Oz Medicine

(Disclaimer:  This post has nothing to do with 'Dr. Oz' or his TV show, which I have only noted in passing while channel surfing.)  

For those of you a bit surprised about the inclusion of a mid-week posting this week, I have to tell you that you're not the only one.  It appears however, that there may some potential side effects to living in the "Land of Oz" (aka Kansas) that some of us may be particularly susceptible to; and I now appear to be running the gamut of these conditions.

As many of you might know, I recently completed what I now like to call 'Tin Man Surgery', in which extensive and extremely necessary repairs were done to veins and arteries around an organ that was apparently in absence in one of Dorothy's companions in "The Wizard of Oz" as well apparently as in many Conservatives.  (No, not my brain.  Try not to jump ahead, please.)  In spite of living in the Wiz's balloon 'fly-over country' however, I was seemingly blessed with some local 'rock stars' of the medical profession and the repairs were not only successful, but my expeditious recovery currently has me up for 'Miss Open Heart Surgery 2013'. (You should see the swim suit competition.) 

In the days since my return home from the hospital however, I seem to have traded the condition that I shared with Dorothy's metal companion for that suffered by one of her more herbaceous ones.  I have recently discovered that my interest and ability to write either quantitatively or qualitatively (writing a lot or well) seems have suffered in a corresponding fashion to my return of the good health of that vital pump in what I am beginning to consider might be the possible onset of 'Scarecrow's Syndrome'.  I am now more than a little concerned that repairs insuring that blood is now properly circulating around my heart have somehow diverted this vital fluid from reaching the near perfect vacuum between my ears.  

As a result, these days find me either unable or unwilling to keep up with my former docile pace of two blog posts a week.  As for concerning myself with the discipline of the multiple personality disorder more commonly known as the staff here at JBS where the lexicographers of the SOS Dictionary are concerned, or facing the mess in the locked attic room (that I keep in my mind) better known as the Department of Just Blowing Smoke Security; forget about it.  This combination of raging inability and apathy doesn't even speak to the apologies that I owe Michael Miller and the staff at the Toledo Free Press for failing to annoy them with nonsensical weekly efforts offered for publication in their well-esteemed product, let alone the constant re-writes that follow in vague but futile attempts to make them at least coherent, if not intelligent offerings.

My continued inability to properly identify the cause for this problem, let alone truly accept responsibility for the resulting lack of literary output leads me to believe that yet a third yet undiagnosed malady may be lurking in the wings.  Such cowardice in the face of (and piled on top of) such inexcusable laziness may in fact be an indication of the first stage symptoms of another one of Dorothy's literary traveling companions.  As fragile as my current mental state is however, I'm not sure if I could face a confirming diagnosis and discovering that I might indeed be suffering from the onset of 'Cowardly Lion's Disease' on top of everything else (though that may just be the fear talking).   

This dilemma is further complicated by not knowing which of the medical professionals that I'm working with in the Sunflower State that I should consult regarding these concerns.  Try as I might, I'm not sure how to determine which of their specialties these maladies might fall under, if any at all.  Since most of them have signed off on my recovery (Oh, if they only knew!), and I am therefore not scheduled to visit with any of them any time soon; I hate to bother them with what may in fact be no more than post-operative psychosomatic disorders.  

Perhaps the symptoms that at least I believe that I'm experiencing might not fall under any of the extensive training that any of them have received, and instead another medical professional must be called in.  (I wonder if Dr. House might be interested in taking my case, though I better hurry before he finishes his final season.) 

Now I'm sure that many of those reading this might by now think you have a pretty good idea or two of who might best be consulted (and I might even be tempted agree with you), but instead I think that I would to take these thematic medical complaints to their absurdly logical conclusion.  Yes that's it!  Dorothy did after all have one other companion on her journey through Oz that I have yet to consider ... Toto.  I need to get on the phone with a local veterinarian first thing tomorrow ....

Side Effects

I have at long last come to believe that the pharmaceutical companies are one of the true banes of Mankind. This is not to say that I have bought into the conspiracy theory that they are charging too much and making obscene profits from the treatment and cure of disease, or that I have drunk the Kool-Aid and now agree that they are in a secret conspiracy to defraud the public while secretly keeping the cure for cancer or some other such disease from us. No, their crime against humanity is much more grievous in type and insidious in nature than that. 

That crime, for those of you too busy watching the TiVo reruns of the "X-Files" or "The Daily Show" instead of news stories, is that somehow these evil doers have convinced us to take their medications, the side effects of which are far more scary, painful, and humiliating than the conditions which they purport to treat; even after they've informed us in their commercials of the true nature and gory details of those effects. 

In the process of treating things like depression, addiction to cigarettes, or erectile dysfunction they are exposing us to other conditions of a far more serious nature. (I know, I know, what could be more serious than erectile dysfunction?) I mean come on people, who wants to be cured of nicotine addiction with the side effects of depression, loss of will to live, or suicidal thoughts. 

Speaking of depression, what does it mean about a product that treats such a condition when its side effects include continued thoughts of depression or suicidal thoughts. (Is it just me, or does it seem to you that such side effects actually mean that the medicine isn't working?) 

And as to erectile dysfunction, even if you had the side effects, how would you find the strength of character to admit them? Who is going to the Emergency room to report that they have been able to perform sexually for over four hours, and continue to remain ready to do so? (Other perhaps, than the exhausted partner of such a potential patient, of course.) 

And lest we believe that these are not the only conditions that we have to look forward to in our moments of physical weakness as we submit ourselves to the tender mercies of these Marquis de Sades, let me go on. Rashes, shortness of breath, heart palpitations, and anal leakage wait just around the corner for those of us willing to place our health in the hands of these so-called miracles of modern medicine. 

I have to ask myself whether such travesties of medical science will be allowed to continue under whatever surfaces from the ongoing health care debate. Will a government, never very good at predicting nor capable of dealing with the unintended consequences of their actions be able to cope with the licensed dispensing of the chemicals that the health care industry suggests we ingest? What will they be and how can such government health care hope to handle the "side effects". 

Fourteen Is Enough Already!

Going through the news over the last couple of days, I couldn't help but notice the stories in every media outlet of the successful birth of Octuplets in California. To me, there are two amazing parts to this story:




First, it appears that this woman has already had six children and was still choosing to go through fertility treatments. I would have thought that after giving birth to six, that one would begin to think about slowing down the reproductive process, if not stopping it all together.  

Second, having already crossed a line that not many would in seeking fertility treatments after six children, this woman has not one, but EIGHT embryos implanted and brings them all to term. Listen, I love kids as much as the next guy (or so I would suppose), but in a situation like this, I have to say that I have a couple of questions on this one. I would have to question the sanity of the potential parents. 

Even if you thought that half of the implanted embyos wouldn't make it, what would possess you to go from six to ten children, let alone fourteen? I would likewise question the ethics and the good sense of the medical practitioner in this case. What would possess this practitioner to do fertility treatments to a mother of six? What would possess you to implant eight embryos when common practice in situations of implantation calls for no more than four? 

And while we're at it, who paid for the miracle of all of this modern medical technology? What insurance company in it's right mind would include compensation for any part of this type of fertility treatment? How would a doctor performing such over the top levels of fetal implantation get on any insurance company's approved list. (Please don't even tell me that any part of this is going to be paid for by the California taxpayer, I'm not sure that I'm strong enough to hear it.)  

Forgive me for being judgmental. It sometimes seems however, as if there is a more detailed examination of a patient's stability and state of mind for a breast augmentation procedure or sexual reassignment surgery than there is for fertility treatments. 

Why is it that doctors would be more concerned about the mental health of a person choosing to change their own bodies, than it would be for a person bringing new life into the world along with its long term commensurate responsibilities? When does our ability to do a thing medically exceed our common sense about the ethics of proceeding with it? When is it time to consider not only whether we can do a thing, but whether we should?

OK, so it turns out that that I had a lot more than a couple of questions on the subject ... so shoot me. 

 

The Cost of Medicine

With a great deal of idle time on my hands, I am often struck by strange thoughts while driving down the highway. This is something I have been doing a lot lately. (I mean driving down the highway part, not the strange thoughts. No, on second thought the strange thoughts come a lot lately as well, but oh ... never mind.) The thought that hit me on this particular trip came as I was nearing one of the cigar Meccas of the US, the JR Cigar store in Statesville, NC. I was thinking about loading up on cigars, because the SCHIP (State Children's Health Insurance Program) appears large on the Congressional radar screen. Without George Bush in the White House to veto that bill again, there is a better than even chance that it will pass and be signed into law. If it does, the tax on cigars will go up significantly in order to fund this program (and my anguish will likewise increase), and "Just Blowing Smoke" will become a lot more expensive for me.

This got me thinking about a different cost of health care however. It is one that will not be picked up by the SCHIP program, or any other government health program. It is also a cost that is not picked up by the health insurance currently provided by my employer, even after my deductible is met. In fact, it is a cost that entirely picked up by me, the consumer. It is also a cost that is directly attributable to the health care provider. This cost has nothing to do with the care provided or the technology required to provide it. In fact, there is plenty of technology available to alleviate the problem, not that it will ever be used. This cost instead is about nothing other than the lack of efficiency in the care provided. It is the cost of waiting.

I know that I have you now. There is none of us out there who has not sat idly, whiling away the hours in a waiting room well past our appointed time. No matter how punctual that we are in showing up to see our health care providers, it is rare indeed if they are equally so in providing such care. For those of us who have, or have had children who cannot get themselves to their appointments (Yeah I know , but you just can't get them to drive themselves to the doctor for at least the first 16 years) that total of wasted hours goes through a significant multiplier, as children require a great deal more care than adults and pediatricians seem even less able at clock management where appointments are concerned. I couldn't help but wonder over the thousands of hours wasted.

- How much the cost to each person or family in lost wages?

- How much cost in lost hours of productivity?

- How much the cost in wasted vacation and personal time?

- How much the cost in frustration, aggravation, and sanity?

- What is the cost to the consumer, their employer, and the nation based on any realistic pay scale?

My guess is that if the number could be determined, it would be staggering. Enough perhaps to pay for SCHIP? Enough perhaps to contribute significantly to perscription drugs for the elderly? Enough perhaps to reimburse taxpayers for the illegal aliens or people without health care who gain unreimbursed treatments in the emergency rooms across the US?

No matter however. While Congress and the politically correct commend themselves on striking a blow for children's health care, while the anti-smoking lobby pat themselves on the back for yet another blow to those who indulge in the evil pleasures of tobacco, while the forces for government expansion exchange their secret handshakes over another step on the road to nationalized health care; perhaps some few will step back far enough to recognize the monster hiding in the corner. Perhaps someone with begin to notice the inefficiency in handling the simplest of business dealings on the part of health care providers today, as it continues to be the dirty little secret of the cost of medicine.

 

Suffering Through Health Care

As many of them do these days, the idea for this posting came from an article I read in the Toledo Blade. This one, dated August 24th, talked about how the doctor-patient relationship is suffering in modern medical care; and why this is the fault of the insurance companies and a litigious society. 

I might be willing to give them some slack on the concept of medical lawsuits, as the only profession committing more a more egregious abuse of power than the doctors is lawyers. As for the rest, I have a few things to say on the subject. (Big surprise, huh?) 

Doctors tell us that they don't like being second guessed by the insurance companies. I can tell you that many likewise don't like questions from the patient or the family of the patient either. Society's recent creation of individuals who live for self-esteem has produced a group of doctors of almost unparalleled arrogance. If you question the tests being run, the number of prescriptions being written, or the standard of health being used as a guideline you are labeled as misguided, uninformed, or simply stupid. 

How dare anyone question the mighty medical professional in the performance of their duties! While we are on the subject of tests and prescriptions, does anyone believe that the never-ending gobstopper of tests being performed on each and every patient these days is contributing to the spiraling costs of medical care? 

Before any doctor will venture a guess about treatment, they ask for more tests than the combined number of exams that they took during medical school. This has us paying not only the hospital costs for the tests themselves, but the lab costs to process results from the bodily fluids and pictures taken and the follow up doctor's visits to discuss these endless reports. 

And what is done with the results of all of this modern scientific testing? The physician inevitably treats the test results instead of the patient. The goal becomes an experiment to produce a certifiably healthy person through the achievement of pre-approved test values. If the tests don't produce the desired result, change the parameters of the experiment through a different combination of chemicals, and retest. 

Lost however in this example of modern scientific medicine is the quality of life of the lab rat (I mean patient) who must submit to such endless experimentation without complaint or question. Let's not take out the profit motive either. What happens to the doctor-patient relationship when the person we normally deal with is not our doctor? We now rarely see those professionals, as a great deal of the work is done by nurses, nurse practitioners, and physician's assistants. 

All of these folks may have our best interest at heart, but let's be honest enough to say that it also facilitates the ability of a medical practitioner to run many more bodies through a version of assembly line medicine. Every caregiver does their part while moving the patient down the line, with the doctor doing periodic quality checks and consultation. While I would like to say that this helps provide greater care, I suspect that it might have more to do with producing better cost efficiencies and a greater revenue to patient ratio. 

Now in fairness to practitioners of the medical profession, they are not the only people exhibiting greed in this industry. Insurance companies are corporations, and as such operate on the profit motive. They do everything that they can to deliver less for the premiums paid in order to maximize their own profits. The relative health of those paying the premiums means no more to them than the people buying gas mean to Exxon. Pharmaceutical companies follow a similar corporate path, with the additional questionable practice of enlisting doctors into their misbehavior. Free samples, medical conferences in exotic locales, and experimental research sponsorships all skate a fine line (and often cross it) in the relationship between doctors and patients. 

And what shining example do these corporations have model themselves on, why the Federal Government. This model of management efficiency, limited bureaucracy, and fiscal responsibility all but insures that abuse of the system (and the patient) will be the order of the day.  

As for the lawyers, they are just the scavenging bottom feeders of the process. Taking a depersonalized system and the mistakes that are bound to occur with "assembly line" medicine, they simply try and turn any of the quality control issues into a winning lottery ticket. 

Oh there are real wrongs to be righted and evildoers to be brought to justice, but I fear that more often than not these situations would be better brought before "Judge Judy" than a jury or our peers who see no wrong in multi-million dollar settlements for pain and suffering. Doing so might allow a bit of common sense to intrude into the process and would certainly reduce the cost of malpractice insurance, and as such, on medical care itself. 

But listen, if the medical profession thinks that it's difficult to deal with insurance companies while trying to do the best job that they can for their patients, if they think that the paperwork and regulations are constricting and overwhelming now, if they think that they have seen what life can be like when dealing with an unfeeling and uncaring bureaucracy; just wait and see what happens if we get "National Health Care" and the government takes over. 

All of this discussion of the current state of medicine is making me feel a little woozy. I think that I'm going to go lie down.

 

The "Practice" of Medicine

I promised, when I verbally abused the legal profession, that I would do the same for the medical profession. Taking my word seriously (It may be in fact, about the only thing that I take seriously) I am therefore happy to present the following: Like most people my age (yeah, yeah I know, older than dirt), I am dealing with the fact that my body does not function the way that it used to, that I expect it to, or that I would like it to. I don't feel the need to be terribly concerned; but much like proper auto care, preventative maintenance is the best way to keep the old heap around, so I attempt to make the effort that is required. It sometimes seems to me however, that the actions of the medical professionals that I have placed in charge of my health could be what ultimately causes my demise. The methods to extend an existence which I am sure some people think has already lasted too long is causing me to agree with these critics. Like the medicine commercials that you often see on TV, the side effects of the treatment appear to be worse than the disease itself. Perhaps this is just the nature of managed health care as we know it today. Health care professionals I suppose, in an effort to treat as many and as much as they can, appear to be experimenting on us most of the time (it is called a practice after all). Treatment consists mostly in the taking of tests and medications that can then be adjusted to reach an baseline established by a bunch of medical researchers who probably have no lives themselves. Add a little this, take a little of that away, and pretty soon you get where they want you to be. This is a great way to make chili (and I gotta tell you that I have learned to make great chili this way over the years), but I'm not sure about using it to make a great ... me, and I have a few problems with it:

• It makes me feel like a backyard pool whose chemicals you adjust every time you take a water sample. Why can't I just take a medicine (or combination of them) and feel better? Why is it necessary to adjust the combinations and doses endlessly?
• Second, adding and subtracting these chemicals costs MONEY! Even with health insurance, the cost of these medications is more than I would like to be spending in the hopes that some day my numbers will look good on somebody's chart. (In fact, the amount is enough to lease a really nice car, and is fast approaching a house payment.)  
• None of this ever seems to be designed in order to make me feel any better. Instead, all it appears to do is make my personal numbers closer to the accepted guidelines. (Maybe it would be easier for them to treat the chart instead of me.)
• All of this experimenting has what the professionals call "side effects". Drug interactions, drug resistance, and (the big one) negative reactions during this seeming never-ending process have profound effect on quality of the life that I am supposedly taking these medications to achieve.
• Failures in the proscribed treatments are not failures on my part. The fact that the guesses being made on my behalf are not working is not because I have done something wrong, or that I don't want my numbers to get better ... so stop trying to make me feel guilty about your failed predictions.
• Finally, that having achieved a certain momentum in the path of life that I have been following, I am not all that willing to make drastic changes in order to ahieve little more than making these health care professionals happy. Beyond a certain age, all of us resist and resent change, no matter how altruistic or beneficial the motives.

Our health professionals need to start realizing that the patient is a person and a customer to be served, not a servant to be ordered about; and certainly not an experiment to be successfully completed. I am willing to be counselled and guided, but not to be scolded and ordered. They need to understand that most of the things being done in the hopes of keeping us healthy make us feel pretty lousy and are keeping us in the poor house (which makes us feel even worse). They also need to realize that the charts that they are asking us to conform to are only the latest in a series of numbers that the researchers change more often than they change their clothes. The Quality of a Life should be as important as any concern in this process; and that information won't be found on any chart, nor discovered by any test. I therefore ask that they keep in mind a bit of wisdom that at the very least, is becoming a meaningful part of my life these days:

"Having given up everything that I need to in order live longer, I now find that I no longer wish to..."