Repost: Dear President Obama

First published July 29, 2010, then again on November 7, 2012, and now brought out again and brushed off on October 6, 2013.

Sometimes it is good to look back, to see how things were, how impossible the situation seemed, and, having come out the other side with only minor wounds, to be grateful.

So let this be a companion piece to today's bookend of rejoicing: Dear President Obama: My Experience at the HealthCare.gov Marketplace.

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Dear President Obama,

This is a follow-up letter to the one I wrote you exactly one year ago.  I thought you might like an update.

It's been a long time since I cried tears of happiness, and I would like to thank you for creating the opportunity for me to sit here like a complete nitwit, boohooing my teeny-tiny brains out.

Truth be told, the occasional blissful moment in an excellent movie can provoke a brief weep -- but tonight, we're talking floodgates, and bitter saline drawn for release from the Secret Inner Pool.

On September 30, 2009, I became one of the many uninsured.  That's no great story, no Big Whoop, as the kids used to say, and I still do.

One of the many things I admire about you and your administration is your willingness to hear individual stories, and to believe in the integrity of the storytellers.  You don't ridicule instances, you don't seem to fear being overwhelmed by them.

Already permanently disabled by a severe case of one of the most severe of pain syndromes, CRPS/RSD [Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy], lupus [SLE], avascular necrosis/osteonecrosis [AVN/ON], and Some Other Annoying Crap [SOAC] -- it was a real blow to my quality, and even hope of, life to come down with osteomyelitis in my prosthetic shoulders and in the long arm bones themselves.

A complicated but not unmanageable situation, given enough Local Talent, and I am blessed with Local Talent Galore.  There are three excellent medical schools within spitting distance of Marlinspike Hall.

The Author of My Story decided to spice things up with plot twists:  Make the offending bacteria be so obscure, nasty, and recalcitrant that it could not be identified by the wily microbiologist's eye and proved resistant to any antibiotic made by mortal man;  Create such a snarl of confusion that even the we-have-seen-everything, ennui-stricken researchers at the CDC threw their hands in the air, preferring an honest Ebola virus to my obscure domestic germs;  Dictate that the conditions under which these bacterial cultures could be successfully grown existed only in the warm, moist, rum-soaked environment of my shoulders.

Each shoulder having previously been replaced, the prostheses had to be removed.  Surgical concrete laced with all sorts of charms and amulets took their place for periods of up to 3 months, and then, most often, had to be replaced with new ones, as surgical concrete, like all other things in my life at this point, tends toward entropy.  Seven surgeries, President Obama, in the space of 18 months.  Five stays in ICU, three stints on a ventilator, and two resuscitations.  A partridge in a pear tree. 

It was not easy.

Lest you think that the drama lessened between sessions in the operating room, I also single-handedly supported a cottage industry of infectious disease warriors, and co-opted all the free time of Marlinspike Hall's Manor Denizens.  Back and forth we went, inserting and tending PICC lines, infusing intravenous antibiotics several times a day, making blood offerings to appease the demanding serum levels of Haute Society Pestilence, and so on, and so forth.

None of this would have been possible, of course, without excellent insurance coverage.  It was thanks to the reluctant involvement of the Grand PooPah of Tête de Hergé's Insurance Commission that I had any coverage at all once our version of COBRA ran out (here, it's THE ASP).  I was already in a high risk pool, but it was an unregulated pool over which the Grand PooPah could only utter tsk:tsk:tsk! 

BCBS of Tête de Herge is a wily enterprise, and my insurance premiums began to rise, rise, and then rise a lot more.  Finally, it was decreed that as of October 1, 2009, I was to pay, in U. S. Dollars, $1513 a month, in addition to the annual $5000 deductible/out-of-pocket expenses.  The cost of being insured would now amount to 96.6% of my private disability income of $1996.20/month, an amount never adjusted for inflation, despite the spiraling costs of Everything, Everywhere.

Of course, we all know that if they would just accept Lumps of Pure Gold Studded With Blue Topaz, there'd be no problem.  It's this Social Contract involving Oblong Green Rags of Value that is screwing everything up.  Some proprietary blend of cotton, silk, and linen is worth more than my Studded Lumps?  I don't think so.

Anyway, a 41% hike in the space of 9 months finally forced me into the scary position of being in the middle of a health crisis without benefit of insurance.

If you read my blog, and we all know you don't, you would read account after account of daily fever, pain, sweats, fatigue, and the certainty that I would need to cheer up to be suicidal.  It's nothing but a broken record, and to make matters worse?  I now write like H. P. Lovecraft.

I almost went permanently insane during the Great Health Care Debate, especially when it looked like the Tea Baggers might succeed in excluding Aliens from Tête de Hergé (très décédé, d'ailleurs).  ArseHoles!

You about lost me as a supporter when you stopped fighting for the Public Option, and at several other murky junctures.  I lost a lot of my natural optimism, my well known spunk. When the package was passed, it was not clear to me what was actually about to happen, if anything.  Everyone said it would be years before the real impact of reform would be felt.

But whispers in the dark persisted, and the word on our unpaved back-country roads was that some sort of High Risk Pool for people labelled uninsurable was going to be available... in July 2010!

Tall tales went the rounds about some website somewhere, rumored to be PCIP.gov, that explained the possibilities in accessible language and without endless complication.

I went, myself, to the fabled site -- I saw it with my own eyes -- It is real, it is real!

There was one hoop through which I had to leap, and leap I did.  The application for coverage by the Pre-Existing Condition Insurance Plan required that a rejection letter based on pre-existing conditions be attached for eligibility.  The letter must date from within 6 months of the time of application.

Last weekend, I spent four hours filling out an insurance application from InHumana, detailing every instance of hospitalization, complication, treatment, diagnostic procedure, and ingrown toenail, and sent it off to Underwriter Land with fervent hopes for swift and complete rejection.

My rejection letter, which Fred is having framed, arrived today.  It is riotously funny, a moment of hilarity in the midst of my Personal Health Tragedy Epic Saga -- every Long Boring Story needs comic relief.

Sincere in my intent to make application to the PCIP, I poured myself a stiff one this evening, downloaded the .pdf file, printed it out, and girded my loins.

Five minutes later, I was done.

My vision blurred as I read about provisions for those who qualify within Tête de Hergé's territory.  I finally made out that my monthly premium would be $495. 

My hands began to shake when I stumbled on this:

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year.

And it was not long before I was weeping.  Fred, too.  La Bonne et Belle Bianca Castafiore even joined in, though she is well-insured by her operatic company.  Unfortunately, she pays more than your average soprano due to a, uhhh, errr... Cyst Situation.  But we won't talk about that...

I would love to shake your hand and give you a hug, maybe even a kiss on the cheek.  Michelle, too.  The girls and the darned dog, as well.  I don't think the Secret Service would much like that, so please accept the enclosed 2010 ManorFest TeeShirts for you and your whole family, instead.

I hope we guessed right on sizes, as they tend to run small.

Sincerely,

The Retired Educator
Your Greatest Fan




If you have serious medical conditions and cannot get insurance because of them -- this is a good place for helpful information and suggestions: Foundation for Health Coverage Education/Coverage for All.
photo credit: Steve Hopson

BCBS/Regence Medical Policy Manual on CALMARE / Scrambler / TENS for Neuropathic Pain

                                                                               

Medical Policy Manual 
Topic: Transcutaneous Electrical Modulation Pain Reprocessing
Date of Origin: November 2011
Section: Medicine
Last Reviewed Date: November 2012
Policy No: 143
Effective Date: January 1, 2013

IMPORTANT REMINDER
Regence Medical Policies are developed to provide guidance for members and providers regarding coverage in accordance with contract terms. Benefit determinations are based in all cases on the applicable contract language. To the extent there may be any conflict between the Medical Policy and contract language, the contract language takes precedence.

PLEASE NOTE: Contracts exclude from coverage, among other things, services or procedures that are considered investigational or cosmetic. Providers may bill members for services or procedures that are considered investigational or cosmetic. Providers are encouraged to inform members before rendering such services that the members are likely to be financially responsible for the cost of these services.

DESCRIPTION
Transcutaneous electrical modulation pain reprocessing (TEMPR), also called scrambler therapy, is intended to interrupt transmission of pain signals by delivering electrical stimulation that is interpreted by the nervous system as “no pain”. Scrambler therapy is performed using a type of transcutaneous electrical stimulation (TENS) device that is specifically designed for this therapy. Cutaneous nerves are stimulated using 5 surface electrode pairs (i.e., channels) that are placed in the dermatomes above and below the pain area.
Unlike conventional TENS, scrambler therapy is administered in the office setting under physician supervision. According to Competitive Technologies, Inc., the makers of Calmare® Pain Therapy device, “the physician provides the initial consultation to discern the most effective path for electrode placement. Treatment applications are interactive between the patient and the provider, with the provider attending and making adjustments approximately every 10 minutes throughout the treatment session, which typically lasts an hour.”

Regulatory Status
The Calmare® Pain Therapy device (Competitive Technologies, Inc.) has 510k approval (K081258) from the U.S. Food and Drug Administration (FDA) under the name Scrambler Therapy MC-5A TENS


MEDICAL POLICY CRITERIA
Transcutaneous electrical modulation pain reprocessing (e.g., scrambler therapy) is considered investigational for the treatment of acute or chronic pain, including but not limited to the following:
A.
Arthritis (any type)
B.
Back and neck pain, chronic or acute
C.
Cancer pain
D.
Chemotherapy-related pain
E.
Musculoskeletal pain
F.
Neuropathic pain
G.
Pain syndromes [e.g., complex regional pain syndrome (CRPS); reflex sympathetic dystrophy (RSD)]
H.
Post-operative pain
I.
Traumatic injury
J.
Visceral pain

SCIENTIFIC EVIDENCE

Background
The most clinically relevant outcomes of therapy for intractable pain are improvements in pain and/or function. Both of these outcomes can be influenced by nonspecific effects, placebo response, natural history of the disease, and regression to the mean; therefore, these therapies need to be evaluated in randomized, controlled trials that maintain satisfactory blinding of the treatment assignment. The appropriate control for electrical stimulation devices for treatment of pain is sham treatment. Pain outcomes require quantifiable pre- and post-treatment measures, which are most commonly measured with a visual analogue scale (VAS). Collectively, the pain measurement literature cautions against using only statistical significance of difference in mean change in scores to determine clinical significance. More meaningful to patients and clinicians is the correlation of improvement in pain scores with improvement in function and quality of life. Thus, quantifiable pre- and post-treatment measures of functional status are also necessary.


Literature Review

Randomized controlled trials (RCTs)
There are no randomized trials that compare active with sham scrambler therapy. The only published RCT is a small, short-term pilot study that compared scrambler therapy with pain medication in 55 patients matched for type of pain which included postoperative neuropathic pain, postherpetic neuralgia, or spinal canal stenosis.[1,2] The authors reported significantly greater pain reduction in the scrambler therapy group compared with the medication control group at 1-, 2-, and 3-month follow-up. While this RCT is useful in informing hypothesis formation, it does not permit conclusions on efficacy and safety due to small size, lack of a sham control group, and short-term followup period.

Nonrandomized trials
The remaining published trials are limited to nonrandomized trials.[3-6] Evidence from these studies is unreliable due to methodological limitations, such as non-random allocation of treatment, non-blinded study design, and lack of comparison groups.

Clinical Practice Guidelines
There are no clinical practice guidelines from professional associations that recommend scrambler therapy.

Summary
The evidence is not sufficient to permit conclusions about the benefits of transcutaneous electrical modulation pain reprocessing (scrambler therapy) as a treatment for pain from any etiology; therefore this therapy is considered investigational.

REFERENCES
1. Marineo, G, Iorno, V, Gandini, C, Moschini, V, Smith, TJ. Scrambler Therapy May Relieve Chronic Neuropathic Pain More Effectively Than Guideline-Based Drug Management: Results of a Pilot, Randomized, Controlled Trial. J Pain Symptom Manage. 2011 Jul 13. PMID: 21763099
2. Marineo, G, Iorno, V, Gandini, C, Moschini, V, Smith, TJ. Scrambler therapy may relieve chronic neuropathic pain more effectively than guideline-based drug management: results of a pilot, randomized, controlled trial. J Pain Symptom Manage. 2012 Jan;43(1):87-95. PMID: 21763099
3. Sabato, AF, Marineo, G, Gatti, A. Scrambler therapy. Minerva Anestesiol. 2005 Jul-Aug;71(7-8):479-82. PMID: 16012423
4. Marineo, G. Untreatable pain resulting from abdominal cancer: new hope from biophysics? JOP. 2003 Jan;4(1):1-10. PMID: 12555009
5. Smith, TJ, Coyne, PJ, Parker, GL, Dodson, P, Ramakrishnan, V. Pilot trial of a patient-specific cutaneous electrostimulation device (MC5-A Calmare(R)) for chemotherapy-induced peripheral neuropathy. J Pain Symptom Manage. 2010 Dec;40(6):883-91. PMID: 20813492
6. Ricci, M, Pirotti, S, Scarpi, E, et al. Managing chronic pain: results from an open-label study using MC5-A Calmare(R) device. Support Care Cancer. 2012 Feb;20(2):405-12. PMID: 21394458

CROSS REFERENCES
Functional Neuromuscular Electrical Stimulation, Regence Medical Policy Manual, Durable Medical Equipment, Policy No. 83.04
Interferential Stimulation for the Treatment of Pain, Regence Medical Policy Manual, Durable Medical Equipment, Policy No. 83.07
Sympathetic Electrical Stimulation Therapy, Regence Medical Policy Manual, DME, Policy No. 83.08
Pulsed Electrical Stimulation for the Treatment of Arthritis, Regence Medical Policy Manual, DME, Policy No. 83.10
Percutaneous Neuromodulation Therapy (PNT), Regence Medical Policy Manual, Surgery, Policy No. 44



© 2013 L. Ryan

Compassion and Goodness

One of the things I do quite a bit these days is cry.  If I did it prettier and without a runny nose, I'd say that I "weep," but who am I kidding?  I have been known to blow my nose on my tee shirt and wipe my eyes with the back of my hand, flicking the moisture willy-nilly, or letting Dobby clean me up.  He does a great job, even if it does mean that I have to go disinfect myself afterward. He gives a bit of a cheshire smile when I attempt a purr. If someone, even a cat, shows you that much love, you don't interrupt so as to make a critique.

Despite the growing proclivity for leaking saline, which, given my fevers, I can ill afford, emotional stuff builds and builds until bursting seems the only option.

 From Compassion and Goodness

That's when having a best friend sitting close, gently, with savvy, holding my CRPS hands just right -- not stroking, but holding firmly -- would be nice to have.  That I don't is entirely my fault, but doesn't keep me from that morsel of self-pity. I could change this friendship dearth in a mere moment, but I don't, and that's stupid.

Add it to the Stupid List.

Back when I tried to help out some in the fight against people being homeless or so flirting with homelessness that their days were built of bricks dense with stress, back when I spent the day encouraging and fussing, modeling and experimenting with young minds, chalk in hand, back when rushing home to make simple pasta, marinara, music on, back when... I never cried, wept, or had many ocular leaks at all.  The lesson?  Stay busy, do what you love, give back, and be open to the day's unexpected gifts.  Lacking a means of transportation, the men at the shelter welcomed me onto their duct-taped, prayed-over bus that left at 5:30 AM sharp, and got me to the closest metro station for the second stage of my journey to school.  They were sleepy sweet, bitter sharp, funny, depressed, hopeful, a boon one to the other, and to me, the hitchhiker.  It got more complicated as I lost mobility and my scooter joined the dangerous pile of wheelchairs and walkers that we very illegally stashed in the doorwell.  But no tears, not even from the men who surely had reasons to dissolve.

I need to recreate that experience -- without the "elderly, sick, and/or disabled" men without physical or emotional shelter to call their own, without the ensuing two-hour trip to school, without the talented teens on hormone overdrive (and their equally uneven instructors), without the pots of roiling, boiling water and rotini, the rush back to the shelter for evenings of laundry and serious competitions of hearts, spades.  In between hands, grade a paper here, grade a paper there.

Please don't stop, don't allow yourself to be stopped.  If you pause, even, covet the busy-ness with love, and return to it refreshed.

Should you, though, find things rough going, and going rough for too long... Should you not feel rested after resting... Should you lose the joy in passing as yourself through hard things, remembering your swollen feet on the crowded platform, and not the too-cool-for-school fourteen year old goth giggling with a cardiganed lady who, given their shared nose stylings, must be his grandmother... Should that happen, don't stop, still don't stop, even if it means a decade or so of traveling to a hard cadence, of walking from the same points back to the same points.  

If you've read much of this odd blog, you will have found the occasional reference to a man called "my MDVIP Go-To-Guy." He's a doctor who stepped out of most of the madness that has overcome medical practice, deciding instead to have a smaller practice, dedicated to wellness and the spending of adequate time and attention to each patient.  I remember him saying that he wanted to enjoy practicing medicine again, that he was spending excessive time on paperwork and insurance companies and we all know to what he is referring.  I suspect he is a Republican, but I forgive him.

When I had to go without insurance because BCBS priced me out of coverage (They raised my premium four times in a year, to $1513/month, plus a hefty deductible;  They simultaneously began denying me coverage for procedures that needed repeating, like cultures to identify nefarious infective bugaroos.)  Left uninsured with an active bone/prosthesis infection, my MDVIP Go-To-Guy got me through that time by researching the cheapest drugs, by being so vigilant that I never once had to be hospitalized.  He was often praised with the highest praise we have here in Tête de Hergé, being named "a prince, a peach, a pear." 

But when the Affordable Care Act passed, with its life-saving provision of PCIP (The Pre-Existing Condition Insurance Plan), I had to have the infections addressed by a bevy of specialists, the bevy-est of micro-managers who saw me as an eyeball, a shoulder (sometimes left, sometimes right), sticky red blood, and ill-behaved connective tissues, some odd neurological disorder, and a twinge of an attitude.

Essentially leaving the attentive care of the prince, the peach, the pear for Infectious Disease Dood, Shoulder Guy, and a host of White Coats that often didn't even bother to introduce themselves before billing me $300 for scribbling in my chart after sticking their pointed heads inside my hospital room to swap howdies, I felt very much left on my own, and helpless.

What was the plan?

Who was in charge?

Why won't you answer my questions?

Because he accepted email communication, I began a process designed to keep my MDVIP Go-To-Guy up to date on the goings-on, because Lord knows, in this technical age, it's nigh unto impossible to fax, scan, email, or convey telephonically any results, plans, ideas related to my care.  We were dealing with an infection whose bacterial, viral, or fungal basis refused to grow in the laboratory, despite being abundantly evident in surgery.

But then, you know all that old story.

Lately, I have abused the email privilege.  Well, honestly, I don't think I have, but I know that most would say so. 

I don't know what I would have done these last few weeks were he not there at the other end of these garbled messages.  He is limited -- by good sense, and by, I am sure, legalities -- in how he can respond.  But that he does respond, and hasn't yet ordered me put in a special quiet quilted-walled room in some out of the way facility?  Well, it's life-saving.

But I do violence to him with my words -- you've seen me do the same here, you know what I am capable of, and how I excuse myself by calling it "honesty." 

This is the wound I inflicted yesterday:

Hi MDVIP Go-ToGuy,
I have to thank Nathalie at Dr. G's for suggesting that I try to get you to have more control over the specialists that are handling my care.  They're great, talented, and all have tunnel vision.
This morning I had another experience like the one last Tuesday, a rapid and distressing temperature spike, with dripping sweats and a heart rate ranging from the 50s to 120s -- within a half-hour of doing my first antibiotic infusion of the day.  You'll forgive me, but I had already had 2 Endocet for pain (=650 Tylenol), so I dug up my bottle of ibuprofen and took 800 mg, got in bed under a heavy blanket, and just got through it.
The second infusion -- about 2 hours later -- also brought on a reaction, but a smaller spike.  I hit 102, nothing near the 103.5 from last week, but it felt pretty awful.  This time I added ice packs.
THE PICC LINE IS INFECTED, it has to be.  Both of Dr. B's PAs, Susan and Jacqueline, came to that conclusion last week, but he overruled them, saying that even if it is, the cefepime should "cover" me according to whatever grew in the blood cultures.  It only occurred to me today to wonder if my aortic valve is at risk.  Wouldn't that be a hoot.  But there's no "hardware" in my heart, so blahblahblah!
Outside the semi-crises that occur with infusions and flushing the lines, the rest of the time, I am exhausted, in extreme pain, but forcing myself to be an admirable domestic.
The pain in what-was-formerly-my-shoulder is worse.  Now this could be because I am forcing its use, trying to grow some of that scar tissue that supposedly will one day function like muscle.   But who knows?  The hip pain is now in both, with the right remaining much worse.
The spasms are back, as well as blood sugars that defy logic. That's at 50 units of 70/30 twice a day and sliding scale before meals.
I'm going to put my four years of experience with prosthesis/bone infection to the test, go out on a limb and cry, "infection!"   And my specialists are all going to look at each other but no one is going to look me in the eye.  If this is going to kill me out right, or some complication of it, just tell me  It won't be a shock.
So long as I have an ID doctor who doesn't even check my weekly CBC results -- only blood culture results matter -- and a super shoulder specialist who only looks at... shoulders, etcetera -- I don't have a chance.  Yes, I believe there are some of those nasty bugs in my hips, so making the appts to see Dr. S's team is smart.  But I'm exhausted, depressed, and tired of telling this story to doctors who then look at ME as if I'm crazy.
I can tell you now that he'll order a "tap" of the hip under guided fluoroscope, they won't get anything to work with, and he'll say, "well, everything looks fine..."  I've had 10 taps, without results, that turned out to all be in infected areas.
Speaking of crazy -- I think my brain is infected, or that CRPS is having more of an impact up there than I expected.  For the first 15 minutes or so at the start of every episode of spasm, I am suicidal.  That's not an exaggeration, I am not trying to get attention.  It lasts almost exactly 15 minutes and it is a real struggle.  Then, I cry a bit, and it's gone.  Not the spasms, of course, they hang around for hours!  I use the mantra of "it's only 15 minutes," but one day, that 15 minutes is going to coincide with something else, and that will be that.
I've passed out twice this week, both times during a transfer from bleeping wheelchair to the bed -- if you have to have a brief black out, doing it on the bed is a good choice.  I am trying to drink more, because it's got to be dehydration...
Beyond a puerile "please just make it all stop" request, is there some way to draw up a plan, slow things down?  I always feel like I need ID help right when they have checked off their to-do list of 6 weeks of X and 4 weeks of Y -- because I go by symptoms, and the rousing sense of failure that hits when they say "we're done, call us if you need us!"  Same deal with Dr. D -- now that the shoulder is gone, why should he care that the pain is worse and eerily familiar to earlier pains from infection?  And, trust me, there's no one to call during my 15 minute dalliances with suicide -- or if I did call someone, it would be a CYA response.  Who do I tell that I am just crazy enough to think my brain is infected?
So... when you were signing up hale-and-hearty patients for the preventive medicine you were hoping to practice via MDVIP, you must have rolled your eyes to see that I wanted to tag along, eh?
Ah -- the worst fever symptom of all?  Over 101 degrees and I want all physical issues solved, as of yesterday.  I am also rude, weepy, and annoying, even to myself.  I hope to avoid a hit of spasms with these fever attributes -- I wouldn't be able to find a single reason to justify my existence, not in a mere 15 minutes.  My reason for living is Fred -- not love of Fred or even fondness of Fred -- but the need to be able to leave him a little more money than I have right now, and with organized finances, and a house in good repair.  Otherwise, he will be lost.
So what can my MDVIP Go-To-Guy pull out of his hat to help this mess?  No, thank you, I don't care to speak to a counselor or a psychiatrist -- that detracts from my primary objective of accumulating massive amounts of wealth to bequeath the guy snoozing in front of his computer, oblivious to all...

This time, I thought, I might well get a "cease and desist" courier-delivered letter on fine linen stationery, thanking me for having made his practice so much fun and encouraging me to go spread enjoyment elsewhere.  The main thing, you're just not supposed to use the S-word.  I use it and use it often, as part of my effort to use the most appropriate word for sign/signifier/signified/referent.  I got bit with the Saussure bug.

You Readers are pretty sharp.  You might well have already imagined MDVIP Go-To-Guy's response, which I just got, right in the middle of a weep.

Sorry for the late response. To be honest with you, I read this late last night but was so overwhelmed by the email, I wasn’t sure how to respond. 

Your issues are clearly not simple and this is way out of my expertise.
The only thing I can suggest is that I call and speak with Dr. B myself to get a clearer understanding of what his plan is. 

Unfortunately, I am leaving town in the morning for a much needed vacation...
I will try and call him [on my return].

I’m sorry that I cannot give you any better advice than this but I truly have no other ideas of what to do. 

In my 23 years of practice, this is clearly nothing I’ve ever dealt with and I must rely on the specialists for advice and guidance.

The office will be open with Dr. K manning the ship in my absence. J will be here.
If you’d prefer to see me for an appt when I return next week, I’m happy to see you.

Like I said, "a prince, a peach, a pear." 

Just being heard, feeling heard, relieves the pressure that threatened to make a protoplasmic mess all over my clean floors.

So I was able to fire off the last word... 

All right, MDVIP Go-To-Guy, I've hit upon a brilliant plan.
You need a vacation (of that I am sure!).  I need a vacation, too.
So I'll make some version of one... maybe do a virtual world tour, immerse myself in the Olympics, remember how to laugh again.  Renew some of the family relationships that oddly seem to start up again after someone dies (very perverse, that).
Maybe I should try doing a good deed now and then.
So... let the vacations begin, PICC lines, and brain dysfunctions be damned!
You are possibly the best doctor around -- but don't get a swelled head.  That's MY purview.
Thank you.

So once I publish this, you will have, and I will have, proof tangible, bolded and in color, that I am far from alone, far from uncared for, and that fighting that 15-minute fight -- for now -- is worth every bit of the effort.

The Affordable Care Act: Info on PCIP (And Some Whoop Ass Thunder Rumble!)

The article below this garbled prologue was written by the good folks at PCIP.  I can attest to its accuracy, having purchased this coverage beginning with its very first month of availability in July 2010.

If I could add anything, it would be to plead with people who feel a responsibility to accuracy to understand that the PCIP program is in no way a charity or an entitlement, and that it is run in an admirable "tight-ship" sort of way under the auspices of GEHA.  My premium has been lowered TWICE since July 2010.  It started out at well over $400/month and is now $338/month.

I have even drooled with appreciation at my exposure to actual customer-oriented customer service representatives, each of whom quickly and efficiently answered my questions and cut through the inevitable red tape of a brand new insurance program.  It helps, I'd assert, that the precepts under which these customer service types work make efficiency easy, as a common sense of fairness seems to be the guiding principle.

Why *yes*, the ACA was created by mostly the same idiots we watched screw the pooch a few weeks ago in their criminal attack on The World Economy.

Screw the pooch is a particularly vile militaristic expression, popularized by Tom Wolfe in the novel, and subsequent film, The Right Stuff:

But now - surely! - it was so obvious! Grissom had just screwed the
pooch! In flight tests, if you did something that stupid, if you
destroyed a major prototype through some lame-brain mistake such as
hitting the wrong button - you were through! You'd be lucky to end up
in Flight Engineering. Oh, it was obvious to everybody at Edwards [Air
Force Base] that Grissom had just f*cked it, screwed the pooch, that
was all.

For those of you fascinated by my constant dabbling in dirt, I did some research and it turns out that the  original form of screw the pooch was fuck the dog.

Umm, also integral to your understanding of the Affordable Care Act, Obamacare, is the distinction between screw the pooch and fucking the duck, though one might be considered the governmental correlative of the other. You'll see this explained in the commentary to the pertinent Jennifer's History and Stuff blog post:

Custer screwed the pooch. Wasting time is another quite profane term. It's 'fucking the duck'. There is, or was, a difference. Nobody buys the farm from fuckin' the duck.

Well, not so.  Had President Obama fucked the duck and given up on any meaningful health care reform legislation, thereby effectively screwing the pooch,  I would likely have bought the farm, as a result.

I'm just sayin'.

And, of course, on to what *really* matters, which would be my actual reference underlying that trite and overwrought "The World Economy" nonsense: the completely undeserved assault-and-battery on Haddock family equities! The Haddocks, they ARE the world!  I mean, if no one takes care of the Haddocks, how will The Captain take care of me and Fred, as well as tend to the upkeep of the miniature Wimbledon All English Lawn Tennis Clubbery? Not to mention seeing to the hygiene of the garderobes of Marlinspike Hall, so necessary to the success of ManorFest?  Infrastructure, people, infrastructure!  Oh, God, just the thought of next year's percolating strains of moat algae...




{hum, hum, hum}

What? Oh.  Right!

To prove my assertion that Obamacare is not Welfare, here's a screen capture of the details of what *I* have paid out in deductible, co-pay, and out-of-pocket expenses (NOT including pharmacy costs).  So the next time someone yammers about "socialism" and "entitlement" in reference to the watered-down health care bill that the President spearheaded, refer them to my actual costs.

What is it, then, if it isn't some welfare "ripoff" perpetrated by a bunch of whiners?  It's FAIR.  My costs are exorbitant -- not so much this year as in the past three when we were actively attempting to stop the infection in my joints and long bones, but still, they are higher than most people's average medical expenditures.  The difference is not some sense that I am deserving or "entitled," no!  The difference is that I am actively *sick* and also deal with severe disabilities and pain brought on by a progressive neurological disorder -- to such an extent that when I was priced out of my private BCBS coverage, no one would offer me a policy.  That's the foundational requirement for eligibility in PCIP -- to have been so rejected!

Medical plan detail

Close window

	In network deductible	Out of network deductible	In network out of pocket	Out of network out of pocket
Current medical plan limits	$2000.00	$3000.00	$5950.00	$7000.00
Accumulated to date	$2000.00	$2098.88	$5950.00	$2199.22

BCBS of Tête de Hergé ended up raising my premium three times in 2009, and finally demanded $1513/month, with a $5000 deductible.  They had also begun to refuse to pay for services that were clearly covered, dragging their feet and making my tending hospitals and physicians request payment many times before moving on to some other delay tactic.

One of my favorites, as well as least-mentioned around here, because it renders me unusually apoplectic, was their assertion that I received not one, but two (and a year apart) policy booklets that had an unfortunate misprint.  That misprint concerned the lifetime cap to my coverage.  My two, year-apart copies both said $5,000,000.  BCBS said, "Au contraire, ma chère!  That was supposed to be $2,000,000." They also scoffed -- in writing, if you can believe their hubris -- at my concern about it, saying that most people wouldn't even have an issue about it, as most people don't max out of 2 million in coverage (negotiated coverage, at that!).  Well, of course, I did.  Max out, that is.  They really do count on us being total hebephrenics.  They do not anticipate things like me turning it all over to the Tête de Hergé Insurance Commissioner... who promptly collected a whole bunch o' "misprinted" policy manuals, including many in their own holdings.

Towanda!

But though they'd lose an occasional battle ("Corporations are people!"), BCBS won the war.  It was highly stressful for all concerned.  It did not exactly improve my health to go a year without coverage, during which time I lost a lot of ground trying to stomp out osteomyelitis. Self pay the $2000+ monthly pharmacy costs for daily meds?  Not likely! Self pay for six weeks of intravenous vanco?  Ya think?  Self pay for removal of a prosthesis and implantation of an antibiotic-laced spacer?  Really?

So... FAIR, to me, is right.  FAIR, to me, is good.  If you must beg to differ, let me know.  We'll talk about it.  Personally, I was profoundly disappointed in the ACA, as the only truly just legislation would have included a "public option."  [Now you may throw words at me!]  To thoroughly confuse you, so long as this country follows the confusion of corporate models with a belief in personal liberty? I am pissed at the people who refuse to pay for coverage but want me to make their health a priority. Who whine and whine about it but don't consider turning off their internet, television, or phone -- who don't move to a more affordable living space -- who consider abusing emergency room services their righteously righteous right, who will pay through the nose for vet services but not "people" assistance. Who eat out on a regular basis, who pay for cigarettes, who put drugs up their nose and in their veins, alcohol in their stomachs and livers, but don't think twice about channeling all that money into health care.  I don't understand people who will not live within their means and are willing to drag others down with them -- children, grandchildren, spouses, live-in lovers -- and us, their neighbors, who end up footing their bills and seeing our own go up as a result.

What truly devastates me?  Watching the mindset passed on to successive generations, watching the belief in the possibility of a better life get actively squashed as a result of a hundred daily decisions to do what is easiest but not best.

Anyway.

Before you have a cow thinking I've betrayed my socialist beliefs -- I've not.  See my original assumption which begins "[t]o thoroughly confuse you, so long as..."  I want that assumption/assertion to change.  But so long as I am stuffed into this ridiculous box of USAmerican denial, yeah, I'm going to go all right wing on your uninsured asses.  Snort!

What's that?  You would if you had a job?  You would if there actually were affordable housing?
My point, exactly.

So "gentle butterfly hugs" all around!  Shazam! [Which is, according to the democratic Wikipedia,  "onomatopoeia for thunder rumble."]


Thunder Rumble!

Please pass this info on to anyone you know who might benefit from it. Thanks!

[If you don't think such people exist in your sphere, well, Towanda, snort, shazam, and thunder rumble.]

***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ ***^^^ 

PCIP offers health coverage, even if you have a pre-existing condition
Many people who have been unable to get health insurance can now get coverage through
the Pre-Existing Condition Insurance Plan (PCIP), created under the Affordable Care Act.
PCIP is provided through the U.S. Department of Health and Human Services and
administered by the Office of Personnel Management through GEHA in more than 20
states.

Choose the plan that fits your needs
PCIP has been improved for 2011, with better premiums, better benefits and a greater
choice of plan options. PCIP enrollees can now choose from three plan options, with
different levels of premiums, calendar year deductibles and prescription copayments. The
HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt
account where you can deposit funds for eligible medical expenses.

Each of the three PCIP plan options provides preventive care (paid at 100%, with no
deductible) when you see an in-network doctor and the doctor indicates a preventive
diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer
screenings. For other care, you will pay a deductible before PCIP pays for your health care
and prescriptions. After you pay the deductible, you will pay 20% of medical costs innetwork.
The maximum you will pay out-of-pocket for covered services in a calendar year is
$5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the
amount the plan pays for your care.

Each of the three PCIP plan options:

Includes all covered benefits, even to treat a pre-existing condition, immediately from
the date coverage begins.

Covers a broad range of health benefits, including primary and specialty care,
hospital care and prescription drugs.

Does not charge a higher premium to individuals with medical conditions.

Does not base eligibility on income.

Are you eligible?
To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen or
national of the United States or residing in the U.S. legally, have been uninsured for at least
the last six months, and have a pre-existing condition or have been denied coverage
because of your health condition.

Want more information?
Health care options in all states: www.healthcare.gov
PCIP administered by GEHA: www.pciplan.com, (800) 220-7898
To apply for the Pre-Existing Condition Insurance Plan: (866) 717-5826

Extreme Unction: Last Rites of the Insured

Here we go, Gentle Readers, setting out on our first LIVE blogging event!

The occasion? If you will direct your eyes to the upper left corner of the page, you'll see a countdown clock, ticking away the seconds until I join the ranks of The Uninsured. See it?

As I write this, it reads: 1 day, 12 hours, 51 minutes, 35 seconds. 34, 33...

And so, down to the wire, with my sour stomach in a knot, I am getting ready to submit for refill as many prescriptions as I can -- because at the moment, I am covered at 100% for medications. That'll drop to zero in 1 day, 12 hours, 48 minutes, and 51 seconds. 50, 49...

Yes, right *now*, I am fulling covered for everything from hospitalization, tests, and office visits to durable medical goods (I'm tempted to try and get a new wheelchair while I can... but don't worry, I won't).

"How wonderful for you!" you may be thinking. Good thing you're not actually here. I might have to hurt you. I might have to explain that in order to reach this level of coverage, I had to bleed many, many dollars -- an amount far beyond what I can actually afford, such that now (1 day, 12 hours, 42 minutes, 6 seconds to go! 5, 4...) I am up the creek without insurance.

The pharmacy I use for all medications except the strong painkillers I take is only a few blocks away, part of a large national grocery chain. The drugs for pain I fill, monthly, in the pharmacy housed in the same building as my pain management doctor, so that the pharmacist knows me or can easily doublecheck my legitimacy. I fully understand -- dispensing methadone and endocet is serious business. I saw the pain doctor last week -- or rather, I saw the PA, who is infinitely more on the ball than he is. She, at least, knows how to keep a small measure of hope alive. Whereas he makes a Pointed Point of telling me, whenever he sees me, that there is nothing more to try in my fight against the pain, primarily from CRPS/RSD and collapsing joints -- except for pharmaceuticals. His average time with me is under two minutes, and given that this includes that Pep Talk? Well, it really is a freaking shot in the arm to talk to that... man. His PA, though, shares information from the conferences she attends, tells me of things other CRPS patients are trying, and tries to resuscitate my flagging faith in the medical arts. Through her efforts, I believe I am taking the appropriate amount of narcotics; When he was running my show, I was overmedicated. I would rather hurt, which I surely do, than be befuddled and vacant. It is a fine line and I am happy to have her help me walk it.

I didn't tell her I was losing my insurance coverage. I sat there, chatting away and panicky inside because I knew time was running out. The way this physician operates, you must make a $195 office visit every month in order to receive pharmaceutical pain management. He is a physiatrist -- a specialty foreign to most people. In fact, most times, when I write "physiatry," I receive kind corrections from people who explain that the correct spelling is "psychiatry." I don't mind. I understand how they might make that assumption! A physiatrist is a doctor specializing in rehabilitation:

Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R).

In other words, my doctor resents like hell being asked by my s.u.p.e.r.b primary care physician to write monthly prescriptions for pain medications. He does not like to treat patients solely with drugs. It's confusing, sometimes, his attitude --which is fairly legible upon his face. He is so resolute about there not being anything else to try -- when common sense might dictate that he would be first in line in favor of alternative, and more permanent, measures.

In fact, he and one of his partners proved to be the roadblock preventing me from getting a Spinal Cord Stimulator or an Intrathecal Pain Pump -- both things that might afford me real relief. And now, of course, as it has turned out -- there is not a surgeon in the world who would agree to implant another foreign body. Until the source of this osteomyelitis is found, it is too risky. Even then, since I am now severely immunosuppressed -- well, blah. And bleck, too.

Now, of course, I have no choice but to tell him and the PA that I'll be paying out-of-pocket. I am scared he will say that he won't negotiate with me -- neither about price nor about frequency of visits. Perhaps he will seize this as an opportunity to finally dump me as a patient altogether.

Sometimes I wish I felt secure enough to tell him how I never take as much pain medication as I am "supposed" to... how I force myself to take drug holidays every few weeks... but I don't think his reaction would be positive.

1 day, 11 hours, 52 minutes, 39 seconds. 38, 37...

Well, there is no putting it off, this list of medication refills. The pharmacy I'm using allows for submission of refills via the internet, so I'm just clicking from this window to another to finally be done with this.

Since the latest Wordle Contest has been such a bust, maybe I should start a "Guess the Grand Total" Competition. The closest to the actual cost paid by BCBS gets The Castafiore for a day! It matters to me, the total, even when they pick up the final tab -- because I pay upfront, and then am reimbursed. I've never had too many problems with them refunding my money (in about 3 weeks or so) but, at the moment? I would not be surprised by anything that bleeping insurance company does...

It can be scary to put all of these things on a credit card every month, trusting that a refund will arrive in a timely fashion. For what it is worth, I pay my credit card balances in full each month. At least, that was my habit.

Here's the list, in no particular order. Last week, methadone and endocet were filled at a cost of $106.28 (remember, too, that these are the negotiated prices).

Prednisone (generic)
Hydrocortisone (generic)
Plaquenil (hydroxychloroquine, generic)
Lumigan
Nexium
Starlix
Glimepiride (generic)
Baclofen
Tizanidine
Amitriptyline (elavil, generic)
Alendronate sodium (fosamax, generic)*
Cymbalta
Lasix (furosemide, generic)
Zofran (ondansetron, generic)
Diabetic testing supplies**

PLUS -- I'll be calling my trusty pharmacist to see if I have any antibiotics with refills, just to have some on hand in case Infectious Disease Dood wants to give any another try.

*I'm filling this instead of Forteo. I mean, scope out how much that costs! I am afraid to charge it this final go 'round, because several times already, BCBS and my doctor have come close to brawling over it. I'll tell you a secret. Shhhh! We are. No, we were giving this daily injectable a shot (sorry) in the hopes that my poor disappearing, "avascular," and infected bones might be reincarnated. I do have severe osteoporosis, but it is as a function of osteomyelitis, severe AVN, and CRPS. If my s.u.p.e.r.b primary care physician had his way, I'd take both Fosamax and Forteo.

**Actually, I may pass on these. I am not technically diabetic. However, due to the combination of steroids and infection, my blood sugars have been too high. I know any doctors and diabetics out there are likely to curse me -- but I prefer not to do a lot of testing. The results don't influence what I do and I think the hemoglobin A1C is superior to my dripping blood all over the damned place. As I lose fine function in my hands? Diabetic testing is not so easy anymore.

There's been quite a lag in between the last paragraph and this one. I'm starting the daily afternoon climb of Febrile Mountain, and that, combined with pure anxiety, has left me acting much like someone hopped up on speed. I've dealt with paying the mortgage, VISA, the electric and gas bills, as well as the phone and internet.

I had a brief internal debate as to whether or not internet service should continue to be a necessity, or whether it was a luxury I cannot afford. The decision -- to keep it -- was based on its capacity to entertain and distract me, lessening the need for breakthrough pain medication. Does that sound strange to you? Hmm. It probably does! Makes perfect sense to moi. Also involved in that decision is the fact that The Fredster, La Bonne et Belle Bianca Castafiore, and
-- though she doesn't think I know -- Marmy, all rely on the internet as well.

I may start passing the hat, though! Uncle Kitty Big Balls is in charge of Feline Accounts Receivable and has hissed in my general direction that some "accomodation" might be possible.

Anyway... so I've been wasting time, trying not to deal with this Final Rite of the Insured. Did you know that "Anointing of the Sick" has replaced "Extreme Unction"?

1 day, 10 hours, 46 minutes, 58 seconds... going, going, gone.

photo credit -- f 128 Simple, Strange, Roots Photography

Geoffe Haney is a photographer that holds a BFA in with a concentration in photography. He enjoys alternative process to make his images. He utilizes digital, pinhole, Polaroid and other methods to create the perfect image to his eye...

Prints are available in limited editions. If you are interested...He can be contacted by writing to geoffe@gmail.com

Asystole

CONGRATULATIONS to BCBS of Tête de Hergé!

In April, you raised my premium to $1,327.00 (from $1073.00). That caused many a sleepless night, let me tell you!

And so it is completely in keeping with your absence of soul and your insatiable greed, that you should raise my premium once again, this time to $1,513.00 -- beginning in October.

YOU WIN.

I am, as I type this, falling through the cracks. I cannot pay that amount. When I called to see if there were any options left me? Oh, the Hem-and-the-Haw of it all! I could apply for cheaper coverage, opined the Customer Care Associate... but acceptance will be based on my medical history.

Given that it took the Office of the Governor to get *this* shitty coverage, I don't think BCBS of Tête de Hergé is going to offer me anything else out of the kindness of its corporate heart.

Good luck to the rest of you.

Dear President Obama,

It looks like too little, too late...

I'm just sayin'

I'm home!*

The Good Doctor ShoulderMan worked his magic on Monday, gifting me with a new left shoulder. He had to do some rearranging but he made it work.

But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé) -- well.

Well, on the "deep tissue" stain, we finally found bacteria waving back at us, all gram-positive-y, upbeat, and downright defiant. But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé)-- Wait one freaking minute! (The fog of anesthesia?)

As of Day 2, there was, natch, no growth on culture! My Infectious Disease Dood's eyes are bugging out. Bless his bones, he cannot decide when, and how much, to lie to me -- in his mind, I think, he sees this as "managing" the patient.

Because, you see, I refused insertion of a PICC line. They thought I was just posturing, joshing, when I made the declaration before surgery. But, of course, this being me (me, under the everloving influence of La Bonne et Belle Bianca Castafiore, both of us under the magic skies deep, deep in the Tête de Hergé) -- arg! Sorry about that, and je vous prie de bien vouloir m'excuser, too -- covering all my bases.

So, Infectious Disease Dood decides that I need Zyvox, a ridiculously expensive antibiotic that just happens to have serious interaction issues with 3 of my meds, as well as some nasty side effects all on its own. The deciding factor? Insurance coverage, as the $1500/week cost doesn't fit my very tired budget. Anyway... Fred and I think it was all a plot. As in, ID Dood was expecting BCBS -- Bull Crap Bull Skeet of Tête-de-Hergé -- to refuse coverage.

I was held hostage, told I could not leave the hospital without either the Zyvox or a PICC line with trusty i.v. med balls full of vancomycin.

[I know that it's overkill for the vanco hyperlink to refer back to this blog, but it astonished me, upon searching, to find out how much vancomycin has occupied my life and mind, and what it has come to signify. Allow me that rare {raspy cough} professorial moment of recommending a read of Macbeth, Act 5, Scene 5. Wunnerful wunnerful commentary --

Life's but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

I'm just sayin'.]

Fools! They didn't know with whom they were messing. Once Fred, all bleary-eyed and pooped, arrived... well, we were hell-bent on leaving the hearsepital. At that point, ID Dood and His ID Minions began weaving tangled webs.

Case managers arrived. All nurses with decision-making capacity suddenly were off the floor, scarfing down lunch. And didn't I wish to order lunch? And, uh-oh, the medication you must take before eating hasn't come up from pharmacy. Let's get a blood sugar and another set of vitals! And then they sneak in: They'll be up to put in the line in about 2 hours, no need to go down to Interventional Radiology, how great is that? [I despise the huge, cold, scary room down in IR.]

They promise a nirvana-inducing insertion, complete with a soundtrack. And lest I scoff, they cite:

PICC the Music and Travel to the Port of Relaxation: Preliminary Results of the Effects of Music on Perceived Pain and Anxiety During the Placement of Ports and PICCs
Journal of Radiology Nursing, Volume 26, Issue 2, Pages 61-62
C. McDaniel, M. Burkett, M. Cormier, J. Duvallm, S. Davis, L. East, G. Gilmer, N. Mahaffey, M. Moran

Giggle.

We left. Politely. Give me a call when you all figure out the antibiotic situation, okay?

Amazingly, BCBS of Tête de Hergé decided to fork over the money and my pharmacist, who inexplicably informs me that "[i]t's like déja-vu," promises that I'll have these ridiculous little white tablets by noon the next day.

My BCBS policy, for which I pay $1328/month [Remember: my (private) disability income is a whopping $1996.20. Without that luxurious twenty extra cents, all would be lost!] -- My policy dictates that I pay for medications and then receive reimbursement of whatever they think arbitrarily fair.

So what a hoot it was to have Discover Card's Fraud Unit calling me, all breathless. Did I know that a $3030.00 charge was just made at the nearby Huge Grocery Chain? That was for a mere 14 days worth, ID Dood suggesting I buy the Zyvox in 2 wk lots, in case I need to stop it for some reason or other. Anyway, to the inquiry about the charge:

"Yep!" said I.

There was a tremendous pause. It was absolutely KILLING the woman on the other end of the line to not be told WHAT I had bought. So she rephrased the question, and, on cue, reiterated the pregnant pause.

"That's right!" I crowed. Her frustration was now palpable.

Why not give her something to liven up the day? Let her imagine an elegant late dinner of lobster and caviar, un petit souper à la parisienne [or A Family of Sans-Culottes refreshing, after the fatigues of the day]. Just a little casse-croûte thrown together by a retired French prof whose purchase habits extended to extravagances of generic yogurt and diet cola. Okay, okay -- I also splurge on almonds and good coffee.

By the time the credit card gods were appeased, the antibacterial troops put all in a ducky row, my clothes 'n sundries put away, urgent emails answered, ablutions completed, phone calls returned? I truly felt like shit. I was febrile to the tune of 101 degrees, sweating, and hurting like the proverbial Dickens ["Fan the sinking flame of hilarity with the wing of friendship; and pass the rosy wine!" -- ummm, any excuse for passing on my favorite Dickens quote].

Alas, poor Yorrick (sic), a quick and easy search about the origin of the phrase "hurts like the dickens" reveals the following:

Posted by James Briggs on December 18, 2001

In Reply to: Re: Hurts like the dickens posted by R. Berg on December 18, 2001

: : My son said this at supper tonight........."It hurt like the Dickens". We wondered if any one knows the origin? I have also heard "scared the dickens out of me". Any enlightenment would be appreciated.

: From the archives, here's a response to the same question.

: Posted by ESC on January 12, 2001:

: "Dickens" is a euphemism for "devil" as in "'what the dickens,'.an
expression common centuries before Charles Dickens was born, having been used by
Shakespeare in 'The Merry Wives of Windsor'." "Morris Dictionary of Word and
Phrase Origins" by William and Mary Morris (HarperCollins, New York, 1977,
1988).

It may be an altered pronunciation of "devilkin"

En tout cas... since then, it's been a topsy-turvy time but anything beats being in the hearsepital. And, thank goodness, we only have to visit ID DoodLand once a week versus the usual three or four times.

My MDVIP Go-To-Guy? He opined in an email: "I'm glad it's over and done with. We are all a bit skeptical that this will take care of everything but please try and keep positive thoughts and prayers as we all are trying to do." I have noticed that since his switch to MDVIP, he communicates much more freely and makes frequent reference to prayer, saying that I am being kept in prayer. At first, I was somewhat taken aback. Now? I am thoroughly appreciative and almost virginal in the prose with which I write him.

However, I will visit Holy Ruin on the first person to suggest removal of this prosthesis.

I'm just sayin'.

*******************************************************************************************

*graphic of huge mouth courtesy of BENBENEK BLOG -- from an entry which consists of the following:

I’m just sayin’…
I’m pretty tired of people using the phrase “I’m just sayin’…”

WTF

I have tried to avoid falling into the blogging trap of "What the Fuck?" postings -- because, really, one could spend all one's time going "What the Fuck?" these days.

Still, this morning's mail provided a great WTF opportunity. I just can't figure this out.

S. Clusterfuck, M.D. -- Medical Director, Vice President of Clinical Programs with Bull Crap Bull Skeet of Tête-de-Hergé -- wrote me the following letter:

Dear Retired Educator,

Maybe you've avoided tests ever since your school days. But did you know that getting medical tests when you need them is one of the best ways to protect your health? Regular checkups can uncover any new developments early in the game. And that gives you and your doctor the best chance of preventing or controlling problems.

To take charge of your health, talk with your doctor about these ideas:

The microalbumin test checks for early signs of kidney damage by measuring the amount of protein, called microalbumin, in your urine. Damage to your kidneys may cause you to need dialysis treatments.

We're available 24 hours a day, seven days a week to help you live a healthier life.

Sincerely yours, and a pat on the derrière to La Bonne et Belle Bianca Castafiore,
S. Clusterfuck, etcetera etcetera...


I ask, with equal sincerity: WHAT THE FUCK?