He was not reassured.

The Beauty and the Bartender - a dating service tale with a heart-warming twist.

How to make cheap wine taste better  – knowledge is free.

A lost girl remembered - an excerpt and follow-up from The Poisoner’s Handbook.

The Costs of Not Vaccinating - the story of a 2008 measles outbreak in Tucson.  

Parasites, boogers, and garlic - oh, and don’t scratch.

Are Talking Heads Blowing Hot Air - Yes, mostly. The literature review beginning on p. 5 of the pdf names a book I now want to read – Expert Political Judgment. The best part of the study begins on page 17 with descriptions of the 26 columnists and types of predictions they made. While the numbers make some of them look good, the descriptions lead me right back to the hot air conclusion.

Ten Peeves About Greenies

Most of what’s gone wrong has resolved or is well on its way to being resolved. One issue (that I’m not going to write about) I’ve simply shoved away for a time.

One issue I will write about is my worry that my husband was developing a dementia of some sort on top of his numerous well-documented (and mostly well-treated) physical problems. Finally, I get the courage and impetus to broach the subject with him and we see his doctor.

Sure ‘nuf, he flunks the mini-test warranting further exploration. The first thing done is an MRI to rule out stuff. One of the things to be ruled out is normal pressure hydrocephalus. And the MRI indicates that might be the problem – but before we get those results back, he passes out and falls hitting his face on our metal trash can.

I hear the crash and find him conscious, but not coherent at all. I call 911 and refuse his requests to help him up. I’ve got to compliment the Shreveport Fire Department and EMS people. They got here quick and they were as compassionate and helpful with my panic as they were my husband’s disorientation.

So we’re off to the ER and find out about the implications of the MRI and that other causes of fainting now have to be ruled out also. Then we experience the horror of being hospitalized over the weekend.

It took approximately 6 hours for my husband to return to “normal”. It was very much like being with someone coming out of anesthesia, though maybe a bit slower. We were told by various representatives of specialists that several tests needed to be done. The first was 24 hour heart monitoring. By the time that was finished, we were told (on a Saturday morning) that the other tests couldn’t be done until Monday or later.

Now… there’s nothing worse than being in the hospital when you feel as good as you ever do… or “fine” if that’s the word to use. The remainder of these tests — a specialized MRI, EEG, ECG, tilt table test for orthostatic hypotension, etc., are all tests that can be and are routinely done on an outpatient basis.

So… perhaps we were wrong insisting on going home. However, I’m not sure that these tests would have been done sooner had he stayed in the hospital.

After leaving the hospital (not against doctor’s advice btw) I ran into more trouble than I’ve ever had before scheduling these various tests. One of the problems turns out to be that the hospitalist intern was now acting (or trying to act) as primary care doc – and he would certainly not be the doc of our choice. Another problem was that the consulting cardiologist in the hospital was also not the cardiologist who has been treating my husband for over 15 years.

Then there was the crazy neurologist. Yes, crazy. My husband and I had both been referred to this neurologist a few years ago and the best way to describe his diagnostic technique is that he refuses to diagnose. So… we were not thrilled, but also felt we had no choice but to try to use him.

There’s a lot of appointment making strangeness, but I’ll not go into that right now.

As it stands now, my husband is having a cardiac cath done next week because he failed the stress test needed to clear him for surgery to install a shunt to treat the normal pressure hydrocephalus.

Of course during all this, I get my annual cold which turns into bronchitis and am pretty much out of commission for a few weeks.

We have an appointment with a second neurosurgeon also. As of now, the main differences between the two neurosurgeons is the brand of programmable shunt they use, the ease of interacting with their staffs, and the location of the operating room… and, of course, their reputations.

One of them is the chief of neurosurgery at LSU medical school and hospital. He practices with a group of neurosurgeons that has managed to not renew the practice’s domain name, has an indescribably poor telephone system that makes making an appointment next to impossible, and… includes the neurosurgeon that scared the hell out of me a few years ago about my meningioma.

I do not think that the neurosurgeon that I rejected a few years ago reflects on the skills of the chief of the department. But I have to ask why the department continues to allow a doctor whose physical impairments quite clearly portray an inability to operate to continue doing so.

The other doctor is one who just might have what I think could be an unethical relationship with a medical device manufacturer. This is merely a suspicion… and I do NOT think that doctors who look to the manufacturer of devices for training are necessarily unethical.

Regardless which surgeon we choose, this is a no guarantees procedure. First, there’s no way of knowing whether his dementia symptoms are caused by the normal pressure hydrocephalus. And there’s also the possibility that some are and others are not. The surgery itself is sort of a test to determine cause.

It’s also a step that I think must be taken. The possibility that this surgery can stop the dementia symptoms where they are now (mild) cannot be discounted. The possibility that the surgery could reduce the symptoms cannot be overlooked, even though that is not likely.

Of course, he could have Alzheimer’s or some other dementia as well as having normal pressure hydrocephalus dementia. I can’t say that is a reason to not have the surgery. One cause seems better than two, doesn’t it?

So… we wait. We’ll see.

Next up – what’s with this shortage of drugs?

What I got was pack of methylprednisone. I knew it wasn’t a cure, but I also knew it would help stop the spiral of the bronchitis coughing (I had bronchitis really really bad several years ago and the coughing seems to be partly due to inflammation… caused by coughing!)

And I knew it would make me feel better. That along with a nasal spray to help drain my sinuses would make the trip possible.

What I didn’t expect was how good I felt by the 2nd day on the methylprednisone. I had an energy level I hadn’t experienced in maybe 10 years and my body ceased to hurt everywhere. I realized that I’d forgotten what a pain free day felt like.

In addition to some fairly severe injuries to knees and ankles (no one ever accused me of being graceful) during youth and as a young adult, I am also dealing with the family tendency toward severe osteoarthritis, carpal tunnel (from hand-sewing more than keyboard use), ulnar nerve entrapment in both elbows, odd little irritants possibly due to a meningioma, and the general physical insults of aging.

None of these things are really serious. I’m actually quite healthy and would be more so if moving were not literally such a pain everywhere but in the ass. I generally do OK with acetaminophen and/or naproxen.

Or so I thought. I realize now that I’ve learned to accept a certain level of pain as “normal”.  In a way, I hate the reminder of what pain free feels like though I enjoyed it immensely.

I had a bit of a rebound effect from the steroid. This past Friday and Saturday were horrible. I took all the acetaminophen and naproxen I thought was safe and it didn’t make a dent in the whole body (excepting the ass) pain.

That’s over and I’m back to my normally accepted level of pain now… but I remember fondly my pain free week.

Usually when I do this it’s because I’m vacationing in the comments on other blogs, but that’s not the case this time. I’ve actually been away from home for 10 of the 20 days since my last post. It’s not that I’ve lacked a connection to the internet, but that I really really am not flexible when it comes to using laptops or other people’s computer setups.

Oh yes, I am spoiled by my messy, but convenient for me, little office space.

I’ve also read four novels recently. Don’t worry; nothing particularly uplifting or literary. It’s just that for the last 10 years or so, I’ve read mostly non-fiction and a lot of that could be considered educational. That was a major change from my previous habit of consuming 3 or 4 novels a week.

I spent the Labor Day weekend with two of my grandchildren. It’s so very, very nice to have them only a 3 hour drive away instead of 20 hours. The 5 month old is just the sweetest baby. She’s fun and easy to care for. When she’s awake, she’s constantly cooing, laughing, or enjoying her new found manual dexterity.

The 3 year is not so easy, but she’s definitely fun. The theme of the visit was words beginning with P. She put together a 24 piece puzzle by herself. Her parents didn’t believe that I didn’t help her beyond verbal suggestions, but they should have. Did they really think *I* was going to actually get down on the floor with her? HAHA!

The other words were Papa, pizza, and piano. She has a little notebook that she wrote all those words in. There’s still a little work to be done in always pointing the z in the proper direction. I like the notebook because I found out that chalk dust really does a number on my nose and throat. She tends to erase her work with enthusiasm.

I was home for a few days and got word that my father was in the ICU with pneumonia. He’s 87 and a two-year lung cancer survivor, so that was scary news. I thought my step-mother would need help caring for him when he got home because he seemed really weak in the hospital.

Well, she didn’t because by the 2nd day he was home he had pretty much resumed his normal activities. Though the bug he got knocked him down quickly, modern antibiotics knocked it out almost as fast.

One of his current normal activities is running for mayor of his small town. I stayed another two days caught up in those discussions and helping a little with the campaign.   

That reminded me that my husband and I have to get absentee ballots this year because we’ve got a wedding in S Carolina to attend the weekend before the election.

Who Goes Nazi? – The Anchoress, via Assistant Village Idiot. Suggested further reading: The True Believer: Thoughts on the Nature of Mass Movements.

Masterminds or Muddlers? - the glittering eye.

The prototype for a mastermind would be Napoleon, someone who with a combination of brilliance, insight, savvy, guile, and the urge to power was able to bring complicated plans with many moving parts to fruition.

Letting Go: What should medicine do when it can’t save your life? — The New Yorker, by Atul Gawande. And… as I see it, a complete misunderstanding of that article by Megan McArdle and most of her commentariat. That misunderstanding is further displayed in this McArdle post:  Does Medicaid Kill? Though not easy to identify, there are multiple points where medicine becomes harmful rather than helpful. Part of this has to do with the way we evaluate drugs — by choosing an endpoint (ie, blood pressure reduction) without evaluating whether that leads to longer life, much less the quality of that life.

That’s enough deep thought for a while. I will now return to my regularly scheduled whining, ranting, silliness, and non-blogging.

“Tempting kids with toys is unfair and deceptive, both to kids who don’t understand the concept of advertising, and to their parents, who have to put up with their nagging children,” said Michael Jacobson, executive director of the Center for Science in the Public Interest.

An even more disturbingly paranoid view of McDonald’s as a corporation (and ultimately demeaning to parents) is this from the Center’s website:

“McDonald’s is the stranger in the playground handing out candy to children,” said CSPI litigation director Stephen Gardner. “McDonald’s use of toys undercuts parental authority and exploits young children’s developmental immaturity—all this to induce children to prefer foods that may harm their health. It’s a creepy and predatory practice that warrants an injunction.”

Such a view of corporations requires one to think that all corporations are run by Lex Luthor clones. To what nefarious end do corporations do this? According to these types, it’s the evil bottom line.

And they are using evil mind rays to control all of us and what they really want is for all of us to live unhealthy short lives. Because in magical thinking land that improves the bottom line. Somehow.

There’s some backstory here that needs ‘splaining. First of all, let’s get the planned itinerary out of the way. I left on Mar 28th and arrived on Mar 29th. On Mar 25th, I got notice from my insurance (Tricare Prime) that I needed to find a new primary care doctor by April 1. The letter was dated several weeks earlier. 

This pissed me off because on March 22, I’d seen my primary care doc and got a bunch of blood tests done pertaining to a chronic problem. Had I known I was about to be “dumped” from treatment at the MTF (which I’d been coerced into 4 years before) I would not have bothered.

Anyway… with little more than five days notice, I have to find another primary care physician. First, I contact the physician my husband has used for years. That’s a no go. Then I find the largest group practicing near my home and affiliated with the hospital nearest my home. I contact them and am told that each physician decides whether to accept new patients and their insurance. After a few denials from specific physicians in that group, I’m finally informed that none of the 13 will take me on.

By this time, I’m in Arizona. So, I search again and this time find a physician who will take me. I fill out the paperwork and am informed by Tricare that if the paperwork is received before the 2oth of April, the assignment to the new PCP will be valid on May 1.

That’s wonderful and I make an appointment with the new doc for May 6. I plan to be home on April 28th… exactly a month after I left. Except for the perhaps wasteful blood tests, everything is good.

Except… on April 25th, I am running a fever and have stomach pain. Monday, April 26th, the pain is worse, the fever a bit higher. Since I don’t think I have a primary care physician to call for a referral to an urgent care clinic, I call Tricare directly. I am informed that since April 17th when I submitted my request (that I was told would be effective May 1) I do have a PCP and that I must get any referrals from her.

Unfortunately, she hasn’t seen me before and ethically can’t make any referrals. (This is another topic…) and therefore I can’t get a referral from anyone. I am advised that since this is the case I should go to the ER since that doesn’t require a referral. However, it’s been pounded into me that using the ER for routine care is a bad, bad, wasteful thing and that Tricare might not cover it. Since I don’t think my problem is an emergency, I’m not that thrilled with that advice. But I’m also worried that I won’t feel like driving 1200 miles unless I get feeling better.

So I go to the nearest ER which is less than a mile from my daughter’s house. Why I should have chosen an ER much further away may be the subject of another post. Let’s just say that the close hospital didn’t have a great reputation. But… I was only going to probably get a prescription for an antibiotic and a suggestion I follow up with my PCP when I get home, right?

Um… no. Now I knew that the hernia I’d had surgery for a year ago had herniated again. It was high on the list of things I planned to address with my new PCP. But it wasn’t causing me any problems… or so I thought. I was wrong. When the ER doc and the surgeon pressed (rather lightly) on that part of my stomach that was already hurting, the pain made me want to jump off the bed. A CT scan confirms that there were “issues” with the hernia.

So… I’m to be admitted and surgery is scheduled for 7 the next morning. I wouldn’t be happy except they’ve given me this wondrous drug through a barely working IV and I feel no pain whatsoever anywhere in my body. (I’m kicking myself for not getting the name of this drug, but it was described as an IV form of ibuprofen and not often given because of its bad effects on the kidneys.)

I realize that one reason I’m being admitted is that I’m running a fever. The first thing done after I’m taken to the strangest* room I’ve ever been in is to give me an IV antibiotic. Except remember how I said that IV port was barely working? So, I get a new IV inserted and get the antibiotic. Finally. What should have dripped into my vein in 30 minutes took close to 2 hours because of a finicky or malfunctioning IV machine.

And then there was a shift change. When the antibiotic bag finally emptied, the IV machine appropriately started its beeping. I finally found the nurse call button… and was told someone would be there momentarily. Or soon. Or something that pacified me for a while.

For an hour in fact. Somehow I managed to ignore the beeping and watched two sitcoms. Then I called again. Same answer. I watched another show. Then, I managed to sit up enough to reach the IV machine. Since all the rails on my bed had been raised, this wasn’t an easy thing to do. All the mechanisms for lowering them are on the outside. Anyway… I managed to turn the IV machine off. (All it took was reading the instructions.)  I’d had all the beeping I could take.

At this point, I managed to catch the eye of a nurse’s assistant (or whatever they are called in AZ) and motioned for her to come help me. She looked me in the eye and walked away. I cannot tell you how angry this made me. At her and at myself for allowing myself to be trapped in this bed.

Anyway, a few contortions here and there and I managed to lower the rails, the controls are all on the outside and obviously intended to be unreachable by the patient. Finally… I’m FREE!!! And I carry myself and my IV pump down to the nurses station. Where I’m ignored in the same way my previous calls to the same station had been.

Oh heck… let’s not be coy. The reason I should have gone to an ER miles away from this one is that my daughter, when she got pregnant, had been told to avoid this very convenient hospital because of the employees’ attitudes. But… I told myself that applied only to the OB/GYN and NICU parts of this hospital. Surely the whole place wasn’t bad…

Wrong. A bad employee attitude infects thoroughly and, IMHO, it’s because it drips down from management. I knew this, but chose to ignore it because I thought my exposure would be very brief.

I’ve never seen a place where “it’s not my job” would have been a more appropriate slogan for employee name tags.

When faced with this type situation, sometimes a hissy-fit is called for. And I can do hissy-fits. Let’s just say that one of the employees thereafter answered my needs.

Now, I’m not a particularly needy patient as long as it is made possible that I can care for myself. This means that I’m not strapped down and that the rails on the bed not be positioned where I can’t get out of bed myself.

I’m not accusing any of the staff of this hospital of deliberately “imprisoning” me, but a lack of thoughtfulness combined with a desire for everything to be ” neatly in line” can make that happen.

A patient who has just had abdominal surgery cannot lower the bed rails around her feet or remove the wraps intended to prevent blood clots herself. Even though she may have been given “permission” to get up and go to the bathroom by herself, when she’s restrained in this way, she needs help.

And… she can’t get this help when some helpful person has come in while she’s asleep and moved the call button out of her reach. Oh yes, it may look neater placed over there, but I can’t reach it!

Finally, I have convinced the nursing and non-nursing staff to leave things where I can reach them and to NOT fence me in, and… to give me the rest of the antibiotic drips outside the IV pump.

Oh yeah… I had another IV inserted (three days, three IVs… that par for the course, right?) but none of them are good enough for the IV pumps. So, to keep me quiet (much more necessary than keeping an IV quiet) the nurses have decided to unhook me from the IV except when the antibiotic is dripped.

But someone forgets to close off the big bag ‘o saline and nearly all of it drips on the floor under my bed. This is first noticed about 7 am and the nurse puts towels on the floor and calls for maintenance to come clean up the mess. Except the nurse doesn’t check the IV and it continues to drip on the floor.

When my lunch (liquids still) is brought I notice that the IV is still dripping onto the floor and close it off myself. I never knew how sticky this IV fluid could be until I stepped in it.

Anyway… because this is an “it’s not my job” sort of place, no one — including the janitorial staff — is able to clean this mess up. When I was discharged 12 hours later, it was still a sticky mess with several towels strewn around the floor.

Speaking of beeping IVs and other beeping alarm medical monitors, I think that hospital staffs in general have learned to tune them out. And I don’t blame them. For some reason, even though I should have been sleepy from the narcotic pain meds I was on, I was instead wide awake. There was a big clock with a second hand in my room and I found myself timing the beeping IVs from other patient rooms.

(I refused to allow the door to my room to be closed because I was terrified that the call button and phones would be outside my reach and no one would hear me calling for help. Yeah, I admit it, I’ve got a problem with being confined.)

IVs seem to beep at intervals just shy of two seconds if the clock in my room was accurate. To make matters worse, this interval starts whenever the machine senses a malfunction. And while all the beeps were close to each other as to what tone on the scale they played, it was if they’d been tuned by tone-deaf piano tuner. The result when three or more IVs are vainly begging for attention is very unpleasant.

The very least a hospital could do for patient comfort would be to tune and synchronize their IVs! Well… not really. I suspect that would make it even easier for the staff to unconsciously assign them to mere background noise. 

But enough about IVs, let’s talk about pain. This was my third abdominal surgery. The hernia is an incisional one from bariatric surgery I had about 15 years ago. (I am a bariatric surgery survivor even though I am still obese.) This was also the most painful recovery of the three. I really didn’t expect it to be so bad because it was laparoscopic. I thought the “minimally invasive” aspect would make this surgery less painful.

Nope. While the incision from my first hernia repair was almost 7″ long, for this surgery I had 8 cuts. Six of them were about 1/2″ each, one was a bit over 1″ and one was 2″. That’s six inches. But the painful part (at least according to what I was told by the nurses and doctor) was due to the air pumped into my abdomen for visibility or access or something during the procedure.

Maybe the pain was made worse by the fact that I was on a clear liquid diet for 2 days and the IV antibiotics. I could not eat anything without fairly severe nausea for four days after I was released. I took more pain medication more often for a longer period of time after this surgery than for any surgery I’ve ever had. It was a week after being released that I could sleep in a bed or stand up straight. Thank goodness my daughter has a very comfortable recliner.

But now let’s talk about the discharge. Remember I can’t stand up straight and my abdomen hurts like hell. (In my worst scenario fantasy, the surgeon took 8 chopsticks and stirred and tossed my insides before fixing the hernia.) The surgeon and the hospital intern both recommend some very minimal home health care — a walker, a toilet riser, and one visit by a home health nurse. It should note here that my daughter could not physically help me in any way that required lifting or straining because she was recovering from a c-section.

So we are now back to the fact that I don’t really have a PCP. For home health care to be covered by my insurance, a referral from my PCP is required. As explained above, I did not have a “functional” PCP at the time. Even if I had, my insurance would have covered only the walker and the nurse’s visit. Yet, the really useful, necessary thing was the toilet riser. None of these things were very expensive and paying for them out of pocket didn’t kill me, but it did make me think about how little thought has actually gone into what insurance covers or doesn’t cover and the hoops the insured and the doctors have to go through.

OK, I’m through bitching about this. For now.

*Oh wait… I’m not quite through! I mentioned that my hospital room was strange.  That’s because it was designed (halfway, at least) for bariatric patients. Except for the bed, which was “normal” sized, most of the room was outsized. The door to the room was about 5 feet wide, the toilet seat was so large and high it was uncomfortable. Yet the door from the room to the bathroom was “normal” sized. On my walks around the floor, I saw at least 5 rooms with the large doors. From this, I conclude that the hospital hoped to cash in on the current obesity surgery fad.

Huh? We’ve been married 20 years and I can guarantee you that he has never seen me wear a pair of high heels. Never. Unless a 1 1/2″ heel fits that definition. I think it was 2004 I last wore anything that high.

Pretty shoes and my feet just don’t get along. I envy women who can wear pretty shoes and I wish I could wear high heels. I’ve tried and the pain is unbearable. This is probably because of injuries to my feet, none of which were caused by high heels. You see, I’m a klutz. Clumsy. Awkward.

I’ve injured my left foot and ankle five times seriously enough to have to use crutches before I was 35. Now that I’m just a tad bit older and dealing with arthritis on top of old injuries, comfort and support in a pair of shoes is the primary goal. I really don’t care what they look like.

So… yes, I wear Crocs. And sometimes Skechers. And even worse, I wear them with socks!

Thanks to the internet and my knowledge of my past medical history*, I was 94% sure the radiating chest pain I’d been experiencing was not due to any cardiac problem.

Six percent lingering doubt is enough for a primary care physician to send one to the ER to rule out an emergent condition.

Blood tests, EKG, and chest x-ray ruled out the heart as the cause of my pain as I was almost sure it would do. I knew the pain was more than ordinary acid reflux and, after much reading, decided esophageal spasm was the best fit to my symptoms.

Yet… the chest pain I was experiencing didn’t involve difficulty swallowing, correlate to eating, position, or exercise, or involve regurgitation or a ”sour taste” in my mouth. Then again, I didn’t have any nausea, vomiting, or shortness of breath that might be associated with a cardiac problem. 

Thus the doubt and the need to rule out a problem requiring some action more proactive than taking a pill.

All I had was a recurring, intermittent, and sometimes severe chest pain that radiated to both arms and almost into my jaw.  Yep, that’s “all”. It is scary to hurt that bad in that part of your body and I don’t blame my PCP for sending me to the ER. As she stated on the phone, “We can’t do an EKG and our lab can’t do cardiac enzymes.”

What annoyed me the most about my ER visit is that a cardiac problem was ruled out within an hour of my arrival. The tests had been run and all returned normal. The next five hours was waiting for someone with the title and authority to tell the ER to dismiss me.

When that guy finally showed up (and I realize I was not high on his priority list because he also knew I wasn’t in danger of having a heart attack) he assured me that my heart was almost positively A-OK. 

I’d had a cardiac cath in mid 2006 which showed zero blockage and he told me that a blockage developing in 3 1/2 years severe enough to cause symptoms was highly unlikely.

(I am overweight and have high blood pressure, so was required to take a stress test to join a fitness center… and I failed. The docs said that it was probably boob size that caused the failing reading, but the only way to make sure was cardiac cath.)

He was more than happy to write me a 3 month prescription for Nexium — which is what I intended to ask my PCP for when I was lucky enough to get an appointment with her.  So…

Is all well that ends well? This time, for me, certainly.  

*my past medical history includes banded gastroplasty, which always creates gastro problems while not even close to always resulting in weight loss… but that’s an entire blog’s worth of rants that I don’t really feel like going into right now, especially on this blog.