Wednesday, December 21, 2016

The Successful Patient: What is a Medical Emergency?

The holidays bring together family, often including friends, and that means lots of potential for health issues. It could be as mundane as indigestion after Christmas dinner, or taking a fall while ice-skating. Or it could be something more serious. It pays to be prepared for anything. But when do you have a real emergency on your hands or something just masquerading as one? 

In the past, I've postponed taking action on a physical symptom because of my mother's voice in my head admonishing me not to bother busy doctors and ERs are expensive. In fact, several times I failed to take good care of myself and ended up in more serious trouble than I would have been if I'd not listened to my mother's voice. Nowadays, there are options to help with determining what treatment is needed.

Triage Nurse Lines
Most medical insurance companies now offer a phone number to a nurse triage or support line. Calling one of these nurses, usually an RN, can be helpful, especially for things like sprains, cuts, flu and broken bones (determining if it's broken or not). I've used a nurse triage line on occasion with mixed results. The nurses I've spoken with have been professional, caring, and worked hard to help me, but they didn't have the specialized knowledge to take into consideration my whole body and its issues and how they could be affecting me. They will tell a patient one of three things: instructions for self-care/instructions in case the condition worsens, a suggestion to go to urgent care, or a usually strong suggestion to get thee to the Emergency Room.

A similar kind of phone resource can be offered by large teaching hospitals. I've used this with much better success. I've called the hospital I usually go to -- it's a teaching hospital -- and asked for the Resident on Call for whatever specialty I've needed, e.g. gastroenterology, pulmonology, etc. The Resident on Call then calls me back and we discuss my symptoms.  Most doctors and clinics also provide a phone number to call after hours to talk with a doctor on call. I've used these too with success.

These phone services are usually free. Some doctors and/or clinics also provide the option for electronic consultation but this could require paying a fee depending on the reason for the consultation, and they usually require an appointment unless it's just sending an e-mail.

Urgent Care
This medical service is usually provided by a hospital or clinic. Urgent care is best when connected with a hospital in case a patient needs more than urgent care. I've gone to urgent care when I've had unexplained pain that I felt needed immediate attention to determine the cause, but I haven't been ill, and it's been after my doctor's regular hours. I know of people who use urgent care when they have the flu, fever, stomach flu, and other minor illnesses that may need treatment and it's after regular doctors' hours. Urgent care is cheaper than going to the Emergency Room.

Emergency Room 
So, when do you go to the Emergency Room? Listen to your intuition (your body) – if you feel you need to go to the ER, go.  Some symptoms that need immediate medical attention:
  •  Difficulty breathing
  •   Fainting or dizziness
  •   Chest or upper abdominal pain or pressure
  •   Uncontrolled bleeding
  •  Coughing or vomiting blood (also bloody diarrhea)
  •   Sudden or severe pain anywhere in body that doesn't stop
  •   Poisoning, includes food poisoning
  •   Major injuries, such as broken bones or head trauma
  •   Sudden facial drooping or weakness in an arm or leg
  •  Unusually high fever
 I've learned that every time I've waited to go to the ER, my intuition had been urging me to go. Every time I've gone, I was right to go, also, and all but one resulted in admission to the hospital for some serious stuff (pancreatitis, shortness of breath from inflammatory lung disease). There was a time years ago when I was experiencing a bowel blockage and in extreme pain for almost 2 days -- I could not move and lay in bed sleeping through it -- and I did not go to the ER. I should have gone. I was lucky that my bowel didn't rupture. I eventually went to my doctor and she figured out the problem so I could get treatment. But I'll never forget that pain.

So, during this holiday season, take care of yourselves!  

Happy holidays and a very merry New Year! 


Wednesday, December 14, 2016

The Successful Patient: Surviving the Colonoscopy

It's that time of year when I begin to think of the new year. It's time to look back on the current year in terms of my health, and to plan for the next year. Most physicians now have some form of online chart for their patients, and as part of that chart, they list things patients can do to maintain good health. That list usually includes preventative check-ups and procedures. Among those preventative procedures is the much maligned but essential colonoscopy.

A colonoscopy is a medical procedure that's recommended for everyone starting at age 50 and done every ten years thereafter. It's possible to have a colonoscopy for other reasons; e.g. if a doctor needs to see the colon to determine the cause of gastrointestinal symptoms. The purpose of this procedure is to examine the interior colon surface for any abnormalities such as polyps or inflammation. This procedure commonly screens for colon cancer.

Any time a doctor performs an invasive procedure on the human body, it has the chance of being unpleasant and carries its own set of risks. Doctors have worked hard to develop preparation procedures and techniques for the actual colonoscopy to make it as easy and comfortable as possible for the patient. Nevertheless, the thought of sticking something up one's behind is not pleasant. So, how to survive it?


Following the doctor's instructions for the bowel prep cannot be emphasized enough. The bowel prep cleanses the colon so that the doctor will be able to see the interior surface clearly. Shirking on the bowel prep or not following the diet instructions can result in cancellation of the procedure (to be re-scheduled and to go through the bowel prep again), and/or your doctor's unhappiness with you. Think of it this way: it is in your best interests to get this right.

The bowel prep usually involves taking a powerful laxative, either in pill or liquid form, over several hours the day before the colonoscopy. Your doctor will also give you a specific diet to follow the day before that includes eating nothing at all after a certain time, depending on when your colonoscopy is scheduled the next day. Tip: Schedule your colonoscopy in the morning, first thing if possible. It's easier to sleep through the fasting part, and you'll be able to eat sooner the next day.

The laxative will make you run to the bathroom a lot. This could result in a very sore bum if you don't take measures to prevent soreness. I usually begin by using Vaseline to coat the anus, and I use baby butt wipes instead of toilet paper after each bathroom visit. I drink a lot of water also, eat jello (not red or purple in color), drink apple juice, and suck on hard candy (not red or purple in color). And I make plans for my first meal after the colonoscopy.


In the past, my doctor has given me written instructions as well as an itinerary for the day of the procedure telling me when to arrive and what to expect. It's necessary to arrive at least an hour before the actual procedure because there is more preparation involved. You will be asked to disrobe and put on a hospital gown. A nurse will insert an IV in your arm for the sedation and pain killer medications. Yes, you really won't feel much of anything once you have the medications. The nurse will also ask you questions regarding your bowel prep, allergies, and any possible GI symptoms you're having. My doctor has usually stopped by to talk about the risks and possible side effects, and to receive my informed consent for the procedure.

colonoscopy scope

Next, you will be moved to the procedure room, usually by wheelchair or gurney. A procedure nurse will be with you at all times. You can choose whether or not to watch the video feed of the colonscopy -- yes, the tip of the scope has a camera so that the doctor can see the colon's surface. It's also equipped with an instrument that can take biopsies of the surface. Feel free to ask questions whenever they occur to you of either the nurse or the doctor. I usually want to know what medications they'll be giving me. The doctor will tell the nurse to begin administering the medications through the IV.  And you are set for the procedure.

Experienced doctors will be watching the patient as well as the video monitor during the procedure. They'll notice if a movement causes discomfort. My doctor has actually re-positioned my lower body in order to alleviate my discomfort. I didn't feel a thing for the rest of the procedure. I choose to watch the monitor usually and ask questions about what I see there. I know a lot of people who doze off during the procedure. It takes about 30 minutes.

After the procedure, you'll be rolled into a "recovery" area where your nurse will give you some juice. I found it hilarious after my first colonoscopy that my nurse kept asking if I'd passed any gas yet. Well, the reason for that question is this: passing gas signals that the intestines are functioning. They want to make certain that they are functioning before letting you leave. It is a requirement, also, that you have someone to drive you home afterward and stay will you for a few hours. Once you've passed that all-important gas, the nurse will remove the IV, and you will be free to dress.

My doctor usually meets with me before I leave to give me the report and discuss his findings. This could be good news or bad. I have already known the results because I watched the monitor during the procedure. But if you dozed off during the procedure, now is the time to ask any questions, voice concerns, and discuss next steps.


I always ask, no matter what the procedure, what aftercare I need to do. The doctor usually will give written instructions, including symptoms to watch for that could indicate a problem. The most common problem is an inadvertent perforation of the colon, and the doctor will probably talk about the symptoms. Also, bloating, fever, abdominal pain, and nausea signal a problem. The doctor will usually give you instructions about what to do if you develop any problems.

After my colonscopies, a friend has driven me home and we've enjoyed a pleasant visit for a few hours that has included a light meal. It's not really a good idea to eat a four-course heavy meal after a colonoscopy. I've usually not been that hungry anyway. Cream soup of some kind and a sandwich has usually hit the spot. Hot cereal is another good meal. The pain-killing medication will wear off after a couple hours. I'm usually happy about that. Feeling loopy is fine during the procedure, but not afterward.

You've Survived! 

Life returns to normal quite fast after the procedure. If there's any soreness, treat it with Vaseline or some other ointment or cream. And now you won't have to think about a colonoscopy again for ten years. Congratulations!

Sunday, November 27, 2016

The Arts and Politics, or That "Hamilton" Incident

This past month has been breathtaking in the world of American politics and elections. I don't ever recall in my lifetime anything as contentious as this year's political campaigns have been, or that a candidate for US President was so ill-qualified, ethically-challenged and ignorant. I've been working on several posts to address my thoughts and feelings about what has happened. Today, I wanted to draw your attention to a fellow blogger's response to the "incident" at the Broadway show Hamilton and the aftermath.

Scott Chamberlain of Mask of the Flower Prince covers the arts, primarily the classical music world, but also the arts world in general. His post, "On the Hamilton Incident," thoroughly plumbs the depths of the controversy from the point of view of an arts administrator and artist. I urge you to read and think about it. 

Think about the role of the arts in your life. Do you go to movies? This medium uses visual art, spoken word art, as well as music. Do you read books? This is the literary art medium. Do you listen to music -- and it really doesn't matter what kind because music is music? Or attend plays at a theater or your kid's concert or play? Surely you notice the buildings around you. They are designed by artists called architects. Doodling is a form of art, as well as drawing, painting, or finger painting. Poetry (or song lyrics). The public art we see in the public spaces of urban areas and airports, in museums, displayed by corporations in their headquarters. We are surrounded by art.

New York City skyline 2016

The best art not only entertains, but reveals truths about the human condition, provokes thought about belief systems, and encourages discussion. I'm a writer. I write to tell stories, to entertain with those stories, but my characters have issues or challenges that can provoke thought as well as insight. I don't plan it that way because I just begin telling the story. The characters have their own minds and lives.

Having said that, I recognize that there are people on this planet who don't want to think, and they don't care about the arts.  They only want to be distracted and entertained. They don't read much. They love their smartphones for the distraction they provide through the internet. They like to see crash-and-burn movies with lots of explosions and nothing more. Maybe they also love to watch professional sports. They believe "art" is elitist and are not open to discussing it. They work hard but often live paycheck to paycheck. I believe these people are the core of Mr. Trump's supporters, and he, despite his wealth, his college education, his many businesses, and whatever opportunities all that would bring him, is one of them.

As for the cast of Hamilton, they have the right, their First Amendment right, to express themselves.  So, too, the booers and hissers in the audience that evening who expressed themselves when Mr. Pence entered the theater. As Scott Chamberlain points out in his piece, when the play began, the audience became united in watching the play together. That's what art does, too.

Sunday, October 23, 2016

I'm an Early Voter

It's been 3 weeks since I've published a post here. My brain has been reeling from observing the life around me. So much so, that I decided to vote early which is possible in my state. It was wonderful. No lines. Fast. I declined the photo opportunity after dropping my ballot in the ballot box. I left the early voting station feeling elated and relieved. Now I no longer felt obligated to watch what's going on with the various political campaigns swirling around the country right now.

Ha. Ha.

Just when I thought it couldn't get any more outrageous and horrifying, a video leaks into our lives of Donald Trump and Billy Bush yucking it up and boasting about sexually assaulting women. At the third debate, Trump allowed that he hadn't done what he bragged about doing, but that seems to be at odds with the women now coming forward with their stories about him sexually assaulting them. There seems no doubt at this point that Trump disrespects women, and that he's a misogynist. Trump cannot let go of anything, even when the truth is up close and personal in his face. Wow. I grew up in the home of a sociopath and narcissist. Let me say from my experience, Trump exhibits the behavior, speech, and beliefs of a sociopath and narcissist.

A friend commented that watching the debates has reminded him of being in elementary school. And Clinton just rises above it all which isn't too difficult, actually. No doubt of who is the adult in this year's election campaign. In addition, Trump makes no effort to educate himself about the job description for a US President, about the limits and checks on the power of the Executive Branch of our federal government led by the President, and about how the judicial system works in our country. For example, as President, Trump would not be able to put Clinton in jail. He does not have that power. Only a dictator has that kind of power. Electing an outsider is one thing, if that outsider is mature, educated, experienced, and intelligent. It's quite another when that outsider is immature, inexperienced, criminal in his business dealings, ignorant, and autocratic.

And then there's the notion that American men are intensely uncomfortable with a woman in power. The reason given for Clinton's lack of support among men, especially men who haven't been to college. I don't know whether to laugh or groan. I wonder if it has something to do with not successfully detaching from their mothers and maturing as adult men? After all, mothers are the most powerful women in men's lives.  Or perhaps it's closer to racism in this country as we've experienced in the last 8 years of Obama's presidency and how he's been treated.

Women have been fighting for over 60 years for equality under the law, for social equality, for employment equality, and economic equality. Isn't it about time men realized that maybe they need to change their core beliefs about women, as well as their core beliefs about men in our society? It really looks like the men just never got the message back in the early 1970's that if they wanted good relationships with women, that they needed to change their thinking and behavior too? We still have a long way to go, as each generation works to replace the old, misogynistic beliefs with those of acceptance, respect, and equality.

So, women have a long way yet to go, and now it's about helping men learn how to be in a world in which men and women are equal human beings -- not a world where men rule and treat women as dependent children that must be kept under control. Trump truly represents the past.  Where's Melania? Why hasn't she been stumping for him on the campaign trail? She's done very little compared to other candidate spouses in the past and present. Perhaps she has no desire to support her husband in that way. Or perhaps she's had no say in the matter.

This is the first time in my lifetime that a candidate running for president thinks he's smart if he can break the law and not get caught, or get caught and either buy his way out or bully his way out of punishment. And then blame it all on the lawyers and prosecutors because of course he hasn't done anything wrong. Our country does not need this person setting foreign policy, meeting with foreign leaders, or having access to the nuclear codes. This person has neither the skills nor the abilities to govern, to work with Congress, to represent the entire country, to compromise and build consensus. This person knows nothing about leading in a democratic system.

This is also the first time in my lifetime that a foreign country has tried to undermine our democratic process. I suppose it's much easier to do now with the internet being essentially borderless and hacking becoming an acceptable method in the world of espionage. And then to have a presidential candidate deny that the hacking has come from a foreign source? I should think a presidential candidate would be concerned about his own data and want to work with security experts to insure that his own data was protected, and cooperate with security experts regarding any information he or his campaign might have about the cyber-intrusions. If he's not concerned, why not? Does he know something the rest of us don't?

And finally, this is the first time in my lifetime a presidential candidate has begun claiming that our democratic processes are rigged, corrupt, and set up to favor his opponent. That there will be election fraud. He does not know what he's talking about, and what is especially sad and scary is that he makes no effort to educate himself about the processes and why fraud does not occur in this country as it does in a truly corrupt and undemocratic system.  Commentators have explained that his claims of a rigged election is preparation for him losing which was underscored at the last debate when Trump refused to say that he would accept the results of the election. Or, another possibility -- it's his way of encouraging his supporters to try to commit election fraud or intimidate voters (both illegal). When I voted early, I could see no way to rig the process in favor of one candidate or another. The voter's identity is checked three times against the information the voter provides, and the voter signs off on the ballot under the scrutiny of an election judge. Any deviation from the process would be noticed immediately and stopped.

In psychology there's a concept called "projection" in which a patient projects onto others beliefs, speech, and behavior that he himself has and has done. Sociopaths are particularly adept at projection. The layperson knows it as "blaming everyone and everything else for a mistake, problem, etc." They do not take responsibility for their thoughts, beliefs, feelings, and behavior but see themselves as always being right. Another way of interpreting projection is the sociopath revealing his profound sense of powerlessness to effect anything in his world because everyone else does and he is under their power.

I'm going to be so glad when this election is over....

Monday, October 3, 2016

Here We Go Again...and Again

It's that time of year!  Time to look at medical insurance coverage if you buy your own and decide if you want to continue with your current company or shop for different insurance. Here in Minnesota, that means shopping on the MNSure insurance marketplace website, or, if you can afford it, going to each company's website to check out their plans on offer.  Man, I wish I could afford to buy whatever I need and not have to go through the exercise of figuring out my 2017 income, checking drug formularies, checking in-network providers, and on and on. Last year, I used a Navigator to help me. Not sure how I'll proceed this year. There are reasons for my uncertainty.

Reason 1

MNSure operations sent me a letter last week, alerting me to the possibility that I may have to prove my eligibility again for my medical insurance coverage provided by the state. I appreciated the heads up, but I'm not looking forward to going through that process again. Of course, maybe I won't have to prove my eligibility, but I doubt that. They required me for this year to provide explanations for how I had estimated my income for this year. I expect they'll be interested to know what I'll be earning next year.  So will I.

Reason 2 

A couple days after the MNSure letter, I received notification from the insurance company that administers the state plan I'm on. They are making changes in their drug formulary, i.e. the drugs that they will cover. As a result, two of my medications will no longer be on their formulary. While I appreciated the notification, I'm definitely not thrilled that I will now need to request two different doctors to submit prior authorization requests for these medications. These two medications are for my dry eye and dry mouth. I've been taking them since 2008. They are working very well for me. The insurance company suggested a different medication on their formulary instead of the dry mouth med I'm taking now. For the dry eye medication, their suggestion was "CHECK WITH YOUR DOCTOR." They suggested that, of course, because there is no alternative to that medication. Not on their formulary, not anywhere.

In addition, this company also outsources its review of medical necessity. I was very upset when I learned this. When I told my doctor, he was not at all surprised. Now I'm very, very curious to know the cost benefit or risk of outsourcing that particular task vs. doing it in-house. But, of course, there is no way any of us will ever see an insurance company's balance sheet, is there? I doubt they'd want us to know just how much money they have in their excess fund, or how much they spend on marketing and advertising. I think drug companies are the same.

Reason 3

I've been on a job search for the last few months. What if I find my ideal job? What if they offer it to me and I accept? How does that affect my medical insurance? This job search business is full of uncertainty, and it affects so much in my life.  It would be a very different situation for me to be a fulltime employee with employer provided medical insurance. I would not need to purchase my own individual plan. However, what would the coverage be with the employer provided insurance? I could end up with higher medical expenses because the employer provided insurance only covered 70% of drug and medical expenses.

For the Working Poor

While my state offers good medical insurance for the working poor like me at the moment, I suspect there's a segment of workers who are really struggling with the medical insurance issue because they make enough annually through work, but maybe they have insurance through their employer that's inadequate to their needs, or maybe their employer doesn't offer insurance and they still must buy their own. Or they are self-employed, making enough money each year to buy their own insurance, but then run into issues of coverage.

When the ACA was passed, I was ecstatic. I thought that I'd be able to get off the state's high risk pool insurance that was costing almost as much as my monthly apartment rent and qualify for the premium subsidy. Yes, I did qualify for the premium subsidy, but my premium costs continued to increase each year. I began to wonder if that was the purpose of the ACA -- to make insurance just as expensive as it was before it went into effect and increasingly unaffordable for people like me.  Insurance companies are working hard to make that the case, or they are choosing just not to participate. So there are lots of insurance plans to choose from out there, but the number on state ACA marketplaces online have dwindled. Good luck if you need platinum coverage finding a platinum plan from anyone!

So, thanks to the insurance industry, if you aren't already a member of the Working Poor, you may end up there because of insurance costs.