Posts Tagged ‘Health Care’

If you see something, say something: just few random thoughts on Robin Willams

August 12, 2014

At the cube farm today a few people passed judgement on Robin Williams and suicide. For various reasons (ok, mostly one), I didn’t bother to speak up about the lack of maturity. I chewed on my lip and thought how lucky they were.

Yeah, you read that right. Lucky.

Only somebody who has never watched another struggle with major depression would say something that stupid.
Only somebody who has not felt the smothering lack of energy where even brushing teeth seems like a monumental task would say something like that.
Only somebody who has not curled up looking for a sliver or a moonbeam to cling to would say something like that.

The absolute tragedy, is, of course, that yesterday thousands of people yesterday killed themselves. One person’s death filled social media spaces. We do a lousy job about talking about mental health. We talk about it after a tragedy for a few weeks and clamor for more funding and less stigmatization. Nothing happens.

Probably because we don’t want to admit it’s us.

We don’t want to admit we are the ones who have fought demons with the help of medication and professionals.
We don’t want to admit that there are times (still) when the mountain seems to be without a trail.
We don’t want to admit how hard the battle was because there is still shame in the battle.
We don’t want to admit that we know it could have been us.

I don’t know what drove Robin Williams to suicide. I know what its like to sit in that darkness and not feel. I only hope he has found his peace.

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A snarky start to the week.

August 2, 2011

Ugh. What a Monday.  The only good thing in my book was watching Rep. Giffords return to the House floor.  Who’d have thought it?

On the half full side … I did manage to remember to bring my lunch to work (yeah!), where I discovered I had a bag of oh so precious Resse’s Peanut Butter cups (score, solves the chocolate problem).  Unfortunately, by 8:30, my day had pretty much been tanked.

Granted, Monday and I are not the best of friends, but yesterday, I had a 7:15 physical therapy appointment.  Already feeling snarky over not getting to see my PT, and because of this whack-a-doodle contract I’m working, I was forced to use a location close to my temporary office that has hours from 7-7 and is affiliated with a major teaching hospital.  15 minutes into the evaluation with the new PT, I made the decision I’d ride out this prescription with her and not return.  Yup, it was that bad.  My number one pet peeve of anybody (but especially those working in the health care professions) is not listening/not reading the chart.  She didn’t do either.

Your doctor writes a prescription for physical therapy.  Most scripts are simply the impacted joint with treat/eval.  My ortho wrote a detailed script: I have a complicated ortho history (usually 28 ortho surgeries indicate that …) and he wanted specific modalities as well as more extensive treatment than a simple ankle/knee one.  At one point, out of sheer exasperation, I said, uh, it’s on the script.  She asked me what I was doing to alleviate some of the symptoms: I went through a detailed list of PT excercises that I do daily.  She then printed off the same exercises substituting a tennis ball for a racquetball for the plantar  and told me I needed to loose weight (thanks).  I was mildly irked: first appointment, yet to check range of motion, strength, laxity and she is giving me (the same) exercises as homework.  I had yet to take off my shoes.

Part of me was just laughing: the other part was livid.  She then told me I was sitting wrong.  My hip was flexed past 90 degrees.  I said, truthfully, my surgeon has seen me sit like that and he is ok with it.  She pulls out her measuring device (don’t ask me to spell goniometer) and says see, you are past 90 degrees. I was at 91.  I still had my shoes on.  35 minutes into this painfully slow ordeal that made me wish for even a student (and I checked – she has been at this facility since ’89), she finally gets around to examining me, you know, seeing what is wrong.  (Note: patients really don’t like FILLING out forms only to have you not read them).  I heard I had my last hip revision done at the wrong hospital (Hi, you don’t know *who* did the surgery, and he is one of the top 10 in the country), that I didn’t have plantar fasiciitis (um, ok, 2 mri’s noted it, plus the huge tightness on the ball of my foot, I have a high pain tolerance and the point of tenderness is in an atypical place), and why did I have knee surgery (read the surgical history: you’d see ACL repair).

Finally, I was asked what was bothering me: Tightness from the bottom of my hamstring to the ball of my foot because I can’t get my right leg into full extension.  My two orthos agree this is an issue: that probably isn’t skeletal but muscular and the best course it to try intensive PT before doing releases of tendons/muscles.  She looks at me and says “there isn’t a different in your leg length, your pelvis is even”.  Head:desk.  I demonstrated.

After more back and forth she asks about my insurance: I tell her.  She says “oh, I can’t treat you.” For real? I have 45 visits a year left (I used 15 when I strained my shoulder).  Apparently she needs to get authorization and why didn’t I tell them this when I called.  At my limit (which actually takes a bit with health care providers), I said “Nobody asked.”  She launches into a tirade of now she would have to do work to get authorizations.  Ok, look, I get medicine has become a paperwork nirvana.  I also know that a well written (probably an issue) evaluation will generate approvals.  I also know that because of the screwed up system, I can’t take my prescription back and get a new PT because it’s a double evaluation.

My hope is that she is a better practitioner than evaluator.  But after finding where she wrote on my heel cord with green ink? I’m not so sure.

I know I’m picky about my health care. I know that I have a complicated history.  It’s why I’ve found away to pay close to 6K a year for my health insurance.  I know there are a ton of good health care providers out there: and for all I know, she might be an excellent PT.  But I also know that if a provider doesn’t appear to be paying attention, I question his/her ability to practice.  And I also know, that telling somebody she can’t be treated is not the best way to start a relationship.  For all she knew, I could have paid out-of-pocket.  I also know, I’m not interested in hearing about the stresses of your job: I’ve got my own and we aren’t friends.  And it would have also been nice for you to ask my name.

(off soap box)

Cracked, broken and a little disappointed

May 11, 2011

Today I did an ‘adult’ thing: I took care of me.  Ok, most days we all do this without thought.  Today, this action involved thought.  I have been working a series of temporary jobs on quite frankly a battered and broken body.  I had accepted an assignment with the following description:

*matching invoices

*organizing slips/paperwork

*pulling paperwork, entering data

 I’ve worked for this company before: it is a fantastic, proactive corporation that is forward thinking.  The reality is that the job involved standing in a non-temperature controlled warehouse pulling invoices out of boxes.  I know my limitations; I’ve painfully become aware of them.

 The company I’m working for and I looked at job modifications: there was one critical element that could not be modified.  I am grateful for them for working with me to try to figure out how/if the job could be modified: yes, it’s the law, but I’m also a temp.

 Today is one of those days, there aren’t enough ice packs, heating packs, muscle relaxants and e-stimulation to quell the pain.  The pain is exhausting.  In the midst of all of this, I was listening to a podcast on lower back pain: I was hoping to get tips on how to manage multi-level disc involvement.  Instead, I found a podcast delivered to medical students about how many people with chronic pain are looking for disability claims.  I felt stabbed.

 As I stood pulling information out of a warehouse, I heard the myth of chronic, persistent pain continued by a medical school professor.  Today was a day I’d give you everything I own if you could promise me a pain free day.  Just one day without pain: one day.  I wanted to find that lecturer and let him examine my body and tell me that I was seeking special treatment. I wanted to find him and show him a few years of working in jobs which caused me to undergo countless steroid injections into my back, a few nerve burnings and constant pounding dull pain. Actually, I didn’t want to see him: I wanted to find the medical students who were subjected to these myths.

 A few decades ago, a wise orthopedist told me that ‘around’ the age of 35, I’d have issues in standing, walking distances.  Telling a 15 year old that . . . well, 25 is ancient.  I wish he was wrong.  I wish one minute when I was 10 didn’t alter my life forever.  And I wish I could find a job.  The sad thing: I can work; I tried to do this job and just realized that I couldn’t.  72 hours of non-stop pounding pain and not being able to modify an aspect of a job, I had to let my boss know that I wouldn’t be back on Monday.  I had to surrender and admit that while I’m willing to do anything, my body can’t.

 And just once, just once, I’d like for my body not to betray me.  For various reasons, I’ve had 31 surgeries: 28 of them orthopedic: all on my legs (everything except my left knee, knock on wood).  And I want to find the myth-mongers who say pain like this isn’t real and let the walk in my shoes for a week.  I’m not interested in disability: just a job that doesn’t leave me wrapped in ice for 10 hours.  And just once, I’d like somebody to understand how emotionally painful this is without saying something like “well, I know my pain isn’t as bad as yours but. . .” or “Oh, I hear you.”  I don’t know what I want people to say.  Maybe just an acknowledgement that the system sucks, that most people who live with chronic pain aren’t looking for an easy way out and maybe understanding that there are jobs that just can’t be done not because of pride but because of the body.  Or maybe I just want a hug.

2 years and giving up

March 17, 2011

I’m going to start by saying I’m not angelic. I’m not even really a nice person.   I laugh at reality shows when I know I shouldn’t (but seriously, after 12+ years of Survivor being on CBS, how can you be surprised at eating bugs anymore?).  I eat meat. I curse. I think some people have zero grasp of reality and mistake “a hard life” for “not getting what they want when they want it.”

8 years ago I made the single biggest mistake of my life. I’ve been paying ever since. Nobody died. Nobody was hurt. No local, state, federal or international laws were broken.  After earning a useless graduate degree 5 years ago,  and because of the second biggest mistake of my life, it’s one I’ll never get to use, I’ve worked such thrilling jobs as a temp job for a non-profit where the owner/ruler/person in charge wanted us to call him King (really), had 6 surgeries, worked for a retail company that laid me off after I refused to back down about seeking medical treatment (Shh, big secret, don’t use your employers health insurance in a recession) and in the past 2 years have had a temp job where I had to explain 8th grade government to a person who wanted a database of all elected officials as well a few others here and there.

Because I saved money, because I don’t live above my means, I’ve held on to my home. Yesterday, I lost it: in the take no prisoners sort of way. I called my student loan company to try to defer payments: I can’t pay them any more. I’ve paid them ON unemployment.  Because I no longer qualify FOR unemployment, I’m not unemployed and therefore not eligible for deferment.  So, I was screwed for paying them while ON unemployment because it was the right, responsible, ethical thing to do.  Never mind our multi-million dollar bailout of this company.

I’ve heard just about everything:

“Work fast food or retail”: Hi, I’ve been rejected by Starbucks, McDonald’s and a few others as I’m over qualified.  I’m willing to work there despite the toll on my body – see my previous job and the every 3 week nerve burning injections on my back because standing exacerbated the fractured discs caused by decades of artificial hips.

“Move”: Aside from not being able to probably even sell the condo, I can’t. I live in a state that allows me to purchase health insurance and doesn’t recognize pre-existing conditions. I can’t take the risk of moving to another state and being without health insurance.

“You aren’t doing enough”: Right. The volunteer work, career fairs, job network stuff plus nearly a thousand resumes aren’t enough.

“Pray harder”: go. to. hell.

“You need to cut back more”: I enjoyed my heat at 60 during winter in the northeast.  I like sitting in the dark. I’m a wild fan of variations of rice, beans, eggs and cheese.  And I really like going without the only pain medication that works.

Just once, I’d like somebody to say “I know things are sucky, what can I do for you?”  Instead, I’ll just figure out how to find enough money to keep paying for what I need.  And since I’m an ass, a list of those who never bothered to see if I was ok.

The power of Yelp

March 15, 2011

I Yelp. Yelp is one of those social network sites that lets you review local businesses (or chains) about service, products, customer service and the like.  I tend to yelp mostly about small businesses and base it on my experience(s) that I’ve had …. it takes a LOT for me to 1 star review an organization. On 3/4, I yelped about a run in with a local dentist (I had a crown put in a year ago … it has broken 3 times!)  Since I’m without dental insurance (and a job), the “you have to pay for it” answer didn’t exactly work as a correct answer – well it really didn’t work as a correct answer even if I had a job with dental insurance.

I posted my snarkish yelp as a warning to others in the area: let’s face it, few people rave about their dentists.  I didn’t think much of it until today when I received a call from the office manager today. They want to replace the crown for free (apparently crowns come with warranties if you go there for cleanings – I won’t go there with that idea. . . ) since it was new.

The sad thing? If I hadn’t been vocal on a public site about the lack of caring, craftsmanship and professionalism? I’d still be faced without a crown on my tooth. For me? I think it’s sad that in order for an organization to step up and to the right thing, they have to be blasted. Maybe that has a bit to do with the anger in this country? How about just doing the right thing the first time – something tells me that might just make the world a bit nicer place.

And really, it does take a lot to get a 1 star yelp from me … even the condo idiots were not yelped about!

My response to Dr. Jones and the Facebook letter

September 23, 2010

For roughly a week or so, there has been a letter floating about Facebook that has been attributed to Dr. Starner Jones.  Dr. Jones’ letter to the editor has been verified by Snopes.  I don’t want to get into the more racial overtones of the letter (and let’s face it, aside from the gold tooth remark, it could apply to any group) and the discussion of shoes or tattoos as they could have been gifted or done before a change in economic status.

I’ve long held that health care reform is critical for the long-term economic recovery of this country. I spend $500 month on health insurance for me. Insurance companies are the nightmare that created the health care crisis. I spent several weeks trying to get my insurance company not to pay for a bill regarding a metal plate that was not put into my ankle: the surgeon, hospital and (not done) x-ray on my ankle would show the lack of a metal plate. After approximately 10 hours, I “saved” my insurance company close to $1,000 for another individual’s error. I’m sure my rates will go up this year. Unlike car insurance, health insurance doesn’t reward people for “good behavior”.

Dr. Jones’ letter raised some issues that need to be discussed: maybe his patient in question could not purchase health insurance and was forced to rely on the system. In many states, individuals cannot purchase health insurance with a pre-existing condition. I am not going to defend smoking or drinking beer but let’s collectively look at some of the ways in which the insurance and medical communities can encourage (and reward) behaviors that would reduce the over burdened and costly medical system.

1)      I recently stopped taking my preventative migraine medication.  After going through a careful, detailed food journal, my doctor and I noticed that processed food and those that have a higher percentage of pesticides associated with them triggered migraines. My answer? I’ve gone green when it comes to food. I buy as much as I can from local farmers markets’, community supported agriculture for both produce and meat and eliminated as much “artificial” preservatives as possible. The result? I no longer need to take a prescription which my insurance pays the manufacturer $72.96 per month.  The project to untangle my migraines was started by me and my doctor.  Cost savings to my insurance company? $875.52 per year. Reward from my insurance? Zero. No, I’m not saying my insurance company should just write me a check, discount my policy or something LIKE that: what I am saying is that my insurance company was willing to go with the quick fix of handing me a pill instead of encouraging me to find alternative means (i.e., non-chemical) to resolve an issue. The out of pocket cost to me, to eat this way, is far more than the savings to my insurance company. But, in the long run? It’s much healthier for me.

2)      Participation in something like a CSA provides a fixed cost for food (you pay for a share). As part of developing a way to combat the growing obesity problem in the US, what about allowing CSA programs to accept SNAP vouchers nationwide at an incentive reimbursement rate? It would create a growth in local economies; provide fresh food to those in need (instead on relying on processed foods which only contribute to poor eating habits and the continuing cycle). Not only would people then have access to healthier foods which decreases the risks of many diseases co-morbid with obesity, it is a way of providing a first level change on the dietary habits.

3)      Eliminate pre-existing conditions. Period. Life is a pre-existing condition. I am fortunate enough to live in a state which as eliminated pre-existing conditions by law. Removing the pre-existing conditions, might allow individuals who are otherwise forced into Medicaid to be able to secure insurance through other avenues.

4)      With respect to Dr. Jones, life can be hard. I hold a graduate degree and have been unemployed for over a year. I’ve destroyed my savings account. I did not “reap what I sowed”: I became trapped in an economy and because of a pre-existing condition I am limited to one state where I can seek employment due to the ability to secure health insurance. It isn’t anybody’s “fault”. It is a systemic flaw that has recently impacted many Americans.

5)      There is an element of personal responsibility and budgeting. There are far too many pages on Facebook that start with the following “if you have to take a drug test for a job. . . “Instead of spreading hate: how about a shift in culture. Provide mandated nutrition courses for those on SNAP.  Provide mandated preventative health education courses for those on Medicaid. Both of these can improve the health and well being of those needing aid. If you can teach a course on budgeting, healthy eating, and job skills: DO IT. All of these contribute to both the growth of the economy and reducing the liability of an unhealthy nation. Contact a local house of worship, food pantry or homeless shelter and offer your services.

The letter written was sent to a Jackson, Mississippi paper. Mississippi is one of the poorest states in the nation. In addition to raising valid points on how people do need to take ownership of their own bodies, perhaps Dr. Jones’ also should have addressed increasing economic opportunities, educational facilities and presented solutions. Instead, he provided an us versus them: and the sad reality? Many of us are a few months away from being judged as harshly as Dr. Jones’ patient by a health care provider. One group can’t fix the system: everybody needs to contribute.

Community Supported Agriculture and Surprising Benefits

June 18, 2010

Just another day!

When I asked Santa for a share of in a Community Supported Agriculture farm that offered single person shares, I had no idea what I would experience.  I probably have moderate cooking skills: I like to cook but cooking for one is a challenge.  Many, if not most recipes are for 4-6 servings.  Grocery stores even present a challenge: many items come in such large quantities that it is easy to see why obesity is on the rise, simply purchasing items for a single household and not having to pay a premium is a joke.  I became excited just because of the lack of waste.  Finally, I could get fresh produce for one person for a week.

There have been a few disasters (the notable sweet potato salad – but that due to my inability to reconstruct what I ate in New Orleans.  I’ll try again in the fall!) and a few no way in the world I’m eating that (some scary looking green things) moments.  The benefits? I’ve dropped weight without intentionally trying (thanks to ankle surgery limiting what I can do for the time being).   My migraines have virtually disappeared.  I don’t crave junk. I simply don’t want it anymore.  I kid with my friends that I am going to prove that eating healthy will kill somebody.  I still have my ice cream moments but pineapple tends to be the first thing I want to reach for – or strawberries.  I might die in the winter of lack of local fresh fruit.

Midway through June, it has been a cool(ish) New England spring.  Our pollen counts have been insane.  My allergies, normally a bane of my existence, have been nothing but a passing thought from time to time.  I have had my windows open – and dusted the pollen OFF the silver laptop!  I am not totally reformed: I drink diet coke and even my doctor agrees with me that I’m allowed that one vice. 

I am not preaching the “shop the perimeter of the aisle grocery store” mantra or use Weight Watcher points only.  For me, this was an accidental tourist meets how to be healthy.  Maybe that is the key.  I have never been the person who can be told what to do: I have to find my way in the dark and the misadventures, culinary and all, for something to stick.  But, if you see me on a treadmill? Please intervene.  God knows I’ll probably break a bone if I hang out one of those too long!

A simple experiment amongst the health care debate

May 20, 2010

I recently had a prescription that could not be refilled on-line or over the telephone.  I decided to conduct a simple experiment on the cost paid  by my insurance carrier to three different pharmacies located within a 1.2 mile radius of my home for the exact prescription.  My co-payment of $5.00 remained the same.  The prescription: exactly the same.  Pharmacy #1: Walgreens.  Walgreens “charged” me $8.99 for the medication.  Of which, I paid $5.00.  Pharmacy #2:  CVS  $7.99.  Again, I paid $5.00.  Pharmacy #3 Hannaford Pharmacy (a regional grocery store): $6.25.  I paid $5.00.  As all of these are located in the same zip code, *and* the regional business has the lower charge back to the insurance company, I am perplexed. 

Health care reform has been one of, if not, the single most divisive issues of domestic policy that I can remember.  Amongst the back and forth on both sides of the aisle (and both sides are to blame), I went back to my experiment.  When I go to purchase a Diet Coke, I *know* how much it will cost.  There is not a hidden charge back to my ATM card or the bottom of my purse.  Yet, for many people who have insurance, the insurance companies to do not post how *much* the original charge, “waived off charged”, insurance covered charges and out-of-pocket charge incurred were to the consumer. 

How can an average consumer, concerned about the rising costs of medical care, hope to help to contain costs if we cannot find out how much a pharmacy will charge our insurance company?  I am pointing to pharmaceuticals and pharmacies (please note not pharmacists because they are employees!) specifically because they provide a fixed cost of goods.  A 5/500 Vicodin pill costs x to produce.  The fact that the lowest charge back to my insurance company was the regional chain demonstrates several pressing issues that can easily aid in health care reform.

1) Start with a full audit of prescription medication reform including the cost of goods.  Unlike food items, they are not dependent on crop issues.  A pill should have the exact same cost cross-country.  While pharmaceutical companies deserve to make a fair profit as that funds research and development, insurance companies do not deserve to profit off of prescription medication to off set other costs.

2) Grocery stores, drug stores need to end promotions such as “free antibiotics”, gift cards for transferring prescriptions.  This only encourages pharmacy hopping and increases paperwork for the pharmacists and doctors offices.  Both of these practices are then passed along to the medical consumer through increased health care cost.  Hannaford’s? They do not participate in such schemes.

Is health care reform necessary? Yes. Do individuals have a responsiblity use health care wisely? Completely. *And* It is up to the consumers to demand from our insurance companies, our legislatures at both the state and federal level an accountability system which demonstrates just exactly how much our medication is really costing us.  We are paying far more than the copays: and we have the right to know which companies are abusing the system that is in place.  And if you can get a free chicken with your new prescription for antibiotics? Chances are your insurance company is being over-billed.