Practice makes perfect

And why its a medical practice. I have had eight surgeries and a billion medical (mis)adventures but I have NEVER asked this question of the person doing the procedure: how many times have you done this procedure? I have never asked that. And this is scary.

A couple of weeks ago I had a filling, a rather large filling to be precise, which is/was borderline for turning into a root canal. I hate the dentist. I hate the drilling and the needles and the potential pain. I am a weinie and have been know to take an ativan pre-procedure to get me through it.

The dentist and I had a big conversation as we waited for the Novocain to kick in. She said if it turned out I needed a root canal she would send me to an endodontist because she didn't do root canals any more. She told me that she said an endodontist would have me in and out  in and hour because that is what they did all day long and they were very good and had the right tools and microscopes and all sorts of fun things I didn't want to hear about it.

Doctors who do the same procedure day in and day out have a much lower rate of errors and mistakes. You really want the doctor who does the same surgery again and again. Go read that article if you don't believe me. But I think its time I start asking questions....

Social visiting and doctor appointments

I have spent a few hours twice this week at the hospital taking other people to doctor appointments which means I was not by myself while I was there. I was there as the designated driver/note taker. These days I go to my doctor appointments by myself again. I went alone for years and then with the second cancer diagnosis with lots of bad news my husband went with me. He also went with me for chemo infusions and for any medical (mis)adventures where I was not able to drive home.Otherwise, I fly solo.

Yesterday afternoon I started noticing groups of people who seem to accompany patients to their appointments. I can understand bring one family member or friend in case of icky news or because of sedation or something. But I can't understand bringing multiple friends, family members, or children.

I was sitting in the x-ray waiting area sitting next to a woman who was watching a tv show on her tablet (without headphones) who was sitting next to a man (husband?) while they waited for another person. There were also several people drinking the prep for one of those 'fun' tests which takes a good hour or two. I think there were at least three patients in that group who had more than one person with them.

The chemo infusion areas are clearly marked that only one person can accompany each patient in the infusion rooms. The patient exam rooms are just big enough for a patient, a medical professional and one other person. There isn't room for another chair.

When is it a social visit to hang out in the hospital waiting room? The hospital is never a 'fun' visiting place. Even the in patient rooms are not fun places to visit. I just don't understand the urge to travel in groups to the hospital. I prefer to avoid the place myself as much as possible.

I assume it was only Chinese take out.

Yesterday morning I woke up feeling fine. I went to work and felt fine. At lunch, a co-worker and I decided to have Chinese food delivered. Partly because our lunch choices were lame (me) or non existent (her) and partly because they would bring it to us instead of us going to pick it up. We get take out every couple of weeks from the same place and we get two days worth of food for one day's price due to the portion size.

We both ordered the same thing pretty much - a lunch special of pork lo mein but we had different appetizers. I ate the mushrooms, she picked her's out as she doesn't like them. After lunch, my head started to spin and I couldn't focus. She felt fine. I ended up going home from work early and took a three hour nap. I slept solidly.

My husband came home and couldn't find me. He thought I had gone to run an errand or something. Finally he looked up stairs and found me asleep.I slept through the phone ringing, him calling me, the cat walking on me. I was out like the proverbial light as they say.

We had soup and sandwiches for dinner. He had 2/3 and I had 1/3. It helped the nauseous feeling I had. I slept all night as well and could barely drag myself out of bed this morning.

Why is she blogging about this?  Why am I reading this (you are asking yourself)? As I left work among comments about bad food, someone said the fateful words 'or are you coming down with something?'  That is the problem. Compromised immune systems and all that.

Yesterday was Wednesday (in case you forgot) and that is methotrexate injection day around here (and methotrexate is what suppresses my immune system). A few months ago, I had a stomach flu thing that laid me up for 9 days. I was told after I should skip methotrexate if I am sick at all.

So yesterday I thought about it and decided I am going to pretend I am a normal person and do the injection and assume it was a minor Chinese food mix up and not something that can do me in for more than a week.

If I am whining about not feeling well for the next week or so you can feel free to comment and say "I told you so" but sometimes its nice to pretend our ailments do not keep us down and a bad bit of Chinese takeout is all it is. Sometimes we do live in the shadow of our ailments as they interfere with all the little things in life. It was only Chinese take out.

Why do I exercise?

Why do I exercise? I read this post on the Huffington Post about a woman with stage IV breast cancer who asked that very question. She isn't giving up on half marathons either. She says its endorphins that keep her moving.

I don't have stage IV cancer and some days just getting downstairs is difficult itself. I read somewhere else recently that only 20% of Americans get the recommended 2.5 hours of exercise each week. That's just pitiful. I am determined not to put myself  in that category.

I also exercise because it  helps me feel better. Really. I may hobble in to the gym but about an hour and 45 minutes later I may hobble out. But in between I get in 45 min - 1 hour of cardio and then another 35 minutes or so of weights followed by 15 minutes of stretching. The benefits to me are huge:

• cardio keeps me moving which is good in more ways than you can image - your body moves so all your body systems do as well.
• I have muscles (they may not be big but they are three) and can pump iron with the best of them with my 1 pound weights (yes they are girly and pink)
• I am flexible, my balance/stability is pretty good, and my muscles are nice and stretchy.
• I have less pain. My core muscles help me support my wimpy back.
• It helps me destress. I come in to the gym stressed and leave relaxed. 

I never stopped exercising through cancer treatment. Back then I used to walk every day but I never stopped unless hospitalized. Eventually I found I needed more than a walk and joined a good gym. I go three times a week and try to walk with a friend another day.

But I'll keep going as much as I can.

A new picture of my garden - the azalea in full bloom.

More on fancy new drug costs

$1,000 per pill or $84,000 for the full treatment. Those are the costs for a new Hepatitis C drug which is basically curring patients of what was previously a chronic, lifetime ailment which can cause liver problems and then death.

That price tag is a bit steep. The manufacturers developed their pricing based on their costs and what they think they can recoup before the patents expire and/or competition begins forcing them to lower their prices.

The claim is that patients are so much better that they are saving millions of dollars in future medical costs by curing the patients.

I have a problem with the price. And so do insurance companies. Its become instantly the must have drug in the Hepatitis C community - quite understandably so.

The problem is because of the cost:

"But under pressure from insurers, which worry about even greater payouts as more hepatitis C patients clamor for the new pill, state health officials are drafting guidelines advising which patients need to be covered immediately.
The guidelines would help insurers set priorities for treating a virus that can remain dormant for years, or even decades..."

"...State government and insurance industry leaders say patients whose doctors prescribe Sovaldi will be able to get it eventually. But some patients who have been told to wait say they’re the victim of health care rationing — long a taboo in US health care.
Insurers in Massachusetts don’t call it rationing. But they say they will have to adopt a “gated” approach to reimbursing doctors and hospitals for the high cost of the drug if they want to stay in business..."

As more and more breakthrough drugs are discovered with similarly high costs for larger patient groups, this problem is not going away. Patients want the new medications. Manufacturers want to sell them. The problem is the payment part - they are too expensive for the system.

So more pressure on both the system to change and on manufacturers to recalculate their pricing structure. The new medications may be lifesavers but they may make a clear division of the haves and have nots - choosing who can afford them and who can't.

How expensive is your hospital?

I had no idea how expensive my hospital, Lahey Health (formerly known as Lahey Clinic) is compared to other hospitals. Its one of those hidden numbers that your insurance company and hospital conspire to keep unknown as they negotiate rates and fees.

I live just outside Boston, which is home to a few big name hospitals, and refuse to go into the city for treatment. The traffic would drive me crazy. And if I am not feeling well, I refuse to deal with the traffic and feel like crap at the same time.

I have friends who went into the city for treatment and whined about all the traffic they sat in and how early in the day they would have to start to get to a 9am infusion. I just assumed all hospitals cost about the same - namely a hell of a lot because nothing is cheap around here.

But now I know... and drum roll... its 12%-40% less than the big hospitals with the fancy names in town. They have a strategy of creating a network of community hospitals where most patients can go for care leaving the big teaching hospital for the sickest people. (Guess which one I go to?) They have been expanding their network over recent years.

Here is a comparison of the costs from 2012 for an inpatient stay.

 

The two hospitals that are lower than Lahey are located away from metropolitan Boston.

I will say I am happy to learn my medical care is not straining my insurance plan as much as if I went in town. And I am happier to enjoy my 10-12 minute drive through back roads with no traffic to medical care.

Risk factors????

Now what the hell am I supposed to do? Look at the length of this list of risk factors for breast cancer!!!!!!!!!

These are the established risks: Being female, age, family history, genetics, personal history of breast cancer,  radiation to chest/face before age 30, certain breast changes, race/ethnicity, being overweight, pregnancy history, breast feeding, menstrual history, using HRT, drinking alcohol, having dense breasts, lack of exercise, and smoking.

Then there are the emerging risks that they are just starting to realize their importance.... (Or but wait, there's more!): Low Vitamin D Levels, Light Exposure at Night, DES (Diethylstilbestrol) Exposure, Eating Unhealthy Food, Exposure to Chemicals in Cosmetics, Exposure to Chemicals in Food, Exposure to Chemicals for Lawns and Gardens, Exposure to Chemicals in Plastic, Exposure to Chemicals in Sunscreen, Exposure to Chemicals in Water, and/or Exposure to Chemicals When Food Is Grilled/Prepared. 

How the hell am I supposed to avoid them? That's it. I am moving to live under a rock!