MAINTAINING THE BOD: FULL TIME JOB

It takes a lot of time and energy and a team of highly trained medical professionals to stay healthy at my age.  In the next 2 months I have appointments:  dermatology to keep my pre-cancerous skin suit from erupting into anything deadly; dentist to replace a crown (not on my head); audiology to see if my "mild to moderate hearing loss" has worsened or if everyone has just begun to whisper behind my back (increasing my paranoia); mammogram to see if "the girls" are still perky (not) and not trying to kill me; and now a brain MRI to see if my migraines are caused by something horrific .

Also, I fell up the stairs recently.  On the very day I filled out a pre-physical form for my annual check-up that asked if I'd fallen in the past year, and by fallen I take that to mean NOT on the muddy slippery Kauai trial, which would trip up anyone, but just in my house moving around normally.  I said no.  Cuz it was true until 12 hours later when it became a lie I didn't correct.  

The front of my bulky slipper caught on the lip of the top stair.  I was not holding the handrail because I had my hands full with my phone, a half finished can of LaCroix, and my Kindle.  I flew forward at a force great enough to smack my forehead on the wall, wrench my neck back in whiplash fashion, and crash hard onto my right elbow, rib, hip, and knee.  I lay there, stunned, feeling a little tingle down my arm.  Hub came running and wouldn't let me move until he'd checked me out.  We determined there was no permanent damage, and he helped me up.  I'm still sore, over a week later.  It could have been so much worse.  New vow: wear shoes and hold the handrail every time!!!  (I also contemplated whether I could have drowned in my spilled LaCroix had my face been smashed into the wet floor and no one around to save me... Thoughts?)

So, I had my annual physical yesterday.  My doc was accompanied by a young man -- seemingly 12 years old, but maybe a bit older since he was introduced as a "pre-med student" doing an observation stint with a real doc.  Only later did I think to question why a PRE-med student was hanging around oogling my unclothed bod and listening in on my stories of creaky knees, migraines, panic attacks, and sexual exploits.  Shouldn't one at least have been accepted to med school to get to the good stuff?  Well, anyway, there he was, watching from the far corner of the room looking very uncomfortable like he was at the Junior Prom in the gym and might be expected to ask a girl to dance.

My doc declared me as "doing great!"  No big scary things going on, that we know of.  So that's good.  Cuz my platelet count that I'd seen on my lab report the previous day was low-ish and I had gone into a bit of a 24-hour tailspin over that and wondered if it could be something deadly and beyond my control to, well, control.  She said not to worry -- we will just re-check it in 6 months.  Nothing life-threatening happening now.  Whew.  But I'm sure my BP was sky high as I felt the familiar anxiety tipping into panic, with rapid breathing, slight light-headedness, and tears just at the surface.  But I didn't want to upset the 12 year old, so I held it all in.

We moved on to my now diagnosed "vestibular (dizzy) migraines" and she decided to order a brain MRI.  I've done that before and it takes all my meditation expertise to not completely lose it inside that machine.  Claustrophobia, anyone?  So that will be fun to look forward to.  I could have had it done as early as next week, but opted for later in May, after Son Two's upcoming wedding celebration and then another vacation, just in case the news is bad.  I don't want to ruin fun times with a deadly diagnosis.  

When we got to the girl parts exam portion of the visit, Master Pre-Med averted his eyes.  So cute. I was ready for his Mardi Gras beads should he have had some in his pocket, but my breast flashing netted me no reward.  Since I'd just had a colonoscopy in January, she offered to skip the rectal exam (always good news) and also skipped the pelvic this time since she asked if I was having any problems and I said, "No.  Nothing going on down there."  Then I amended, "Well, there's a lot going on down there...just nothing bad."  LOL   I noticed a slight upturn of a smile on the young man's face, so I said, reassuringly, "See?  Even in your 70's you can still have a great sex life!"  My doc and I laughed.  He did not, but I think he was amused (or appalled) nonetheless.

All of this to say, it takes a lot of maintenance as one grows older to keep the bod in good working order.  I am incredibly grateful to modern medicine, practitioners, scientists, and my daughter-in-law for being the practice manager (boss) of two branches of the big multi-speciality clinic I go to, for keeping it all in working order.  I saw her on the way out as she waited for a team to arrive on a PR visit of some kind where one of them was dressed like a mascot dog or bear or something.  It might have been the 12-year old pre-med student doing double-duty -- or perhaps I scared him out of the medical profession into a less stressful career where he could wear a disguise.

At least, that's the view from here...©

P.S. Next we will move on to the mental health portion of my upcoming appointments, wherein I will explore why I used the word "panic", "kill" and "deadly" so often in this post.  

Photo Credit: www.pixabay.com

DOCTOR, PATIENT, NURSE...OH MY!

Well, it's been a helluva month.  My writing took a backseat as it so often does when I'm overwhelmed and distracted.  I am a most undisciplined writer!  I know the half dozen of you who read this must grow frustrated with me.  LOL

Earlier this month we retuned from our Southeast trip (see last post) and I did another Weekend Intensive for my Yoga teacher training.  Then, on May 15 I drove Hub to a 5:30 a.m. check in at the hospital 30 minutes from where we live to have his total knee replacement surgery, which has been on the horizon for many months.  He was eager to get on with it, anticipating a great outcome and a return to snowboarding by December.

I was a jangle of nerves, full of anxiety about the logistics of getting him there and back, medical anxiety about just having to be in the hospital environment for the day, performance anxiety about whether I could adequately perform the nursing duties I was expected to do post-operatively, and all the attendant "OMG what if he dies on the operating table?" anxiety as outlined in the release forms he signed.

I so admire people who handle these things with ease.  I was mostly short of breath, (fearing my own heart attack), a little light-headed and befuddled (I was momentarily overwhelmed navigating the hospital's vast cafeteria), and made several trips to the restroom to relieve my GI distress.  Classic anxiety attack territory.   I soothed myself by eating the absolutely biggest apple fritter I've ever seen in my life, thus blowing a hole in my Weight Watcher points for the week, but it was an emergency.

Turns out, Hub came through surgery without incident and all went "perfectly" according to the surgeon.  When I got the word, he said I'd be able to see him in about 45 minutes.  I waited, waited, waited...nearly 2 hours passed during which time I imagined all sorts of unexpected post-operative emergencies -- heart attack (he does have that little teeny blockage thing they discovered last summer), blood clot (ample warnings on that one!), stroke.  You name it, I imagined it.  But when I was finally ushered into Recovery, I found him fully dressed, sitting up, sipping a Starbucks.  I was almost mad at him.  The long wait wasn't his fault of course and he was frustrated too, just wanting to go home; it was a "short-staffed" snafu of moving patients through the various post-operative stages.

His surgery began at 7:30 a.m. and by noon we were on our way home.  Son One met us at the house, ready to usher his dad up the stairs of our completely stair-laden home and into bed.  Hub was not having it.  He felt great!  Wanted to navigate the initial stairway from the garage on his own.  He didn't want to continue up the next flight of stairs to the bedroom, which we'd set up as a Long Term Recovery Space with all kinds of pillows, tables, chairs, computer, books, etc etc for him to access during his initial recovery time.  He propped his leg up in the living room and spent the day saying how great he felt.  I think there was residual anesthesia on board which would have made me drowsy and puke-y, but seemed to make him talkative and upbeat.  Weird.

Since that day his recovery has been steady and successful.  We've had visiting nurses here, home physical therapy appointments, adjustments to the realities of recovery vs the anticipation in our imaginations of what it would be like, based on the information the doctor gave us.  Hub is way ahead of schedule in regaining his range of motion and strength, but he works like a fiend on his PT exercises, being highly motivated to be at full strength as soon as possible.

As for my nursing anxiety?  All for naught.  I forgot along the way, that my husband is an "I'll do it" man who prizes self-sufficiency and who, in this case, felt anything he could do for himself would only make him stronger in the long run.  My attempts to "help" were rebuffed for the most part, with my role relegated to fetching ice packs and food.  He even navigated our stairways alone.

This created within me a feeling of being unnecessary and rejected, having mentally prepared and studied the manual sent home with us about post-op care.  I really wasn't needed very much at all and I was sad...and angry to be shut out.  But how can you argue with a man who, as a doctor himself, is dead set on managing his own care and recovery and didn't need my hovering around?  I'm still trying to find the answer to why I grew so resentful of a situation many would envy...I hear tales of caregivers run ragged by the constant demands of their patients!  As with all disagreements, we've talked and talked with neither giving ground, but better to talk than to seethe, so we are pushing on.

Yesterday was his two week post-op appointment and the Medical Assistant we saw (I guess the surgeon will never appear to us again) was most pleased with Hub's progress.  Next on the horizon will be to continue PT, increase walking distances, and regain driving privileges.  None of this was as onerous as I'd imagined it would be.  When will I learn that my anxiety creates scenarios so far from the reality of a situation that it becomes a fiction of the mind?

Turns out that, thankfully, all is well.

At least, that's the view from here...

P.S.  The surgeon texted me photos of the inside of Hub's knee with before and after shots.  Just let me know if you want to see them.  Gross! And fascinating!

BLOOD PRESSURE RISING

WARNING: RANT AHEAD

A few weeks ago I tried to get a refill on a prescription for my low dose blood pressure medicine, but my request to my mail order pharmacy had been ignored when I was on vacation.  I returned home early this month and tried again, and finally heard from my (newish) doctor that he would refill it but I had to come in for a recheck on BP and labs.  OK, fine.  Made the appointment and went in.

First the nurse confessed there was a screw up along the line and my meds should have had a whole year of renewals instead of none.  Uh-huh.  Agree.  Then as she reviewed my med list she rattled off a bunch of supplements I had been taking but at my last visit the doc told me to stop some of them.  Guess they had not made that note in the electronic records (which were supposed to make things oh so much easier!)  When I told her he took me off them, she sort of rolled her eyes and said she still takes the supplements she wants to; she tries never to go to the doctor; her supplements are her business, etc etc.  Hmmm...team approach to health care?  When I laughed and said I would follow her advice, she did try to backtrack, but the damage was done.  Nurse undermining doc -- noted.

Then the doc came in and immediately after saying hi, without taking a breath, started telling me about his recent trip to NYC.  He went on and on about this and that person, event, meal, site, death in family, family birthday, Uber experience, income inequality in NYC, tips for being safe on the street, price of restaurants, gentrification of Brooklyn and his dislike of Queens ....  Interspersed was some minimal attention paid to why I was there, but really I learned MUCH more about his life than he about mine.

He reviewed the lab results and I think he was ready to leave me on the lower BP med dosage, in spite of my numbers being intermittently a little high and also seemed to want to ignore my rising cholesterol numbers since going off the previously prescribed statin from which I had some minor side effects.  He also said those labs shouldn't really have been done yet, since he'd need to repeat them in a few months, but he was out of town and, well, someone approved them.

I was actually glad we had the labs because with the new results I insisted he take the numbers seriously.   I have a family history of cardiac disease and vascular dementia/stroke and I want to be well-controlled, not borderline.  He said OK, but not to worry about dementia because most people don't get it and all you have to do is challenge your brain with new learning which is why he is learning French and then he showed me he has the French version of Harry Potter on his Kindle.  Sigh.

What I think should have been a 15 minute visit strung out to 40, but there was the value added travelogue and brain exercise tip, so no complaints.  And I got a good laugh out of the whole experience.  (Also, after two visits with this guy I'm looking yet again for a new doctor.)

Since that appointment last Friday I've waited for an email from the pharmacy to let me know my meds were on the way....thinking he'd called them into my mail order place.  No word yet, so today I went online to check.  No orders pending.  Then I thought maybe he called them into the local pharmacy so I called them.  Sure enough they had his order.  I asked why I hadn't received a call from them.

The tech on the phone said, "We didn't fill the orders because we didn't know if you wanted us to."  What?!?  Of course I wanted them to fill my prescription.  She said they often just wait to hear from the patient.  I was so confused, I let it go, telling her to fill them asap!

But the more I thought about it, the madder I got.  What the hell?  I called back for an explanation of the delay and the protocol for filling prescriptions.  A new tech told me they often get orders from docs that people do not intend to fill at that pharmacy if the patient isn't already in their system.  They don't have the staff or stock of medicines to fill orders that will never be picked up.  So they just hold the order until the patient calls in...eventually...as I did.

I let her know I've been using that pharmacy for 30 years on and off and I definitely should be in the system.  Turns out they were recently sold to another outfit and my information was there, but "old".

I fell into the category of "don't do anything until the desperate and/or irate patient figures out we aren't filling their prescription."  "We will go ahead only when the patient calls from their deathbed  due to untreated this or that because BY GOD WE, THE PHARMACY,  WILL NOT TAKE 2 MINUTES TO CALL AND GET THE PATIENT'S OK TO FILL A PRESCRIPTION CALLED IN BY THEIR PHYSICIAN!"

I do not have dementia (no foreign language study notwithstanding) and I speak English; I have a college education and fair degree of confidence in dealing with authority figures.  And I know how to navigate an infuriating health care system (with persistence).  What of those who have any number of difficulties that preclude figuring all this out?!?  I sort of ranted to the pharmacy tech that I hear loudly and clearly that it is obviously the patient's responsibility to coordinate their health care needs among all the various entities involved.  She basically agreed, but assured me I'm now current in their system.

I simply cannot fathom trying to negotiate all of this as a person who is critically ill, disabled, alone, hearing or vision impaired, mentally ill, maybe with a touch of dementia, whatever....  You have to be the picture of health to get appropriate health care!   And I'm not dealing with some back country mom and pop GP office.  This is the largest multi-specialty clinic in the region, with the ridiculous marketing slogan, "We're Here for Your Health".  Are you?  Are you really?

At least, that's the view from here...©

RATS IN THE MAZE OF MODERN MEDICINE

AAAARRRRRGGGGGHHHHH!  That's me screaming in frustration.

Backstory:  The local multi-specialty medical clinic here was, until a couple of years ago, physician-owned and operated, founded by a handful of doctors in 1924.  When my husband joined the clinic in 1982, there were 33 doctors (one female!)  He went through a round of interviews, two of which included me.  These were social events, but I was aware that we were being evaluated as to whether we'd be a good "fit".  For my part, I was asked if I was sure I wanted to move so far from my midwest home and family -- they didn't want the little wifey to get homesick and demand to move back home to Illinois.  I told them we were looking forward to our new life in Washington.  Assured that he wouldn't flake out and quit, Hub was hired.  The docs in those days committed their entire careers to the clinic.

The clinic has grown tremendously since those early days and now has 500 care providers and 2,000 staff members and dozens of satellite clinics in outlying communities.  My daughter-in-law manages one of them and got the position all on her own!  No nepotism!

In 2016 the Board made the controversial decision to "merge" (which was a sneaky way of saying "sell") to a larger corporate outfit.  Big payouts went to some shareholders, to the consternation of others (us), and many took their wad of cash and quit or retired; everyone was in a state of flux.  No  one knew what to expect of the new bosses.

Well, the new bosses got in over their heads, grew disillusioned with their purchase and now have sold the clinic again!  The new new corporate bosses will come on board within the next year.  So the place is still in a state of flux.  Doctors are bailing left and right because they are overworked and understaffed and the bean counters want them to work harder for longer hours.  Support staff, as well, never know what the new decree from on high will be.

And patients, like me, are being jerked around!  Let's just establish that I admit to being bitter about this whole debacle because of my constant loyalty to and belief in the excellence of this clinic and it's doctors for the 25+ years Hub worked there.  To see it struggle now and to find myself a victim of the transition and the business (not the quality of care) of medicine is aggravating.

I had an excellent primary care physician for a number of years.  I loved her.  We got along great. But she decided to close her practice in 2014 and work in a different medical model (which is really cool and how all medicine should be practiced!)  I went to another doctor the following year and that did not go well.  She treated me like a warm body passing through the exam room, focused primarily on that stupid Medicare questionnaire about whether I've fallen lately and do I eat enough vegetables, etc.  She ignored what was important to me, brushed off my questions, and didn't order any routine labs.  Nope!  Not going back.

So I looked for another doc and found a woman who was sort of great. She helped me through a number of issues and I had a good rapport with her.  Whew!  I was relieved to find a new doctor I could rely upon.  Nope.  She quit.

I was "assigned" a doctor at that point, a man.  I hadn't had a male doctor in decades, but I was a bit worn down and decided just to check him out.  I liked him.  He was friendly and funny and listened to me and we were on the same page about being partners in my care.  I was happy.  I saw him a couple of times....before he quit.

Before leaving he referred me to a woman in the department, an Advanced Registered Nurse Practitioner (ARNP), who are being utilized more and more to "extend physician access".  Basically you don't have a doc, you have a Nurse Practitioner, who are also skilled primary care providers.  Anyway, he said she would be a great fit for me.  She was interested in a holistic approach to health care and would be open to me pursuing my interest a healthy lifestyle rather than taking medications.  I made an appointment in May to see her in August for my first visit with her.

I got a call last week confirming my August 13 appointment.  Then I got a call on Monday telling me she had to reschedule my appointment.  I was annoyed, because my last three doctor visits have been rescheduled due to the doctor needing to change the appointment.  This was becoming a trend.  But oh well.  OK.  I called back to reschedule and the gal in the Resource Center (nowhere near the doctor's office, in a separate building 3 miles away!) told me my new provider was leaving the clinic in September which was why she was cancelling and rescheduling some appointments.

My initial response was to laugh maniacally, I'm sure startling the gal on the phone.  "You've got to be kidding me!" I said.  "I've had 4 primary care providers in 4 years and I haven't even seen this one yet!"  I felt myself becoming angry, then sad, then discounted....I started crying as I talked, then sobbing.  Geez,  I could just imagine this poor young woman putting Behavioral Health on speed dial as she tried to help me with this dilemma.

I quickly calmed down and told her I knew a doc I wanted to see at an outlying clinic 20 minutes from my home, which frustrated me because I live 3 minutes from the main campus but it appears there are NO doctors there!  Whatever.  She checked and then told me the doc I wanted was no longer accepting patients.  I burst into tears again, ranting that I could have gotten in to his practice had I not wasted my time waiting to see the ARNP who had the gall to freaking quit on me!  I assured her several times this was not aimed at her and I was sorry for my reaction and I thanked her for her help.  Still, I hung up without an appointment with anyone.  But just before our goodbye, the gal in the Resource Center whispered, "Bless you."  So I guess I scared her into thinking I was a helpless lunatic.

An hour later I got a voicemail from the clinic from a nurse in the ARNP's office telling me I should have my labs done prior to my appointment on 8/13.  WHAT????  I thought they just told me I had NO appointment!  I called back and after 13 minutes on hold finally talked to the Medical Assistant in the office who confirmed the ARNP is leaving the clinic but she would still see me once and that my appointment shouldn't have been cancelled after all.  NO!  Why would I establish care with a provider who has one foot and half her brain out the door, only to have to establish with another doctor in short order?  The MA agreed this made no sense.  She recommended a few other providers, but I hung up with no appointment.  I have research to do and a letter to write to the CEO and Board President of the clinic.

I'm grateful to be healthy, able to navigate this craziness to some degree, articulate enough and savvy enough to know what I want and have some idea how to get it, but still I feel ultimately at the mercy of a system that no longer treats patients with the respect and care we deserve.  I'm sick of being a "customer" and paid the lip service of being their "#1 Priority"when the reality is anything but.  I'm sad for the many, many people who don't have the confidence, the courage, or the inside info I have to advocate for themselves.  I'm sad for those truly ill, confused, and those with hearing issues who likely can't navigate the six automated options offered every time you call the freaking doctor with a simple question!

We come to health care providers in a vulnerable state.  Our very lives are at stake.  We share with them the most intimate details of our physical and emotional selves.  Being shoved around like rats in a maze, expected to adjust to a new system (devoid of friendly faces now that check-in is completely automated and no receptionist is in sight!), and then expected to accept any care provider who happens to have an opening at any given time  (and who barely look up from their computers and are loathe to see us unclothed or have to touch us) is disrespectful and dismissive.

I guess I'm old enough now to compare this experience to the "good old days" and I hate that stereotype of being stuck in the past.  I'm all for change and modernization and generally welcome it, but in some cases we got it right back then.

At least, that's the view from here...©

Photo Credit:  www.pixabay.com

https://www.nbcnews.com/business/business-news/doctor-out-why-physicians-are-leaving-their-practices-pursue-other-n900921?cid=sm_npd_nn_fb_ma