Saturday, April 4, 2009

Doctors and Medicare

Medical bloggers have been sounding the alarm for a good while, for years
-- and today's New York Times' article, "Finding a Doctor Who Accepts Medicare Isn't Easy," reiterates their warnings.

Poor reimbursement rates and mounds of paperwork are not much of an incentive to stick with this mammoth -- and, of course, the extended fear these days is that the paucity and inefficiency of the Medicare paradigm will form the structural basis for the new [Socialist] Health Plan for All.

A shortage overall of internists/primary care physicians already makes finding basic health care difficult. Add to that the fact that, increasingly, these doctors are opting out of the Medicare system, and the future does not look promising for Medicare patients seeking a primary physician. A significant number promise to keep the Medicare patients they have, but decline to accept new ones.

Some are doing what my internist decided recently to do: open a concierge practice. He told a group of his patients at an informational meeting last Fall that he feared losing his passion for practicing medicine -- losing it to the steady drain of paperwork and insurance interference.

I did not comfortably have the financial resources to stick with him in this new paradigm -- but I did it anyway, and at a time where I had just lost about 55% of my financial resources. In what proved to be a series of embarrassing moments, he tried to offer me a "scholarship," saying that the overarching company (MDVIP) allowed for a certain number each year. This was an affront to my pride, so I declined. That proved to be the right decision, for I have ended up seeing him roughly every 4-6 weeks, with telephone and email communication at least weekly. In other words: I am getting my money's worth!

This is something of an odd duck, this article. It's tucked away in the Retirement section, a subset of Business. There are no ideological arguments. It is short and to the point, clear -- so much so that I'd wager (if only I had a good bookie) it aimed for about an 8th-grade reading comprehension level.

Exactly what I need on a bleary-eyed Saturday morning.

Friday, April 3, 2009

Margaret and Helen, I love you

It is not just because their posts have titles like "my god, bush was an idiot." No, that's just the initial attraction, the cheap come-hither and bright pink boa pulling me into their dark boozy doorway.

I don't leave comments at Margaret and Helen's place. If I did, it would always be "ditto." What he said, what she said. There is one comment that -- so far, at least -- sums up my feelings precisely: "When I grow up, I wanna be just like you."

"little by little, a disturbance into words"

The cover of the NYTimes' Sunday Book Review this week? The Letters of Samuel Beckett -- and oh, oh, oh -- I am so happy! Three more volumes will follow this one. This settles that burning question, "What do you want for Christmas/Hannukah/Kwanzaa/Your Birthday/Our Anniversary/This Weekend/Next Weekend/Friday, etc.?"

Joseph O'Neill writes:

Submerged for years in a murk of international literary diplomacy and scrupulous academic exertion, “The Letters of Samuel Beckett” has finally surfaced; and an elating cultural moment is upon us. It is also a slightly surprising moment. Beckett, in his published output and authorial persona, was rigorously spare and self-effacing. Who knew that in his private writing he would be so humanly forthcoming? We always knew he was brilliant — but this brilliant? Just as the otherworldliness of tennis pros is most starkly revealed in their casual warm-up drills, so these letters, in which intellectual and linguistic winners are struck at will, offer a humbling, thrilling revelation of the difference between Beckett’s game and the one played by the rest of us. (Beckett played tennis, incidentally.)

I loves my Beckett.

Volume I: 1929-1940
Edited by Martha Dow Fehsenfeld and Lois More Overbeck
Illustrated. 782 pp. Cambridge University Press. $50
Here is the Cambridge Catalogue page.

61 things on my cat / Sam Hart

La Bonne et Belle Bianca Castafiore would give five stars, if she had them, for Sam Hart and his music. (She also loves Toby.) Check Sam and his tunes out on YouTube (blinktwice4y). Catch him live tomorrow night in Davis, California:

Event: Pilipino Time '09
When: Sat April 4 show starts at 7pm
Where: Richard Brunelle Performing Arts Theater at Davis High School (Davis, CA)
315 W. 14th Street, Davis, CA

This is a song that [Sam] wrote for [his] cats called "Kitty Song," along with video of 61 things being stacked on top of [his] cat Toby while he slept.

No Tobies were harmed in the making of this video. Please don't yell at [Sam], and please don't be mean to your cats.

--Sam Hart, blinktwice4y


Little kitten feeling lonely
come and sit upon my lap
and I'll pet you run my fingers
through your fur as you cat nap

I'll feed you bits of tuna
and we'll stare at my tv.
I'll sing for you this song about
how much you mean to me.
It goes

Kitty come kitty play
Kitty love kitty stay
Kitty jump to me
Kitty land on your feet

When I get a little angry
or I'm feeling like a jerk
I can scratch you on the chin
and feel the rhythm of your purr

There's nothing that can phase me
when we're playing with a string
so I wrote for you this melody
though you hate it when I sing
it goes


Wednesday, April 1, 2009

Affectionate Light Bulbs, Toilets, and Surgery

The toilet overflowed.

I was on my way to see the orthopedic surgeon, was running late. Of course, the toilet chose that moment to do its thing. Yes, I *do* believe my toilet has free will.

That reminds me. Richard Brautigan wrote a poem about the lightbulb in his refrigerator, and how he believed that the lightbulb was fond of him. Fred was walking around the other day with a lightbulb in his hand, exclaiming over and over about how he thought it would never go out. I thought the household was going to have to go into mourning.

Here is the Brautigan poem, titled "Affectionate Light Bulb." So it turns out the bulb was in the toilet instead of the fridge. Looks like TOILET is the theme for the day.

I have a 75 watt, glare free, long life
Harmony House light bulb in my toilet.
I have been living in the same apartment
for over two years now
and that bulb just keeps burning away.
I believe that it is fond of me.

I remember the day that The Great American Writer and I went on a pilgrimage to Brautigan's place -- why, I don't know. I have a beautiful shell that I picked up there, on that dreary day. I remember that the sand wasn't so much sand, as mud. Muddy sand. It wasn't long after he had committed suicide -- the Fall of 1984.

That was a strange and wonderful time full of writerly things, trips and readings, periods of fecundity. Oppen's widow. Palmer. The time of Après-Foucault. Before the era of The Great American Writer Does Waitresses.

Sometimes the plumbing at Marlinspike Hall resembles more a mysterious labyrinth than anything that could be reasonably plotted on graph paper. Most of the "conveniences" were put in before plumbing hit its heyday in the 19th century...

I cried in the car on the way home. Poor Fred didn't know what to make of me, sobbing. Apparently, it just needed to happen.

Surgery is scheduled for Monday, April 27. It was going to be sooner, but I begged for time. I mean, I just had the last *major* surgery on February 16. This will be the fifth *major* surgery in 8 months.

And sometime between now and then, I have to go see another orthopod about the possibility of the osteomyelitis being in my knees. Yahoo. ShoulderMan said he is sending me to "the guru of knees."

I don't know how I ended up with Dr. ShoulderMan -- I mean, of course, I do know... What I mean is that he is great and I really lucked out.

Anything even remotely good that has happened since -- oh... -- 2000? I am in awe, I am grateful, I know what a gift is. That I have this superb surgeon who is also a superb doctor and person? A big "Thank You" emanates from my heart to the heart of the universe.

Jokingly, I showed him the two infected fingers -- it's a fungal infection and apparently not unusual if you're immunosuppressed. I said, "Thank goodness that *this* is not growing in my bones!" and got ready to guffaw with him...

So, of course, he said: "Hmmm. It just might be growing in the bone... but I think you'd be much much sicker. Of course, we're talking about *you*, so who knows..."

Good Golly, Miss Molly!

I find that as my trust in him grows, I accept his opinions as innately superior -- when I told him that the I.D. doctor had stopped the i.v. antibiotics after 10 days because of the muscle pain and sky-high CPK, and then stated we were "out of antibiotics to try," ShoulderMan said he would have let me "rest" for a week or so and then put me right back on it.

I hope I.D. and Ortho will work and play well together. When I asked the I.D. doc what we should do after the next surgery -- what antibiotics, etc. -- he said, "I've no idea." He thinks even vancomycin is now useless.

I can't worry about it. My bloodwork sucks, I am tired and depressed, in pain, constantly fighting a fever, sweating, exhausted. I never seem to be done cleaning or doing laundry. We had to stop at the pharmacy to get a new blood glucose testing meter -- while we were waiting, I had a terrible episode of chest pain. I couldn't really even communicate with Fred -- he didn't seem to hear me everytime I tried to tell him that I thought I was croaking. It lasted at least 20 minutes. But you know what feels GREAT? When a pain like that *stops*!

As soon as we got home, the roofer showed up to fix a small leak, and Fred showed off by fixing the toilet. (Hey, I never had the benefit of Boy's School.)

So... that leaves the clean-up chores for me, courtesy of Girl's School, I suppose.

I am so tired of these surgeries -- but there is no choice. He has to get the spacer out because the antibiotics embedded in it have all leeched out, leaving what he believes is a "bacteria magnet."

Well... there is a mop calling my name.

Monday, March 30, 2009

Have You Had Your Placebo Today?

The United Kingdom's Daily Mail Online, certainly my top source for up-to-the-minute health news, recently published an article titled "Which pills should you take to beat your pain?"

Their painkiller guide is actually quite good, with an emphasis on non-narcotic NSAIDs. I know that most of them are very effective, especially for bone-on-bone pain; I also know that they're very rough on the stomach. The last time I really felt like my bone pain was being contained was with the medication Diclofenac. And then came a smidge of internal bleeding and some bloodwork anomalies. "Drat!" I recall exclaiming in a fit of profound pique. "Doggone and shucks!"

The best part of the article comes at the end. After 25 entries for prescription drugs, the 26th reads as follows:

26. PLACEBO: Research based on more than 10,000 people show that 18 per cent of those given the sham treatment get a 50 per cent plus improvement in pain levels.

I've always found the idea of relief via the placebo effect fascinating and I know that it is sometimes very effective for me. It is odd, but I am able to consciously apply it -- that is, when my pain is out of control, I will take my allotted amount of breakthrough medication and then tell myself that in 30-40 minutes, I *will* have relief. I make a point of checking the time and then I write down the time by which I expect to have this relief.

It rarely fails.

The placebo effect is intimately aligned with my expectations -- so why not make those expectations both quality-specific and time-specific?

Sunday, March 29, 2009

Le Pen

Le Pen is at it again.
Non: Le Pen has never stopped.
Le Pen is consistent.
Never let it be said that I was not fair to Le Pen.

I copy below a snippet of the conversation about this YouTube vid that is contemporary with this posting. Why? Because I am struggling with United-States-of-Americans and what feels like a sucking vacuum of vapid, fetid breath born of GroupThink.

Not to be overly dramatic about it.

Please note the civility of the back-and-forth, the lack of a need to cite authority when one is both reasonable and reasonablyeducated. I copied daswerck91's little tale because it made me smile. I pasted Reinhard2152's remark because it made cold shivers ran up my spine (but I wondered if I wasn't over-reacting. Of course, one cannot control un frisson. What do you think?).

[oh! you will need to read the thread from the bottom up.]

Reinhard2152 (1 hour ago) si j'etais un putain de polak je fermerais ma gueule lol surtout vu comme on vous l'a mis en 39 ahahah

daswerck91 (6 hours ago) Hier, j'ai mangé une pomme.
Après j'ai eu mal au ventre, mais sa c'est un détail. :)

worldharrypotter (9 hours ago) ça ne change rien parce qu'il est le seul à le dire... Mais si tout le monde disait ça, là l'histoire changerait...
Certe il a le droit de s'exprimer si ce qu'il dit n'est pas nuisible or ça l'est pour les familles qui ont été détruite par ces chambres à gaz. : "ma liberté s'arrête où commence celle des autres"...
De plus, le négationnisme est puni par la loi, d'où l'amende de 200 000 euros... (ce qui n'est pas énorme pour cet homme)

amecharitable (23 hours ago) Franchement 200 000 euros d'amende pour ça... Déjà j'ai du mal à concevoir qu'on puisse être condamné à quoi que ce soit rien que pour avoir parler.

Marre de voir et d'entendre les gens s'indigner juste sur des mots. En vrai, que Le Pen dise ça ou pas qu'est-ce que ça change à l'histoire?
A-t-on encore le droit d'exprimer des opinions un peu à contre-courant ou faut seulement se taire et penser dans un seul sens???

worldharrypotter (1 day ago) Penseriez-vous la même chose si on vous enlevait les membres de votre famille, quon leur faisait vivre un enfer, quon leur coupait leurs cheveux pour en faire des perruques ? Mais pensez aussi, que ce soit vos petits frères ou sœurs, vos enfants, parce que oui, il ny avait pas tellement de pitié.

worldharrypotter (1 day ago) Est-ce un détail de vouloir tuer tout un peuple ? Est-ce un détail de faire de la mort une industrie ? De dépouiller les gens pour senrichir ? De vendre même jusquà leur cheveux ?
Dernières questions pour vous qui penser que tuer, torturer, dépouiller est un détail : avez-vous un cœur, êtes-vous humain ?

worldharrypotter (1 day ago) Comment peut-on dire que faire de la mort une industrie est un détail ? Parce que vous qui parlez, avez-vous déjà visité un camps ? Les nazis les organisaient telles des usines, qui fonctionnaient jour et nuit jusquen 1944.

worldharrypotter (1 day ago) Parler des chambres à gaz comme un détail est faux. Rappelez vous que les chiffres, 5 ou 6 millions de juifs morts ne sont seulement quune approximation, certains pensent quil y en a bien plus. Rappelez vous également que les juifs ne sont pas les seuls à être morts dans les chambres à gaz, que faites-vous des Tsiganes (environ 250 000 personnes), des Slaves considérés par les nazis comme « sous-hommes », des résistants, des communistes ?

worldharrypotter (1 day ago) Regardez la définition de détail, puis de génocide dans un dictionnaire. Vous verrez quun génocide ne peut pas être un détail.
Demandez-vous ensuite ce qui vous vient à l'esprit lorsqu'on vous parle de cette Seconde Guerre Mondiale et répondez (sans vous mentir). Ce mot génocide a été inventer suite à cette guerre, croyez-vous qu'il est alors secondaire ?

meetbee (1 day ago) Justement c'est pas la mort de ton proche qui est un détail mais la manière dont il a été assassiné faut arriver à comprendre à la fin...

JPNAT78 (1 day ago) la question n'est pas de savoir à partir de combien de millions de mort ça arrete d'être un détail !
Tous les morts sont importants.Le jour où tu perdras un de tes proches en mêmes temps qu'il y aura 10 000 autres morts, est-ce qe tu apprécieras que je te dise : "ton père (ou ta mère), c'est un détail"


Shhh. Don't tell Fred, but I am having a very good morning. I promise to tell him later -- *after* he has brought me another wonderfully brewed cup of coffee, in bed! To me, this is the height of luxury -- to have slept five hours without interruption and to wake without my first thought being that of pain medication, and then to have this sweet man offer me caffeine.

I need a better adjective than "sweet."

It's hard to accept gestures from him.

There is so much in my head and heart right now that I once again wish for Dumbledore's pensieve:

The Pensieve has multiple functions.

At times, when one's head is so full of thoughts that one cannot hear oneself think, it is useful to be able to take some of those thoughts and literally set them aside. The practiced Wizard can extract a thought from his head and store it in a phial or in the
Pensieve for another time. If it is in the Pensieve, it is possible to stir the thoughts stored there together and look for patterns. It appears that the wizard has the choice of extracting an entire memory, leaving no trace of it in his head... It is also apparently possible to edit these extracted memories, though it is a difficult task and one which is often not done well.

If one places one's head within the Pensieve, one becomes immersed in a memory that is stored in the Pensieve, and is able to relive it as if one was living that time over again...

A thought or memory stored in the Pensieve can, with proper stimulus, appear to nearby viewers as if standing on the surface of the basin.

It is also possible to take another person's memories, place them in the Pensieve, and then enter them to relive them as if one were the person whose memories you have just added to the Pensieve...

Most interestingly, the memories viewed by the person watching in the Pensieve are more complete than the person's own observations.

Ah, the coffee? I just dumped a few good gulps down my shirt. It's lovely what the tics and spasms of CRPS can do. I remember making an ambitious meal one evening -- cooking from a wheelchair in a kitchen that isn't handicap-friendly can be a challenge -- and as I was carefully lifting some filet with my spatula -- ticticticspazspazspaz -- and the fish went flying through the air backward over my head, landing with a satisfying *SPLAT* next to the catfood bowl, which of course determined its destiny.

At least the italian roast provides me the incentive to get out of bed, wash up, dress, and put the pensieve back in the closet. Throw in a load of wash --

Ah, the laundry? I have it on the brain. I was up at 3 am doing laundry because Sam-I-Am decided to piss on my dirty clothes again. This threat that he feels from Little Boy is getting serious -- as in: I cannot deal with any more cat piss. There are worse odors in the world but none that can line the sinuses quite the way that acrid, oily smell does. Bleck. Little Boy is the big-balled stray who is Marmy's brother, Dobby's uncle, and who is continually lurking around the exterior of The Manor. He has been injured recently -- it looks, Fred says, like it might be a bite on one of his rear legs -- but he is walking and feeding/drinking well, so I think he will be as "all right" as a stray cat can be in this cold-hearted world.

Marlinspike Hall has a few chinks loose here and there, especially in those wings dating from Medieval Times -- and Little Boy finds every little hole and access and marks, marks, marks with joyful abandon.

Following impeccable feline logic -- it only makes sense that Sammy, threatened by this virile male, would then do the expected: seek out my dirty clothes and piss all over them. No, I don't leave dirty laundry strewn about -- not when Captain Haddock might pop in at any time (for I do NOT believe he's still with that Swearing Bongi, photographic evidence be damned). I keep a clean Manor, thank you very much. But I will be keeping my laundry in some new, highly classified, secret spot.

A FEW HOURS LATER: I was planning to blog a bit about John McCain's performance on Meet the Press. Dick Gregory is doing a great job of making the show his own -- he is comfortable in his own skin, up on the topics -- Tim Russert must be smiling. McCain seems to be somewhat returned to his old self -- the man obviously does not fluorish when under the thumb of those political advisors and bobbly-headed pundits that the presidential campaign forced upon him. Forced upon him? Whatever. So now he thrives as part of the "Loyal Opposition." He is right to be angry about President Obama's failure to pick the pork out of his legislation, for not going with a line-by-line veto, as he promised. It is a bit of a pain, though, to listen to things like how McCain is anxiously waiting for guidance on Obama's plans to revamp immigration policy; Yes, it needs to happen, but can we decide once and for all whether he is doing too much too fast, the wrong things too soon, the right things too slow, or -- O, hilarity! -- whether he is doing everything just right, the Socialist Mad Man? The funniest moment of the show, was Gregory asking McCain if he planned to support Sarah Palin for President in
2012. It was hilarious. I haven't seen lips flap that fast in months. Why, surprise, surprise, it appears that there are many fascinating and qualified potential Republican candidates emerging!

He put the mark of approval on the new administration's foreign policy decisions and gave a smarmy yellow-toothed grin at being reminded that the fundamentals of our economy "are sound."

He plays the statesman well when he is not called upon to lead -- and just as I will never forget to remember that he was a brave man and that he served his country, and now suffers for it, physically, daily, I will also not fail to recall the seamier, steamier details of the man's life. I need to dig out that Rolling Stones' article from last Fall... it was an eye-opener.

Found it. Make-Believe Maverick: A closer look at the life and career of John McCain reveals a disturbing record of recklessness and dishonesty
By TIM DICKINSON, posted October 16, 2008

Yeah, so I was going to say a word about McCain!

Fred has gone to church and is staying afterward to give some sort of guidance about the lighting changes the congregation wants to make. Yes, I still have trouble with meanspirited jealousy. I long for the days when I woke up (Odd. I see myself as *single*, too.) early on Sunday morning, threw on some jeans and walked the grounds for a bit before hopping in the car and going and doing whatever the hell I wanted. But I am doing better in that I know my feelings have nothing to do with The Fredster's doings, nothing to do with him at all.

He helped me out the other day. Hmm. This won't make much sense to you, or seem at all important, but it was A Moment for me, somehow. We were flying down the highway to a doctor's appointment, it was pouring rain, I had not slept, my legs were enjoying some wild myoclonic jerks, and the allotted doses of pain medication had all been taken to little effect. The night before I had made noises about wanting to get my hair cut after the appointment -- since the route we had to take brought us near the hair place that knows how to tame my tangles and love my locks.

After seeing the PA (God forbid PainDude should pop his head in), while we were loading me back into Ruby the Dutiful Honda C-RV, Fred asked if I still wanted to get my hair done -- it was fine with him, said he.

And in that little moment, my world caved in. It just did. The fatigue of -- the shit of -- the large and total crap of it all. I kept hearing the voice in my head repeating ad nauseum -- Why does everything have to be so hard? It's an unfortunate mantra of late. I am trying to keep it unuttered. You know, think before I speak, edit what comes out of the mouth -- that sort of self-improvement [?] project.

I ducked my head and was searching for the ability to just do it (this would be others' mantra for me -- it bleeds out of their eyes, it is so obvious. Shut the fuck up and just do it. Anyway, strength of character can sometimes be found on the car floor mats.)

Ignoring me (or whatever), Fred said, still in that detached but kind monotone: "You just can't do it today. You hurt too much."
You know -- kind of like how you might say, "Well, skinless boneless chicken breasts are on my shopping list but I don't like the looks of these, so we'll just move on. I am more in the mood for a salmon salad, maybe with capers and some really finely minced scallion anyway."
It mattered that he didn't interrupt his movements to make an announcement; It mattered that... what? That he seemed confident that soon I would be able to do it, that soon I would not hurt too much.

He threw me a rope.

As today takes shape, it turns out to be a normally bad day -- which is, oddly enough, fine. The only things making me wince are these damned spasms and jerks (remember the coffee down the shirt?). And the thing fuelling my energy? A fever of 101.2. It really can give me the energy to get a lot done. I think Iwill surprise him with a lovely dinner.

I feel like cooking.

I hope I don't toss the food across the kitchen.

Oh! Do you remember The Turtles song -- no matter how they toss the dice/ it had to be/ the only one for me is you/ and you for me? Being just a wee lass, I "heard" that lyric as "no matter how they toss the tights..." Don't ask. I guess I kept an image in my head of everyone throwing leotards around.

This is a terrible post. Sorry. Maybe I'll come back to it. Likely not. Sufficient unto the day, and all that jazz. My goals remain modest -- a *deep* clean of the kitchen (as in, take off the grill from the bottom of the fridge and wash it; as in, pry the knobs off the stove and soak the suckers; as in, wash the trash cans!) and a lovely supper for the guy that throws me rope.