A little something on the ACA

I just wrote a short post about the HHS Secretary on my other blog. Read it here. 

It's Obamacare

Here's a great post about an ad blaming Obamacare on a woman not being able to choose her doctor. Money quote from Paul Waldman at the American Prospect:

The ad mentions not being able to choose your doctor, which would be bad. If you chose an insurance plan in an exchange established by Obamacare, that plan will probably have a network of doctors from which you have to choose if you want your care paid for, and if your doctor isn’t on it, then you’ve been prevented from choosing your own doctor. 

Of course, that isn’t because of Obamacare, it’s because of the way insurance works in America; it’s how it worked before Obamacare, and it’s how it’ll work after Obamacare. But it’s a lot simpler to say, “Now that we’re under Obamacare, I didn’t get to choose my doctor!”

The Problem With Getting Jacked Up

With gift subscriptions to The New Yorker, The New York Times, Time Magazine, Travel and Leisure, and Cooks Illustrated, there is never a lack of reading material in my apartment. With all these publications covering tables, desks, and bedside tables it is sometimes hard to find a book to read. This household went from having zero subscriptions I was interested in to five in the span of a few weeks. All this reading material has been a bit overwhelming and lately I haven’t been doing the best on keeping up with it. As an example of that, I was reading a New Yorker issue from late January last night.

The article (available online here) was written by Ben McGrath and titled “Does Football Have A Future?” It was well researched and informative in a good, addicting kind of way—the way all magazine writing should be. McGrath covers a lot of ground in this article, which addresses a topic sports fans have heard a lot about in the last year, concussions. I think what a lot of sports fans or parents of footballers aren’t terribly aware of are the repercussions from a career in football. And I’m just not talking about NFL football; I’m talking about junior high football to the NFL. And, to be fair, McGrath does point out that concussions occur in sports other than football, but the focus here was football and chronic traumatic encephalopathy, or C.T.E., which occurs in an alarmingly high number of football players. Detailed in the article are current and former players who admit to having memory problems and some who fear the side effects of a hit (not the hit itself) so much that they leave the sport altogether. I read about a 40 year-old brain resembling a brain from an 80 year-old Alzheimer’s sufferer.

I thought this quote about the parents who encourage or don’t mind the thought of their kids having a career in football rang true.

“Any parent who has let their child play football in the past fifty years and claimed never to have understood the risks involved was either kidding himself or an idiot,” Buzz Bissinger, the author of “Friday Night Lights,” wrote last week in the Daily Beast.

A few lines down, the author poses a question:

How many of the men on the field in the Super Bowl will be playing with incipient dementia? “To me, twenty percent seems conservative,” Nowinski said.

A conservative estimate? 20%? Ouch.

Right off the bat, this article addresses the issue of reporting on the concussion crisis and being attacked as anti-football, which translates for some to mean anti-fun, wussy, etc. And I understand that attack. People don’t like to find out that what they’ve been doing or what they want someone else to be doing is life threatening and certainly life-impairing. It’s like millions of people who must have been in denial for so long once people were coming out about the dangers of smoking and saying, surprise, smoking isn’t good for your health. Look, it makes your lungs look like this and they don’t work so well when they look like that.

I suspect, for many, knowing what we now know about concussions won’t be enough for them to step off the field or guide a son or daughter away from a sport which could make them a vegetable by 60, if they even live that long. We pick and choose the risks we are willing to take. I didn’t have this decision to make, but if I did, I hope I wouldn’t sacrifice the second half of my life for incredible material wealth during my 20s.

Up in Smoke

I live next door to the Colorado Department of Health building. It is an ugly, 12-floor structure, a perfectly hideous building to be used by the government. And that's about it. There is nothing special about the building besides its daily example of irony, the omnipresent group of employees huddling around outside to get their smoke on. Even in the gusts this morning as a storm moved through Denver, they were circled up getting their dose. I chuckled.

Just Do It

Proof that there are good ads on TV. I love this commercial. It gives me goosebumps.

This Just In: People Make Mistakes

As my time in Milwaukee comes to an end, I am seriously considering rejoining Facebook—after a 19-month hiatus—in hopes that it will help me stay in touch with friends in Milwaukee. After spending a significant amount of time off the Facebook grid, it should be easy to evaluate whether or not I feel more connected to friends or if communication with them has been eased and made more accessible. If Facebook proves once and again to be inconsequential to maintaining close friendships, and instead becomes a waste of time (no matter how many minutes are burned up by it), then I will quit it again.

But just as I am about to sign back on, I read this article at NYTimes.com called “Company on the Verge of a Social Breakthrough,” by Michiko Kakutani. The article is about Facebook and a new book about it, which was written by David Kirkpatrick, titled The Facebook Effect. Kirkpatrick was granted unprecedented access to the Facebook team for months and was presented with arguments in favor of the social-networking tool’s presence in our lives. He writes in his book, “Some claim, for example, that because of Facebook, young people today have a harder time cheating on their boyfriends or girlfriends. They also say that more transparency should make for a more tolerant society in which people eventually accept that everybody sometimes does bad or embarrassing things.”

I take issue with both of those claims. Firstly, I doubt the first statement is true. If it is, provide me with the numbers showing the decline of relationships having come to an end because of cheating. Facebook’s transparency does not contribute to moral fortitude, it perhaps makes having an affair or cheating on someone harder to hide, but when it comes down to that moment when you commit yourself to an affair, Facebook isn’t going to be in your decision making process. If you are going to cheat, you are going to cheat. Facebook, cell phones, text messages, Twitter and the blogs aren’t going to stop you. Additionally, people are increasingly voyeuristic (the other meaning) when it comes to their Facebook addiction. They love, in a sickly way, to see people stumble, to see flaws. And there are also those people who are more tempted to cheat on their boyfriend or girlfriend because of the social shockwaves it will send through Facebook. These people most certainly suffer from narcissism, they crave admiration and are willing to get it even if means self-abasement.

Secondly, let’s focus on the next statement about the transparency of Facebook leading to “a more tolerant society in which people accept that everybody sometimes does bad or embarrassing things.” Which is to say, what? That before Facebook people didn’t believe or accept the idea that everyone screws up every once in a while. Please. The fact that humans aren’t perfect isn’t exactly breaking news. Maybe folks over at Facebook and its most ardent supporters love to believe this, but to attribute the discovery of human infallibility, and its acceptance as a universal trait, to a social-networking site is absurd.

Furthermore, this statement assumes we benefit from knowing every bad or embarrassing thing our friends and acquaintances do. I am not convinced this is healthy. Concerning our lives, mistakes and errors in judgment included, privacy is important. While sharing with a close friend or relative about a bad thing you have done is very important, sharing about that bad thing you have done on Facebook via a status update hinting at a mistake, or a post, video or picture about it is not comparable or healthy. While the former approach is an attempt to heal, the latter is more of an exercise in narcissism once again and a cry for help from someone who doesn’t know how to share the old fashioned way. We are left to assume that friends of the person who takes the latter approach will meet the other person halfway and make a connection with them, but I don’t believe that is happening on Facebook, at least not in most cases. Why? Because Facebook—ironically called a social-networking site—is outrageously impersonal. It is too easy to walk away from someone crying out for help on Facebook. It is not too easy to walk away when they call you on the phone sobbing or show up on your front door completely broken. The latter scenario is both harder for the person seeking help and for the person who help is sought from.

Lastly, I wouldn’t be that surprised if the transparency on Facebook, which, people say, helps people accept that everybody does bad things, doesn’t lead to more tolerance, but leads to lowering the standards of human behavior and morality. I know, this makes me sound old, like some fuddy-duddy who just doesn’t get it. Well, is it so hard to imagine a world in which every one of our mistakes is known by our friends and relatives because of Facebook’s transparency? No, it isn’t and in this world would we become comfortably numb to errors in judgment from one-night stands to trying cocaine? Yes, it is possible. ‘Everyone screws up’ and tolerance are great things to practice, but it is dangerous to let them become your mantra because although we all screw up, we all need help too. While Facebook may help with bringing the former truth out of the shadows, the latter truth, the one that speaks directly to our love, compassion and our need to edify each other, isn’t exalted by the saturation of our world by Facebook and all of its friends.

Advancing Fear

Some people watch Oprah. Some people don’t. I fall into the latter category, but that hasn’t kept me from being fascinated by her show and by the host herself. I have my opinions, but last week’s cover story in Newsweek about Oprah’s show, spoke directly to a specific one.

I believe, and apparently other people do too, that Oprah will get behind and support, or at least consider, a lot of fanciful ideas, from vaginal injections to prolong a youthful look, to the idea that the MMR vaccination is linked to autism (an idea advanced by Jenny McCarthy despite any scientific evidence). A fact-based presentation seems to continually be overshadowed by the fear-based presentation, which, unfortunately, is the one that sells.

This is a very good read. Harsh. Witty. Fact-based. What will her comeback be?

Thankful for...

There were many things to be thankful for on Thanksgiving, but I kept on thinking about last year’s Thanksgiving. Thus, I was most thankful for my health last Thursday because last year I didn’t have it and one’s health—physical, mental and social—means everything.

Last year I had to spend the first part of my day alone because Kate was at work. I don’t think I’ve ever felt more alone. I was in a place I hated. I felt I had been banished away to die at a young age, having accomplished nothing in my short 24 years on the Earth. I literally thought I was dying. I was scheduled for an MRI the next day. The whites of my eyes were scarlet. The closest I could get to family was a pitiful phone conversation that provided me little comfort and in the end made me more depressed about my lot in life.

Somehow, things turned around and here I am, thankful that year has passed.

It's hard not to make a Forrest Gump reference here.

I ran in my first 5k over the weekend. I was running pretty regularly during the summer, but haven’t so much since I have been coaching. I’ve only been swimming four times in the meantime, so I am not working out really hard. I am trying to say I am not in shape and not proud of my time, although I had a lot of fun doing it.

I finished 115^th out of 1,437 competitors. Mind you, not all those people were running.  1,437^th place was at a 14:29 mile pace. 1^st place maintained a 5:21 mile pace, finishing in 16:37. I crossed the line at 22:32, holding onto a 7:16 pace.

Had I run that route (2 loops through the Milwaukee County Zoo) by myself, it is doubtful that I would have broken 23 minutes. In fact, I may have walked for a little bit after running up a pretty vicious hill the second time around. However, I ran with a pack of humans, trying to complete the required distance in as little time as possible. I found it thrilling, racing again, this time on land. It felt like a competition, but the atmosphere was not at all like other competitions I have competed in. There were friendly conversations before the start, good-natured joking and honest encouragement from stranger to stranger during the race. It was fun to be a part of that.

I’ll race more. Maybe not that much in the next 5 months, but after this rain freezes and whitens Milwaukee and thaws in the spring. Then, maybe I’ll take a crack at breaking 21:00. 

Health...Care?

It is hard to evaluate the health care one receives when there is no diagnosis. This scenario tempts me to be overly critical and negative about the care I received. But another scenario demands that I view my experience in a positive light. This scenario, the one that I am living now, is that I have come out of whatever it was that handicapped my life for five months. Barring an unforeseen problem, I am healthy on all fronts.

Now to the care…Once Kate and I decided to seek professional help, which didn’t take long given the whole loss of taste and facial paralysis thing, we were able to get a neurosurgeon to order a CT without a prior visit. This was the first of many perks of being married to someone in the health care industry. Kate knew someone who knew a neurosurgeon that did a big favor for us which eliminated the usually necessary visit to the doctor before a CT is ordered. That saved us $350. If you are wondering, that is after insurance. We did have to pay for one visit with this neurosurgeon so he could tell me that there was no visible tumor or huge problem with my brain.

This same doctor wrote a prescription for dexamethasone a few days later when it was determined I had Bell’s palsy. This prescription was written without a consultation—another perk. Although there were those perks and a few others, namely having a nurse practitioner as a mother-in-law and an anesthesiologist as an uncle and a wife who is a pharmacist (who also could double as a MD sometimes), I can’t say the perks drastically improved the quality of the health care. In the long run the perks saved us some money and some appointments by bypassing some health care bureaucracy.

The range of doctors I saw was a direct consequence of not having a diagnosis. Being sent from a neurosurgeon to a neurologist, to an ophthalmologist, to an ENT doctor, to a rheumatologist and to a family practice doctor is the unfortunate path of a patient with an undiagnosable illness. That journey wasn’t a byproduct of poor care, rather it was a byproduct of a health care industry that needs reforming. And with that thought, maybe it is a sign of poor care. Let me elaborate. With all the doctors I visited I came to realize how hard it is to find a choice doctor. There are many doctors out there, but few see patients as anything besides a chart or can remember why the heck you are seeing them for the second time that week. I went to more than one appointment where the doctor was hesitant to order tests or prescribe drugs that they sent me to another doctor even though they knew that ordering that blood work or giving me that drug is going to be the end result. When there seemed to be risk involved, half the doctors covered their asses by referring me to a doctor with the fortitude to order the test.

This slowed down the process of actually getting the care I needed or the answers I sought. It is a practice that prioritizes one thing—the doctor. Not surprisingly, the doctors that were referred to me by the doctors too afraid to make the call were always significantly better. They asked a lot of questions. They sat quietly while listening to my answers and I could see the wheels turning. There was much more patient-doctor dialogue. Probably most importantly, I felt like they were concerned about my health like it was their own life on the line. The care I received from these doctors was also more efficient. In one appointment the doctor quizzed me about my whole ordeal, came up with a list of likely problems/issues, and acted on one of these issues right away by ordering an x-ray. I got the x-ray, waited fifteen minutes and was able to meet with the doctor to discuss the results five minutes later. Let me remind you that this was all in one visit and, if you haven’t figured it out yet, not ordinary.

In stark contrast to the doctors that truly cared about me, there were two who were certifiable assholes. The first, an ER doctor that was convinced I had cluster headaches. She put me on oxygen, prescribed fiorocet, and discharged me from the ER. It was an agonizing few hours. We realized she wasn’t going to do any more for me so we obeyed her orders because that was the quickest way out of the ER that afternoon. The second, an ophthalmologist, was the worst doctor either of us has ever encountered. This guy met and exceeded all of my expectations of the crappiest, most arrogant doctor. He always seemed to know more about my health than I did. He would ask me questions and interrupt me while I was answering. Kate was often along on the visits to this doctor and on the last visit her patience with the doctor expired. She was beginning to ask a question of him and after she got out the first two words, not nearly enough for the doctor to know what she was asking, he held up his hand and stopped her and said, “No.” Kate started again, putting some frustration in her voice. This time he let her finish but immediately said, “No.” Again, he gave no explanation.

These two doctors represented some of the lows throughout my sickness. It was hard to imagine how they might have loyal patients. They consistently did the minimum in order to expedite the process. For the eye doctor, it was all about the money. You could tell he didn’t put much thought into his work. Sad to say, but he was a bitter, crabby, old man.

In addition to the poor doctors, the lack of diagnosis was the most frustrating factor to deal with, but that wasn’t necessarily a sign of the quality of the health care. Although at times I forgot that. With that said, I still think the care I got was only mediocre. Kate and I have great health insurance. We are in a highly rated health care system. However, this health care system appears to be very bogged down by bureaucracy and a few silly rules that are probably in place to ensure that patients can’t work the system. That’s a shame. It is also a shame that I ran into a few doctors that seemed reluctant to use the powers they had at their disposal. Why do they do this? Well, I assume some don’t want to be accused of a misdiagnosis or ordering unnecessary procedures. I don’t have the answers, but maybe some of them are just too afraid. It might be as simple as that. Or they could be deliberately passing me on to a doctor that they believe is better than them. Fine, but that process is slow and expensive. It might mean weeks between appointments and even longer before the next test is ordered or the next drug prescribed, thus making for an agonizing wait for a diagnosis or a result from a test. In this system there is no quick route to a diagnosis even if from the beginning the patient’s symptoms match those of a specific disease.

Health - The Statistics

A couple of weeks ago I set out to do this post on my health. I ended up with a colossal post, but one that covered too broad a spectrum. I ended up with chapters instead of paragraphs.

So, the first installment of a new series of posts on my health debacle is going to feature mostly numbers. Here are the stats:

1 - Average number of doctor appointments in a six-month period, prior to this sickness

23 – Appointments I had from October 10, 2007 to March 6, 2008. The actual number of appointments is probably higher because some days I would go in for a routine visit and then have the doctor schedule another appointment later in the day…mostly blood work.

10 – Different doctors that I saw

7 – Vials of blood drawn

1 – CT Scan

2 – MRIs – One without contrast, one with contrast

4 – X-rays

1 – Echocardiogram

6 – Drugs

1 – Hearing test

0 – Diagnoses

The last number really is my favorite. After all that, what I can’t tell you is what made me sick. Instead of trimming the list of possible diagnoses, each appointment seemed to broaden the many ways I could experience pain, suffering, and death.

Throughout, I have gone back to October 8^th—the beginning. I’ve ran through the events of that day and that weekend countless times trying to pin down a possible culprit of this scary and expensive adventure. Like I said not too long ago, I believe it might have been Lyme disease because of all my matching symptoms, but we will never know for sure. I was also in a heavily forested area the day before my headache set in and I could have easily picked up a tick. I was tested for the Lyme antibody earlier this year and it was negative. However, prior to having that round of blood work done, I was told that the test for the Lyme antibody is often inconclusive, meaning it can be negative but still the patient can show symptoms of Lyme disease.

Coming soon:

Thoughts on the health care I received, faith, death, finances, and my miraculous comeback from a disease that took me to the precipice of eternity and back again.

That last part was a joke, but really, I am doing much better and am very healthy by all accounts.

Did I have Lyme disease?

As promised, I will post a longer health update blog, but first this.

I have a day-by-day calendar that is from the writers of The Worst-Case Scenario Survival Handbook. The topic on Monday was “How to Recognize Lyme Disease.”

More than a few times over the last five months it sounded like a disease I could have had, or have, once I found out you could have it and never have the classic bull’s eye rash.

The listed systemic symptoms are many and I have had many of them, including, ear pain, temporary hearing loss, ringing, sensitivity to noise, headaches, facial paralysis, stiff neck, stomach pain, nausea, vomiting, loss of appetite, inflammation, and possibly a sudden onset heart murmur.

I was tested for the Lyme antibody back in January. The test was negative. The mystery unsolved, but I was told it is sometimes hard to get a certain diagnosis of Lyme disease.

It is still one of my theories that I had Lyme disease and I am very slowly fighting off its grasp. Who knows?

A pill-counter she is not

Here is a snippet of a conversation Kate had while we were in California a week ago.

Person: So what do you do, Kate?

Kate: I’m a pharmacist.

Person: Oh. A pill counter.

Kate: Well, actually not.

The conversation continues. Kate explains that pharmacists don’t count pills. The person, obviously a little surprised, listens.

This happens a lot. I’m sick of it, and I’m not even the pharmacist. There really is a swath of people out there that think pharmacists are the ones that count out the pills and fill each and every bottle of prescriptions at the local pharmacy. A lot of people don't even realize there are pharmacists employed at hospitals.

Here’s a little education. Think of it as a little tutorial from the inside of the drug world and my head.

Often the people that count pills at pharmacies are pharmacy technicians. These are people like you and I that could walk into a local pharmacy and apply. We don’t need a degree. We don’t need a background in the medical field. With proper training we could be back there counting some pills, by fives of course (this speeds up the process while maintaining accuracy) in a matter of months, maybe weeks. Sometimes it is the pharmacist counting the pills, but this is not the pharmacist’s primary responsibility at work.

Kate works in a decentralized hospital pharmacy. She actually meets with patients and consults them. She has to talk with doctors and even sometimes let them know that they have prescribed an incorrect dosage. This year she is working 60+ hours a week. Her work is hard and draining. Not to mention, when you are consulting doctors and patients on which drugs to use there is absolutely no room for error.

She didn’t go to school for six years to count pills and, one more thing, Dr. Perica, is not a typo.

Not an uncle yet...

Back from San Diego. I am not an uncle yet. Megan is late, and will probably have to be induced on Tuesday. The trip was great. I felt great while I was there, not noticeably improved, but much more preoccupied with family, amazing weather, and an awesome dog named Greeley.


Kate and I fly to San Diego on February 1. Although we will not be there for the birth, we will see our first niece when she is not even two months old. We are excited for that trip!

I hope and expect to make a reasonable return to blogging next week. By reasonable return I don't know if I mean 30+ blogs a month, but I can't have another month like I just did. I don't expect to get any sicker. I believe I will get better. That should lead to more regular blogging, which is great; it's therapeutic for me.

We are going to Kate's aunt's house in Burlington tonight. That's a little south of here and closer to Chicago where we will be spending the day on Saturday.

Hope everyone has a good weekend.

Oh, it's what you do to me...

I feel like I've been gone from blogging and writing for months, even thought it has been closer to three weeks now since I had to completely abandon sitting in front of a computer.

This is where I give you an update. It'll have a lot of holes in it, the update, but I'll cover the important stuff for now.

I had an MRI last Friday. We got the results yesterday. They were good. The neurologist didn't find any abnormalities and he wasn't concerned about my minor chieri malformation. You can look that up. It is very common. A lot of people have it, and only a percentage actually need surgery on it.

My headaches are gone for the most part. I feel like they are there, but the pain has been zapped. It is hard to explain. I am taking Topamax every night for those. The doc thinks that they are migraines. I am going to continue with that stuff and see him in two months if necessary.

I saw an eye doctor on Monday and he took a brief look at my eyes before telling me I have Iritis, which is an inflammation of the iris. The cause is mostly unknown, but I think it might be allergy related, possibly something in the apartment. The doc gave me steroid eye drops. They are helping a lot with the redness. When the patient has Iritis in both of their eyes, like I do, there is a 20% chance that it comes from an auto-immune disease. I am not currently showing any other symptoms of something like that. That is good. I know a lot of you pray, so pray that continues to be the case.

I am surprised I haven't collapsed from stress or a panic attack at this point. There is not much here in Milwaukee to keep my mind off of my health and every little ache and pain I have.

Kate is going to Las Vegas on Saturday for a national meeting of pharmacists. Yep, they are all into drugs. And I have been given a surprise trip to California. I'll be going to San Diego on Sunday and staying until Thursday. My sister is due on Sunday. Hopefully, while I am there, Brooklyn will be born.

Word. So, that's where I am at. You might have been expecting more. I can't blame you. There's more, but it is not ready to come out. I need to see my family first. I need to take a deep breath first.

There is some figuring out to be done.

For Dry, Red Eyes

This picture doesn't really do the redness justice. It can be better and worse throughout the day. So many of you have asked, "Just how red are your eyes?" I thought putting a picture up would show that I'm not just dealing with a case of mild redness that can be washed away by Clear Eyes. People take a step back from me if we make eye connection. That's a bit annoying.

Now...off to work for a little bit. Kate and I are celebrating Thanksgiving tonight with the other pharmacy residents.