of Wales outside the White Hou...

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And while it was rumored at the time that Diana allegedly spoke a few words to Prince Charles, that was obviously not the case. “When Prince Charles and Diana’s sisters arrived in Paris, they found Diana looking serene and composed in death, wearing Lady Jay’s black cocktail dress and shoes, her hair freshly blow-dried, the rosary which Mother Teresa had given her in her hand. After Charles and her sisters had spent time alone with her, she was placed in a coffin for the return journey.” 

According to those who accompanied the hearse through the streets of Paris, there was an outpouring of support for the People’s Princess.

‘They do it differently in Paris–they applaud. With the coffin, Prince Charles, the President, millions of police by now,…and the vicar (the Rev. Martin Draper), the whole of Paris was applauding…

Sadly Diana’s body was not received with the same honor bestowed upon it by the Parisians and the British masses, when it came to rest in the Chapel Royal at St. James’s Palace. Good friend, and the woman thought to have been most like a mother to the princess, Lucia Flecha de Lima flew from the U.S., where she lived, to London, upon learning of Diana’s death. To her amazement the coffin lay “…in lonely state, without flowers.”

Flowers for Princess Diana's Funeral

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‘The first day when I arrived at the chapel there was not one single flower on her coffin. Then I said to the chaplain that if he didn’t allow flowers in, I would throw open the doors of the chapel so everyone could see her there without a single flower and all the flowers outside that people had brought. I said, “Tomorrow I’ll come back with my flowers for her.” And I came every day. And from then on I brought flowers, not only mine but from friends and people who knew her. And I went to a flower van outside the Michelin restaurant (Bibendum in the Fulham Road) and he said: “What are they for?” And I told him, and every day after that he insisted I take flowers to her for nothing…’ ‘And they (the flowers) were around her, over her coffin representing the flowers of the world, and I said to Prince Charles, “These flowers represent the people, thousands and millions of flowers all around the world that people want to give to Princess Diana.” I’ve never felt like that in my life. I have experienced personal loss…but the public’s reaction was extraordinary…’

 One other item mentioned in Bradford’s book caught my attention. While Queen Elizabeth seemingly struggled with her decision to recognize Diana’s death with the pomp and circumstance demanded by the people, personally she too had to deal with the passing of her former daughter-in-law, the mother of the queen’s beloved grand-children. Bradford wrote of Dickie Arbiter, the most experienced of royal officers who had worked for the Waleses before their divorce,

The coffin passing through one of the streets.

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Contrary to public perception, the Queen was, Arbiter said, ‘very grief-stricken’ by Diana’s death. ‘On the day of the funeral when the Royal Family came out of Buckingham Palace as the gun carriage carrying Diana’s coffin passed, the Queen bowed. And the only other time that the Queen bows is at the Cenotaph.’

…there are the rumors…there are the myths…and then there’s…the truth…hugmamma.

Rose, Diana Princess of Wales

Image by nekonomania via Flickr

…princess diana…england’s rose…

 

Diana, Princess of Wales, at the Cannes film f...

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no a/c, a stroke, and bedbugs…???

Red bedbug

So we finally come to the end of this tragi-comedy about bedbugs in my daughter’s apartment, the old one that is. Content with having secured a new place in the nick of time, my daughter felt extremely fortunate to have somewhere to go, leaving her unwelcome buddies behind. (Fingers xxxxx.) But just when things seemed to be going her way, the a/c in her new apartment went on the fritz…almost immediately.

Traveling west to be with my husband and me, my daughter missed the initial couple of weeks without a/c in her new digs. A couple of friends took turns trying to have repair people stop by to put more freeon in the old a/c unit. The excuse given by the company  who was referred by the apartment’s owner and landlord, was that the technician didn’t have a ladder long enough to get to the roof where the unit stood. When my daughter and I returned to her home, that was the same excuse given by a couple of other a/c servicers. In fact one technician who did come, left without even telling us he couldn’t do the job. Not until an hour-and-a-half slipped by without a knock at the front door, did my daughter learn after calling his company that he left because they don’t service that particular brand. Upon relaying this info to the landlord, he exclaimed that the company got the brand name wrong. He indicated he would try to track down another company through the insurance he had for repair services. My daughter also gave him the name of the company whose truck we had seen in the parking lot of the neighboring apartment house, the same day our disappearing a/c guy showed up. Those workers looked like they were diligently working to get some problem resolved, even in the sweltering 90+ temperatures. As it turned out, a couple of men from that company visited my daughter’s apartment later that afternoon.

Upon checking the interior part of the a/c unit in my daughter’s apartment, it was determined that there was a leak. After reporting this to the landlord, the company’s co-owner visited us the next day under orders to do whatever it took to fix the a/c. Because it was so old, the replacement part could only be gotten from a manufacturer in Texas. It wasn’t expected to arrive until the following Tuesday, so that the a/c couldn’t be fixed until Wednesday or Thursday. That meant several days of sweltering heat inside the apartment.

Happy that the a/c was going to be fixed, I didn’t calculate the hours we would have to suffer through the 90+ degrees even as we tried to sleep. I imagined with 5 fans blowing day and night we would manage. Was I ever wrong! One night is all it took to decide that my aging body was not up to the task. I awoke to find my hands and fingers, feet and toes swollen. The blood had rushed to the surface of my skin as if to escape the confinement. I’d never had to worry about high blood pressure before. But I was certain if I slept there another night, my pressure would be through the roof!

And that’s why we made the unlikely decision to bed down with the bedbugs, my daughter on the couch, me on the bed in the second bedroom. Because both had been treated, we hoped we wouldn’t make a hearty 9-course meal for any starving bedbugs. I think we willed ourselves not to scratch. 

My daughter’s new landlord must’ve “paid an arm and a leg” to repair the a/c. Besides it being an emergency repair with a new servicer, the necessary part had to be Fed Exed from out of state, and a crane was hired to haul the a/c from atop the apartment building so that it could be fixed on the ground and then put back in place. Added to that, the servicer had to repair the indoor unit which had been leaking the freeon. Why the a/c was installed atop the three-story building in the first place is unknown to us. I guess things were done differently in the 70s. But it was while my daughter and I were waiting for the a/c to be fixed that we got food poisoning. After that, everything else  became “background music.”

A Bed Bath and Beyond store in a shopping cent...

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How did we manage to contract salmonella, you ask? Well on one of our outings to Bed, Bath and Beyond to secure new pillows and their corresponding bedbug resistant covers, we stopped to buy a few groceries on the way home. Remember, the temperatures were in the mid-90s. Deciding to eat a light, healthy lunch, we opted for a veggie platter. Not realizing that the included dip was probably turning rancid as we drove another 20 minutes home, we proceeded to chow down once there. With floor fans set to their highest levels, we munched away feeling the cool blasts on our faces and bodies. Mind you, the indoor temperature over the next several hours was also in the mid-90s. It’s my belief that we were ignorant to the fact that salmonella was probably making its way into our digestive tracts. My daughter’s case may have been slightly more severe since she also feasted on a dessert of chocolate pudding pie. Something we’d picked up from a nearby restaurant the day before, which served up real southern cooking, a haven for high cholesterol foods.

As I mentioned before, my daughter’s recovery from food poisoning went relatively smoothely. There were no residual effects, unlike my bout. While my vomiting and diarrhea ended, the nausea, queasiness, and mild dizziness persisted. I just didn’t feel 100%. A couple of times I was overcome by tears, so frustrated that I couldn’t attack the chores with the same gusto I’d had prior to being ill. The second time was when I heard my husband’s voice on the phone asking how we were. Bawling, I told him how much I missed him and couldn’t wait for him to arrive to assume control. My brains were “fried,” I told him.

I’d wanted to accomplish so much before my husband joined us. Because of the extreme heat and humidity I feared his asthma would flare up if he tried to do too much. I didn’t want him landing in the ER during his short, four day visit. I even contracted a private mover to transport my daughter’s large pieces of furniture from one apartment to another. The price was fair for the heavy lifting involved, and the 2 flights of stairs the men had to climb at her new place. My husband was immensely grateful for my last minute decision to hire someonelse. He’d forgotten how weighty the huge, glass bookcase was. Not one to drink bottles and bottles of water, my husband felt moving such massive furniture in the heat would have been very difficult for him. I also took pity on any male dancer friend of my daughter’s who had offered their services. I didn’t want their aches and pains or worse, broken bones, on my conscience.

Grateful for my husband’s contribution to our ongoing efforts to move stuff from storage to the old apartment, and then to the new apartment, I continued to deal with the lingering effects of food poisoning. It was distressing to have to stop what I was doing and rest until I felt better. I attempted to ignore what I was feeling, but wasn’t able to in the end. I had to give in, and go with what was happening. Such an occasion occurred while we were shopping for hardware at a local Lowe’s Hardware.

 

A typical Lowe's storefront in Santa Clara, Ca...

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Walking up and down the aisles looking at storage paraphernalia, I felt lightheaded, as if I were about to faint. After a few more aisles, I nearly passed out. We decided to leave, my husband quickly making his purchases. He headed out to get the car so that he could pick me up at the exit. My family and I decided I should go to a nearby walk-in clinic.

Upon arrival at the clinic, I felt spacey. My husband and daughter each held an elbow as they escorted me inside where I immediately took a seat. My husband checked me in and filled out the necessary paperwork. When my name was called, my daughter accompanied me in to see the doctor. After waiting a short while, he appeared. After asking me questions, and listening to my replies, he asked me to follow his moving finger with my eyes. I did okay although I felt myself struggling a bit. The doctor then asked me to stand and walk towards him, which I did with some hesitation. After I sat down, he advised us that I might be having a stroke. I must admit, strokes never come to mind when I feel something might be awry. Heart attack, maybe. Stroke, never. And yet two of my brothers have had strokes, serious ones, from which they’ve thankfully recovered.

ER (TV series)

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At the doctor’s insistence I went to the nearest ER. I think my husband and daughter were somewhat alarmed as we drove to the hospital near my daughter’s new apartment. I was going to the same ER I’d taken my daughter to in February, when she suffered from an unremitting migraine headache. I think I felt relieved that I might finally discover why I wasn’t “up to snuff.” I was really sick of feeling sick!

Unlike the lengthy wait my daughter had during her prior visit, I bypassed much of the bureaucratic mumbo-jumbo because I was a possible stroke victim. It didn’t help when I burst into tears because I couldn’t remember what day it was when the receptionist asked me. I turned to my husband for help, crying as I asked him what day he’d arrived. Even as I lay on the hospital bed answering the doctor’s questions, I felt I had to will myself to relax, taking my time to mouthe the answers.

Treatment began with forcing fluids into me intravenously, along with a medicine for nausea. After that there was an EKG, cat scans of my brain, and abdomen (I’d felt a sharp pain when the doctor’s hand compressed my side), and a chest xray. I’d also given them a urine sample. Happily, all tests came back negative for a stroke, heart problem, appendicitis, or anythingelse. And by the time the fluids had made their way throughout my body, I was feeling much better. So in the end I was probably suffering extreme dehydration brought on by my bout of food poisoning, and possibly some heat exhaustion as well.

With my new lease on life, we finally settled our daughter into her new apartment, cleaned out the old one, assembled a treasure trove of stuff for her to cart off to Goodwill, and transported a nominal amount into her storage unit for safekeeping. The last 2 nights my husband and I were with her, my daughter and I were up Saturday until 4 a.m. putting things away. On Sunday my husband fell asleep on the air mattress (not the old one, but a new one) at 2 a.m. I remained up again with my daughter, laying down for just one hour before getting up to prepare myself for the trip home to Seattle. Grateful for all my husband and I had done, our daughter tumbled contentedly back into bed after our car drove away.  

I’m sure you’ll understand now why my daughter and I agree that “you should let the bedbugs bite.” It makes life a helluva lot easier that way…

 

Halloween Parade 2007: Bedbugs!

Image by LarimdaME via Flickr

 

you think?…hugmamma. 😉

proactive…against alzheimer’s

My friend Sylvia sent me a nice email which, among other things, expressed her concern that perhaps I dwell on the possibility of succumbing to Alzheimer’s more than I should. I’m certain the disease is not in her genes, for I’ve never heard her speak of either parent or any family member having died with it. Sylvia’s a decade older than me, and shows no signs of memory loss. Having done extensive reading about the disease, I know that she’s already got several factors in her favor for NOT developing Alzheimer’s.

Sylvia is a voracious knitter. Challenging herself with difficult patterns probably keeps her mind agile. She is a meticulous housekeeper and gardener. You could dine off her kitchen and dining room floors, and spread out luxuriously on her manicured lawn, while your eyes feast on the abundant clematis flowers that climb the nearby fence. The exercise involved is also good for the brain, not to mention the body. Finally, Sylvia relishes socializing. She and Jim traipse hither and yon to listen to the big band sounds of “Peach Tangerine.” She has belonged to the “Happy Hooker’s” knitting group for 20+ years, inviting the ladies to her home for an annual Christmas luncheon. And she goes above and beyond to help those in need, from family members to elderly neighbors in her retirement community. Sylvia’s got socializing down to a science which is great, because it’s a key ingredient in the fight against Alzheimer’s.

Sylvia has taught me invaluable lessons on growing older gracefully…and keeping my mind healthy and happy. From what they’ve written, others have also given me useful information so that I can take a proactive role in slowing the onset of Alzheimer’s or perhaps preventing it altogether. I regularly share this information in the hopes that it might encourage others to take action as well. I don’t do it as a plea for sympathy, or to sound my own horn. I truly feel this disease, like others, can and should be addressed as early as possible. If there’s any cause for which I am fully committed, rather than “burying my head in the sand,” the delay or prevention of Alzheimer’s is the mother lode of all causes for me. I take a stand not only on my own behalf, but also on behalf of those I love, and who love me.

Cover of

Cover of Preventing Alzheimer's

Leeza Gibbons, one-time TV personality writes in the “Foreword” for Preventing Alzheimer’s – Ways to Help Prevent, Delay, Detect, and Even Halt Alzheimer’s Disease and Other Forms of Memory Loss by William Rodman Shankle, M.S., M.D. and Daniel G. Amen, M.D.:

If you’ve picked up this book, you’re probably scared. Or if not afraid, at least interested in what causes Alzheimer’s disease and learning whether you are at risk.

The reality is that we’re all at risk of having this “terrorist-like thief” randomly break into our brains and begin to rewrite our life stories. As Baby Boomers beginning to face our mortality, Alzheimer’s is the unwelcome stranger that reminds us of our vulnerability.

The good news is that we don’t have to be defenseless.

My grandmother lost her life because of Alzheimer’s disease. We lose a little more of my mom everyday. Before Mom was fully trapped behind the fog, she asked me to promise that I would tell her story and use it to educate and inspire. I am, but doing so often brings more questions than answers. She looked into the face of her mother at my Granny’s funeral knowing what her fate would be. I looked at Mom and wondered…What about my children, and what about me? Am I next in line to have my memories stolen?

When my three children ask me if I will get “it” I tell them–truthfully–that I don’t know.

Thanks to Drs. William Rodman Shankle and Daniel Amen, what I do know is that perhaps I can effectively manage my risk of getting the disease, and you can, too. Whether or not you have a history of Alzheimer’s or dementia in your family, your goal is to keep your brain strong and healthy. …

We all know that the “age wave” is about to crash in our culture and yet we are not at all ready. Even in the wake of President Ronald Reagan‘s death, there is still so much shame and stigma surrounding memory disorders that many families try to compensate and deny until they are bankrupt–financially, spiritually, and emotionally. Alzheimer’s is a disease that depletes and depletes, and it is never satisfied with the diagnosed individual…it wants the entire family.

It’s for this reason I created the Leeza Gibbons Memory Foundation. Our family was numb and paralyzed with fear when Mom was diagnosed. It was almost impossible to find the help and support we needed. Answers were scarce. …

Leeza's Place

At Leeza’s Place, our mantra is early diagnosis. We believe in memory screenings to get a baseline reading, against which any decline can be measured. We believe in educating our guests about the latest in alternative treatments to complement traditional approaches. We believe in being proactive against this frightening force. We believe in support for both the recently diagnosed and those who care for them.

That’s why I am so impressed with Drs. Shankle and Amen and their work. They are well-respected scientists whose work is world-renowned, but I also know them as kind, compassionate men who not only focus on how to tackle this disease, but on connecting with families who arrive in their offices with their breath knocked out of them, looking for a miracle. These two doctors will never try to talk anyone out of expecting a good outcome…they have seen it happen too many times. They have been the guiding forces toward success stories that may offer real hope against a dark landscape of despair. …

You are perhaps doing nothing short of changing the course of your future, and possibly someone else’s, by reading this book. Can you think of anything more powerful or important? It’s a popular notion that we must gracefully surrender the things of youth. Yes, we will lose our firm muscles and unlined skin, but memories should be ours for keeps. They are what resonate at the end of a life, sweetened over time.

We must do what we can to bolt the door to our minds so that our treasured recollections of those we love, where we went, and what we felt will be kept forever as a sort of “soul print” of our time here on earth. This book suggests options that might have the potential to lock out Alzheimer’s disease in order to do just that.

This image shows a PiB-PET scan of a patient w...

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Under the heading “What the Brain Needs to Stay Healthy,” Drs. Shankle and Amen write:

Fuel
Just like any other living thing, a brain needs fuel to grow, function, and repair itself. Glucose and oxygen run the engine powered by your brain cells. Glucose is a simple six-carbon sugar. Unlike other cells in your body, your brain cells only know how to use glucose. Anything that impairs glucose delivery to brain cells is life-threatening. Oxygen is required to produce energy; without it your mitochondria will not produce enough energy to keep your brain alive. Because blood delivers glucose and oxygen to your brain, nothing must get in the way of blood flow if the brain is to stay healthy.

Stimulation
Although largely genetically programmed to turn on its functions at the right developmental age, the human brain also depends on proper stimulation to grow and develop throughout childhood and to maintain its functioning into old age. When you stimulate neurons in the right way, you make them more efficient; they function better, and you are more likely to have an active, learning brain throughout your life. …

The best sources of stimulation for the brain are physical exercise, mental exercise, and social bonding.

Physical Exercise
Physical exercise is important for brain health. Moderate exercise improves the heart’s ability to pump blood throughout the body and helps maintain healthy blood flow to the brain, which increases oxygen and glucose delivery. Exercise also reduces damage to neurons from toxic substances from the environment, and it enhances insulin’s ability to prevent high blood sugar levels, thereby reducing the risk of diabetes. Physical exercise also helps protect the short-term memory structures in the temporal lobes (hippocampus and entorhinal cortex) from high-stress conditions, which produce excessive amounts of the hormone cortisol (20). …The Honolulu Study of Aging found that untreated high blood pressure during midlife (40 to 60 years old) greatly increases the risk for dementia. …This study emphasizes the importance of regular exercise and proper treatment of any medical conditions you may have. …

Mental Exercise
Physical exercise has a global effect on the brain, but mental exercise is equally important. By mental exercise, we mean acquiring new knowledge. It is possible to use your brain without learning anything new, which in the long run is not terribly helpful. For instance, Dr. Joe L. reads mammograms all day long–reads thousands of them a year–and although he is working his brain every day, he is not actually taking in new information. Whenever the brain does something over and over, it learns how to do that particular thing using less and less energy. New learning–such as learning a new medical technique, a new hobby, or new game–helps establish new connections, thus maintaining and improving the function of other less-often-used brain areas. …

Social Interaction
One common source of brain stimulation that is often overlooked is interacting with other people. Social interaction is the fuel the brain needs to develop the ability to negotiate, cooperate, and compromise with others, to know right from wrong, and to know when to respond and when to keep silent. These highly complex human abilities are largely controlled by the tips of the frontal lobes. They start to develop before two years old, such as when the infant starts saying no to the parents. These abilities continue to develop at least until 50 years old, according to studies of brain myelination, and perhaps longer.

Child neglect has been associated with many brain-based developmental difficulties such as personality and learning and behavioral problems. Likewise, adults deprived of the company of others experience a clear negative effect on cognitive abilities, memory, and social skills. In studies on social connectedness in the elderly, it has been shown that people who spend time with others on a regular basis are cognitively sharper. In addition, their emotions are more even. Psychiatrists have seen time and again that people who are isolated commit suicide dramatically more often than those who are active in society. Simple social interaction stimulates particular neuronal circuits. For instance, there is a self-awareness circuit at the very tip of the frontal lobe. If its capacity is diminished, the person can no longer judge her own abilities. Self-awareness is maintained, literally, by being aware of oneself, and that is aided significantly by feedback from other people. If the circuits in the crucial areas of the frontal lobe aren’t being used, they atrophy, and the person’s social skills suffer.

Page 71 of the book carries “The Shankle-Amen Early Dementia Detection Questionnaire.” Listed are 21 short questions to which the answers are either “yes” or “no.” In parentheses are numerical scores. Upon completion, one is asked to total the scores for the “yes” answers.

Interpretation
If the score is 0, 1, or 2, then you have low risk factors for developing ADRD.
If the score is 3, 4, 5 or 6, then you should annually screen (see Appendix A) after age 50.
If the score is greater than 6, then you should annually screen (see appendix A) after age 40.

Following are the questions for which I answered “yes.”

1._(3.5) One family member with Alzheimer’s disease or other cause of dementia

10._(2.1) High cholesterol (hyperlipidemia)

Mrs. Laura Bush, First Lady of the United Stat...

Image via Wikipedia

As you can see my score is 5.6 indicating that I should test for memory loss, which I will be doing. Coincidentally as I write this post, there’s a Larry King special on TV, “Unthinkable – Alzheimer’s Epidemic.” Among other guests speaking of their experiences with family members who had Alzheimer’s are Leeza Gibbons, Laura Bush, Angie Dickinson, Ron Reagan, and Maria Shriver. Contributing to the piece are the Mayo Clinic, the Cleveland Clinic, as well as doctors, scientists, and other experts in the field. Larry King underwent testing, including an MRI, to see if symptoms of dementia and Alzheimer’s could be detected. He came away with a clean bill of health as far as they were concerned.

β-amyloid fibrils.

Image via Wikipedia

The message of my post, and Larry King’s TV special, is to recognize and accept the potential for Alzheimer’s. But more importantly, it’s that we should be aggressively proactive in remaining out of its debilitating grasp for as long as we are able. For once its tentacles take hold, there’s no escape…ever.

preferring to be the aggressor…and not the victim…hugmamma.  

moms do what’s needed

Got a surprise call from a blogging friend today. Jaclyn and I met months ago in Cat Rambo’s “Blogging 101” class at Bellevue College. I got good vibes from Jaclyn while in class. And she’s every bit as nice as I thought she would be.

During our conversation today, she reminded me what her life is like on a daily basis. For 18 years Jaclyn has been caretaker for her only child. While this doesn’t seem an unusual situation from that of other moms, her situation is unique in that her daughter has a rare disease known as Galactosemia, a milk sugar disorder.

Galactosemia is a rare congenital disorder which affects the body’s inability to convert galactose into glucose. Galactose is a type of sugar, which is a breakdown product of lactose. Lactose is found in milk and milk products, including breast milk. Given that the galactose can not be broken down, it builds up in the body and acts as a poison that can cause serious damage to it‘s carrier(“galactosemia“). “As milk is important to a baby’s diet, early diagnosis is essential to avoid lifelong problems from this potentially fatal disorder.”     

The first trace of information that was brought to light about galactosemia was in 1908 by Von Ruess. He composed an article of his findings in an infant with many of the symptoms we now relate to galactosemia. This work has widely been accepted by scientists as the first reported case of galactosemia. However, at this time the diagnosis of galactosemia was not yet possible. It would be nine years before a similar diagnosis of galactosuria was largely accepted by scientists as a hereditary disorder. 

At the time Jaclyn’s daughter was born, galactosemia was not yet within the mainstream of medical knowledge. So doctors failed to correctly diagnose her digestive problems. Meanwhile the disease took its toll on the youngster’s body, leaving her permanently handicapped, mentally and physically. Having recently turned 18, the young woman reads at the level of a 4th grader.

Needless to say Jaclyn has been at the forefront of fighting her daughter’s fight to make the most of her life, such as it is. Where schools were not willing to pursue academics at a more challenging level, consigning her daughter to classes for children with special needs, Jaclyn decided to home school instead. With the help of other adults, her daughter is experiencing as full a life as she can. Their assistance also allows my friend some much-needed respite from her 24/7 role as caretaker.

Surprisingly, or maybe not, I never find anything in my friend’s voice to suggest that she is pained to be saddled with her daughter’s predicament. Jaclyn sounds like other moms I know who love their children, and do what needs to be done for them. Jaclyn is always upbeat, never belaboring the fact that her child is, in fact, unlike those now capable of venturing forth to make their own way in the world.

When Jaclyn calls it’s usually to ask how I’m faring with my blog. The last time she phoned it was to suggest an online site where I might want to self-publish. Today she recalled that I’d mentioned that my writing skills were honed when I had served as a paralegal for TWA in NYC. She wondered if I had the title of the book which had been instrumental in my learning to write. I replied that I learned on the job. I was enrolled in classes at night to obtain a paralegal certificate, a condition for the job to which I had already been promoted. So writing legal briefs for the attorneys with whom I worked during the day, quickly instilled me with the skills I still possess today. I learned to organize my thoughts on paper, and offer support for my assertions. Blogging has enabled me to regain my skills as a writer, after a 24-year hiatus.

When I asked with what she was currently involved, Jaclyn explained that she’s trying to secure social security benefits, however meagre, for her adult daughter. We both agreed that government bureaucracy can be mind-boggling. Because galactosemia is unfamiliar to most, she has found it daunting trying to convince bureaucrats of her daughter’s disability which has essentially robbed her of an independent life.

Ending the phone call with her usual laughter, Jaclyn admitted to signing up for Cat Rambo’s class on the writing of fantasy stories. My friend wants to take a breather from reality, and escape to the land of fantasy. God knows she deserves to enjoy a little make-believe.

for a mom whose life is her daughter’s, huge hugs…hugmamma.

correction, petit daughters

Someone who knew Dr. William Petit has left a comment with a couple of corrections to my previous post on he and his family. I feel they’re important enough to mention them in a separate post for they speak to who the daughters were.

The eldest daughter went by the nickname “Hayes.” Michaela, the youngest, was known as “KK Rosebud.” And it was also she who fashioned her life according to “be the change you want to see in the world.”

I’m also grateful to the reader who brought these facts to my attention, for she, or he, also knew Dr. Petit personally, and spoke to his humanity. He, as seems evident from all he said during the interview with Oprah yesterday, is an extraordinarily compassionate person, and physician. And as he indicated, “the smartest man” his wife, Jennifer, knew. And the reader agreed that the doctor should resume his practice, for his humanitarianism and talent are sorely needed in our society.

grateful for insight into the man, and his daughters…hugmamma.

two housewives, “founders of tea party movement”

I’d always wondered whether or not ordinary housewives could run the country. Looks like last night’s election proved that they can. Evidently we can do the extraordinary, when we decide to put our passion and energies behind a task. I’m sure all women will agree that’s a “no-brainer.” When wives and moms decide to do something, they do it, like Margaret Whitman, creator of the multi-billion dollar business, E-Bay.

Sarah Palin’s first brush with the media was as a beauty queen. Setting her sights on politics, she became mayor of little known Wasila, and then governor of Alaska, and then GOP candidate for VP. While she and McCain lost the presidential election, Palin landed back in front of the cameras. While she may not have been the media’s darling then, mainstream reporters seem to be back pedaling now. This morning on CNN, the political spin-meisters spoke of her as a force with which to be reckoned, especially in the 2012 election. OMG, I thought! Talk about going the “way the wind blows.”

I’m a liberal, too compassionate to turn my back on those needing a “hand-up.” My husband and I, both from large families, 12 and 9 siblings, respectively, are inclined to “give back,” and “pay it forward.” But I do understand the frustration of those on the unemployment lines, those who are barely making “ends meet,” those whose homes are “under water” because of foreclosures next door, those whose businesses are struggling, those who want a balanced budget, those who want less government, and those of us on Main Street who are fed up with the millionaires on Wall Street. Might I just add here, why are we still making millionaires of athletes, and celebrities, and doctors “playing” the Medicare system? I’d just as soon take all the money we’re pouring into these peoples’ pockets, and help the homeless, the abused, those unable to get health insurance.

While I may disagree with conservative efforts to take the country backwards, I have to applaud Amy Kremer and Jenny Beth Martin, Atlanta housewives who are the geniuses behind the Tea Party movement. According to the Wall Street Journal’s  “Birth of a Movement-Tea Party Arose from Conservatives Steeped in Crisis,” on 10/29, both women “were 30-something suburbanites…frustrated by recession, dismayed by the election of Barack Obama and waiting for the next chapter of their lives.” Quitting her career as a Delta flight attendant to raise her daughter, Kremer turned to blogging after becoming an empty-nester, “one on gardening, one on politics. ‘I had this empty space in my life’… Ms. Martin, a software manager by training and part-time blogger, was cleaning houses to help pay the bills after her husband’s temporary-staffing business collapsed. They were in danger of losing their home.” Martin was enraged after Senator Saxby Chambliss, in whose campaign she had been a volunteer, voted in favor of President Bush’s bail out of Wall Street banks. In her estimation, ” ‘Sometimes it stinks when your business goes bad. But it’s part of our system….The government doesn’t need to come in and hold a business up and keep it from failing.’ ”

In the span of a few weeks in February and March 2009, the two women met on a conference call and helped found the first major national organization in the tea-party movement. Within months, they became two of the central figures in the most dynamic force in U.S. politics this year.

Ms. Kremer, 39, currently chairs the political action committee known as the Tea Party Express. It has raised millions of dollars for upstart candidates and engineered the campaign that threatens Senate Majority Leader Harry Reid (D-Nev.). Once shy about public speaking, today she crisscrosses the country addressing thousands at a time. ‘Are you ready to fire Harry Reid?’ Ms. Kremer bellowed to a crowd of 2,000 in Reno, Nev., this month.

Ms. Martin, 40, is national coordinator of the Tea Party Patriots, an umbrella group claiming affiliation with nearly 3,000 local groups around the U.S. Leaving her young son and daughter at home, she is on a 30-city tour, revving up activists for the victory she is counting on next Tuesday.

‘This was something I had to do,’ Ms. Martin says. ‘There were just so many of us who were fed up with the Republican Party.’

 Comprised mostly of middle-aged, middle-class citizens with little political experience, “a braid of many strands of discontent and passion, ranging from opposition to illegal immigration and a national sales tax to support for gun rights. A vocal faction questioning Mr. Obama’s legal eligibility to be president provided another source of grassroots fuel.” If John McCain’s campaign was a “babe” in the internet “woods,” the Tea Party political machine seems hell-bent on giving Obama’s proven internet savvy a “run for its money” in 2012.

Many conservatives felt Sen. John McCain’s presidential campaign had never fully exploited the Internet to raise money and unite disparate activists. The Obama team had proven deft at harnessing technology.

And so the TEA PARTY MOVEMENT was born online, in the internet universe.

  • Michael Patrick Leahy, a Nashville technology consultant,  built a network of like-minded activists
  • Eric Odom, among the above, compiled a large list of activists “through a group working to lift the offshore-drilling ban”
  • Stacy Mott, started a blog for conservative women, “Smart Girl  Politics,” launching a website by the same name which drew in Kremer and Martin from Atlanta
  • Keli Carender, arranged the first protest, drawing 120 like-minded activists, after it was broadcast on a local talk-radio show and written up online by Fox news consultant Michelle Malkin
  •  On 2/19/09, in response to the $75 billion dollar bailout for homeowners unable to pay their mortgages, CNBC financial commentator Rick   Santanelli  started the “rant” when, broadcasting live from the Chicago Board of Trade, exclaimed ‘This is America! …How many of you people want to pay for your neighbor’s mortgage that has an extra bathroom and can’t pay their bills?’ To the cheers of traders behind him, he continued ‘We’re thinking of having a Chicago Tea Party in July’… “The rant went viral.”
  • After massive internet organizing among all of the above parties, 50 rallies occurred simultaneously nationwide. Within a year, 2,000 local tea party groups were formed around the country.
  • Wealthy interests threw their support behind the movement, like Americans for Prosperity and FreedomWorks, “groups born from a conservative think tank formed in the 1980s by members of the Koch family, who run oil-and-gas conglomerate Koch Industries Inc.”
  •  On 4/12/10, Kremer said she wasn’t boasting in claiming ‘I started this’ when she began a social-networking website called “Tea Party Patriots,” the name her husband recommended.
  • Enter the media. Fox TV’s Glenn Beck “launched his own initiative, the 9/12 project,” as well as touted the Tea Party’s 4/15 rallies, as did Sean  Hannity, and blogger Malkin.
  • Hundreds of thousands of “tea partiers” “gathered in city halls, at post offices, at town squares, parks, and along busy streets.
  • The “Tea Party Express” was formed when Sal Russo, Reagan’s adviser in the 60s and 70s, re-energized a 2008 political action committee, Our Country Deserves Better, as a “tea-party-themed group.” With Joe Wierzbicki, a colleague, they spread the word on a cross-country bus tour. In 2 years the newly christened group raised more than $7 million.
  • Tea Party Patriots, among them Kremer and Martin, maintained a nonpartisanship stance, preferring to stand for issues, and not endorsing specific candidates. On the other hand, Tea Party Express “wanted to raise money for candidates and engineer campaigns.”

The break between the two factions of the Tea Party movement, found its momentun when Obama pushed for massive, health-care reform.

  • FreedomWorks, in its “Healthcare Freedom Action Kit,” suggested ways to omit socialized medicine from the budget.
  • A Patriot coached members on how to “Rock-the-boat…’Watch for an opportunity to yell out and challenge’ the representative. ‘The goal is to rattle him.’
  • The Patriots, except for Kremer, declined to participate in the Express’  first bus tour, since the groups had different philosophies.
  • Taking part in the D.C. rally organized by Beck’s “9 1/2 Project,” which drew 75,000, Kremer returned home ” ‘a changed person…I didn’t need to stand in the shadows of Jenny Beth Martin and Mark Meckler (activist and Grass Valley, California Internet marketer and attorney)…I felt good about myself.’ “
  • Prominent Florida physician and tea-party activist David McKalip whipped up a storm when he Googled “a doctored image of Mr. Obama as a a tribal witch doctor with a bone through his nose…” In an email to the Wall Street Journal, he publicly apologized. Kremer defended him, to the dismay of other Patriots. ” ‘David, we all support you fully and are here for you…I can assure you of one thing and that is we will protect our own. We all have your back, my friend.’ “
  • In August 2009, the Tea Party incorporated with a 4 person board, Ms. Martin, Ms. Kremer, Mr. Meckler and Rob Neppell, a conservative blogger. “But relations quickly deteriorated…Ms. Kremer indicated she had hired her own lawyers and might try to claim ownership of the group’s intellectual property, according to an affidavit from Ms. Martin. A few weeks later, she was voted off the board.”
  • Kremer shifted to the Tea Party Express, urging it to back Scott Brown, for the Senate seat vacated by Edward Kennedy.
and as they say…”the rest is history”…hugmamma.
 
 
 
 
 

 

“a fox in the hen house?”

Health care is rampant in the news these days. One article that got my interest in the Wall Street Journal on 10/27 was “Physician Panel Prescribes The Fees Paid by Medicare.” As my husband and I near retirement age, Medicare looms large on the horizon. I’ve already gotten an earful from friends, who gave me one more reason to take care of my health now.

The article, written by Anna Wilde Mathews and Tom McGinty, gives insight into the significant role played by physicians, in determining how much doctors are paid by Medicare.

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars. The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

The problem, it seems, other than the obvious one mentioned by Tom Scully, a former administrator of the Medicare and Medicaid agency that “it’s not healthy to have the interested party essentially driving the decision-making process,” is that the committee is “contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start–and save money.” Dr. Barbara Levy, Seattle gynecologist and RUC chairwoman has indicated that the committee is aggressively moving “to correct evaluations that lead to higher-than-appropriate payments for some services.” Next month Medicare will render doctors fees for 2011, which should include the committee’s recommendations.

Another inherent dilemma in the assignation of monetary values to medical procedures, is that doctors will be motivated to perform those that pay more. An inevitable by-product is spending growth, since there’s “all the associated costs for hospitals, lab tests and drugs.” Also of great concern are Journal findings that “services were paid too generously in some cases because the fees were based on out-of-date assumptions about how the work is done…more than 550 doctor services that, despite being mostly performed outpatient or in doctors’ offices in 2008, still automatically include significant payments for hospital visits after the day of the procedure, which would typically be part of an inpatient stay.” As an example, is an operation to treat male urinary incontinence which, according to Medicare’s 2008 statistics, were performed as outpatient services or in doctors offices 80% of the time. But because the procedure was last evaluated by RUC in 2003, the service still “wraps in payment for 118 minutes of hospital visit time after the day of surgery.” However, the Journal goes on to say that it’s unclear if the committee will suggest doctors now be paid less for the procedure anyway.

Granted, there’s great debate among physicians as to the value of medical procedures based upon personal experiences. It’s also fair to say that nobody wants to surrender what they’ve already come to expect in financial recompense. Nonetheless, having RUC rely “heavily upon surveys performed by doctor specialty groups, requiring as few as 30 responses,” with the instruction that it “is important to you and other physicians because these values determine the rate at which Medicare and other payers reimburse for procedures,” is an enticement to score high. “William Hsiao, the Harvard professor who led the original physician-work research used to set Medicare fees, argues the approach is almost guaranteed to inflate the values used to calculate fees. ‘You do not turn this over to the people who have a strong interest in the outcome.’ he says. ‘Every society only wants its specialty’s value to go up….You cannot avoid the potential conflict.’”

Medicare requires that out-of-sync payments be reviewed every 5 years. MedPac, a congressional watchdog, reveals that “ in the three previous reviews, the RUC endorsed boosts for 1,050 services, and decreases for just 167.”

Reimbursements for placing cardiac stents in a single blood vessel are based upon a 1994 RUC analysis. In 2008, doctors were paid $205 million for 326,000 such procedures.  Cardiologists suggest that stenting today, as compared to the mid-1990s, “is more routine and may often be less stressful.” According to David L. Brown, cardiologist at SUNY-Stony Brook School of Medicine, ‘The example used to set the code’s value is ‘way out of date,’…’In those days, stents were used when you were having a catastrophic event or thought you might have a catastrophic event.’ Stents and the catheters used to thread them into arteries are now smaller and easier to use, he says. The time varies by patient, but Dr. Brown says he required around 45 minutes on average to perform a single-vessel stenting. The RUC’s valuation suggests a two-hour procedure.”

On the other hand RUC member, representing The American College of Cardiology, and director of cardiology at Geisinger Medical Center, James Blankenship feels the stenting procedure is “ ‘fairly valued’. ” While he agrees that 2 hours may be too long, he “argues that the procedure may be harder because cardiologists now take on challenging patients who might once have gotten bypass surgeries.”

While we may not be inclined to question cardiologists’ fees since they have the power of life and death over us, how about payments for carpal tunnel surgeries. “A study published this June in the journal Medical Care Research and Review found the procedure times used by the RUC to calculate values may sometimes be exaggerated.” While Medicare’s payment of $44 million paid in 2008 was based upon a procedure time of 25 minutes for carpal tunnel surgery, Sullivan Healthcare Consulting Inc, which keeps the hospital database, showed the average time for teaching hospitals, based upon 2,602 surgeries was 17 minutes, and for community hospitals, based upon 4,093 surgeries was 18 minutes. Meanwhile, RUC’s figure of 25 minutes came from “39 surveys of surgeons, out of 150 sent out by groups representing hand surgeons, orthopedic surgeons and plastic surgeons.” Upholding Medicare’s payment, former medical director for the American Academy of Orthopedic Surgeons, Robert H. Haralson III, says the “payment isn’t too high, because the surgery is a more intense procedure than the current value implies.” And RUC leaders wrote to the medical journal insisting that the article was “outdated” and that different standards were used to classify the procedures than that used by the committee. I guess they were suggesting that it was like comparing “apples to oranges.” Hmmm.

It seems we must leave matters in the capable hands of RUC’s head Dr. Levy who assures us that the committee “has reduced values for nearly 400 services in the past and it is now reviewing hundreds more.” And in answer to primary-care groups who are pushing for more representation, we should accept her retort that “ ‘The outcomes are independent of who’s sitting at the table from one specialty or another.’” We should also feel reassured by Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services, who “says that for now, ‘we are comfortable’ with the RUC process. The federal health-care overhaul requires the government to insure that the doctor-fee values adopted by Medicare are accurate. ‘We’re not going to rubber-stamp recommendations,’ he says.”

I feel so much better now.

Yeah right!…hugmamma.

 

hugmamma,m.d.

Here’s a bit of medical trivia. Just to set the record straight, I’ve returned to self-diagnosing my condition of a few days ago. Given my very close proximity to the patient, whose symptoms I’ve watched with extreme interest, it seems, in my “expert” opinion that I’ve been suffering from symptoms of “dry mouth.” Referring to my copy of  “The Merck Manual of Patient Symptoms”, it seems likely that my dry eyes, dry skin, rash on my eyelid and neck, and decrease in saliva may be owing to “dry mouth.” In my case it is probably due in large part to Claritin, an antihistamine I’ve been taking for a couple of months to combat allergies. Under GERIATRIC ESSENTIALS, the book claims that “…dry mouth becomes more common among the elderly,…probably due to the…many drugs typically used by the elderly rather than aging itself.” And I am getting elderly.

A walk-in-clinic physician at Philadelphia’s airport had prescribed Claritin. I’d been suffering allergy symptoms for some time, without realizing it. I know I’m affected by seasonal changes, but they seem to occur without my taking notice. Only after I’m forced to see a doctor for relief, am I aware that allergy season is in “full swing.” Not wanting to ruin my trip to Venice, I did as the doctor prescribed. Claritin was added to my daily intake of vitamin supplements. Who could know that it would cause an altogether different ailment, like “dry mouth.”

In the recent visit to my own GP, the symptoms hadn’t yet fully developed. So my doctor felt I was still suffering allergy symptoms and prescribed Benadryl when needed, in addition to continuing the Claritin. So after doing what I was told by 2 physicians, and still not  finding relief from the problem, I’ve decided to follow my own advice for now. I discontinued taking both antihistamines. We’ll see. As of now, my diagnosis and prescription seem to be working. Oh, and I should probably be getting more sleep, according to Merck. Well, that may be a difficult pill to swallow with my recent appetite for blogging. It’s now 2 a.m. 

I don’t take medical conditions lightly, although I address them with “tongue-in-cheek” humor. But I am a proponent of being an active participant in my own well-being. I heed expert advice, but I question it and continually assess my symptoms to make certain that my health is improving. Doctors offer their best-educated opinions in the moment, but they are not experiencing it first-hand. I know what I’m feeling all the time. I wish my medical team lived with me 24/7, but they don’t, so I’m the next best thing.

I can see the next patient now…hugmamma

medical mystery

Preparing  to head to my exercise class, I felt my throat start to constrict. Standing still, I focused upon what was happening inside my mouth. My tongue felt “thick” and slightly swollen. My throat was beginning to exhibit similar symptoms. “Don’t panick. Don’t panick.” I thought. “Calm down. Calm down. Think. Think.”

Feeling like my tongue is “thick” is not new. I’ve felt it for several days, chucking it up to my voracious downing of shelled peanuts for more than a week. Having a few handfuls a day didn’t seem like a crime, although I’m very aware that nuts are high in calories, extremely high. There, you’ve discovered my Achille’s heel.

While I thought the salt intake might be the culprit, a niggling thought sat menacingly at the back of my brain. Because I was drinking water to salve my swollen tongue, was I actually on the brink of moving from pre-diabetes to full-blown diabetes? My common sense said “no,” but the self-diagnostician in me said “might be… could be…you think?”

So I whipped out one of my many self-help books, “The Doctors Book of Home Remedies-Thousands of Tips and Techniques Anyone Can use to Heal Everyday Health Problems” by the editors of PREVENTION Magazine Health Books. It wasn’t a visit to my doctor, but hey, it’d do in a pinch. And I felt my throat starting to “pinch.”

Scrolling down the list of headings under “Asthma,” my eyes fixed upon “Watch what you eat.” Among other things it stated “…foods that trigger asthma are…nuts…” This didn’t register as too worrisome since I’ve never had a problem with them before. Yes, I know, there’s always the possibility my sensitivities can change. As age has crept up on me, so have the countless things I can’t eat or do anymore. But another section did catch my eye.

“Be Salt Sensible.” It maintained that “In a study conducted at the Department of Community Medicine of St. Thomas Hospital in London, researchers discovered that table salt could have a life-threatening effect on your asthma.” They found a strong link between salt purchases and asthma mortality for men and children. “Buying the salt wasn’t killing people; eating it was.” You think my gender might save me? Something to think about. Further down the page, another section peaked my interest.

Use nonaspirin pain relievers.” Allergist Richard Lockey, M.D., director of the Division of Allergy and Immunology at the University of South Florida College of Medicine said ” ‘If you have sinusitis and nasal polyps and asthma, I wouldn’t recommend any nonsteroidal anti-inflammatory like aspirin or ibuprofen because it could make your asthma worse or even kill you.’ ” Allergist Sidney Friedlander, M.D., clinical professor of medicine at the same college adds “This aspirin sensitivity could just suddenly develop, so it’s best to stay clear of aspirin products altogether,…’ The problem doesn’t happen when you use acetaminophen,…’ ” I don’t know if I have nasal polyps, but I have had chronic sinusitis in the past, and I have mild asthma, so I’m 2 for 3.  Something else to consider.

And finally, the last paragraph “Listen to your lungs.” offered the wisest advice yet. “Of course, the best way to fight an asthma attack is not have one in the first place.” So while  willing myself not to have an asthma attack, I got a second opinion from the best source of all. I phoned my husband, at work, of course. He’s always “on call” for me there.  Himself an asthmatic for many years, I reviewed the mechanics of using my inhalant. Rarely needing it, I had to refresh my memory as to how I should administer the puffs, and how often I could use the inhalant during my episode.

During my “attack,” I had calmly gotten my purse and removed my inhalant, put it to my open mouth, and sucked in my breath while inhaling a quick “puff.” I repeated this a second time. Consulting with others was to confirm what I already knew, including no peanuts (for a while anyway) and cutting back on my salt intake. (Did it contribute to my “thick” tongue?) I’ll have to ponder the aspirin piece. My physician prescribed it as a daily regimen for staving off strokes. Difficult to choose between having an asthma attack or a stroke? Maybe I should ask my doctor?

hmmm, something else to consider…hugmamma