Entries tagged with health

Entry tags:

health

security vulnerability: pharmacy edition

While waiting to pick up a prescription, I noticed that the person in line ahead of me picked up prescriptions for both himself and his wife. Oh, good idea, I said to myself -- I should authorize Dani to pick up mine, just for flexibility.

When it was my turn I asked how to add my husband as someone who can pick up my prescriptions. Oh, the person manning the desk said cheerily, you don't have to do anything -- he just has to know your birthdate.

Whoa.

When picking up a prescription the only challenge I ever have to answer verbally (besides my name) is my birthdate. I do not, for example, have to say what medicine I'm here to pick up, or even how many prescriptions. The usual interaction is:

Me: (name)
Them: two prescriptions?
Me: Yup.
Them: birthdate?
Me: (answer)
Them: Any questions?
Me: Nope.
Them: Loyalty card? (swipe) Sign here. That'll be $X.

I don't have to show ID, but I assumed they were reading that out of my loyalty card. But no, anybody who knows an easily-compromised piece of information (how many data breaches have included this by now??), shows up in person, and has reason to believe that I have some prescription waiting can (a) collect it (denying it to me) and (b) find out what I'm taking. Hell, if the attempt comes up empty -- no prescriptions currently waiting -- the person can probably say "oh, I was expecting my doctor to have called in, um, I can't remember the name now" and be prompted for options.

Granted, this is a physical attack so it can't be done by just anybody on the Internet. But it's still a security vulnerability, especially when targeting older customers (good odds of being on something) or people known to need expensive medicines (either because of street value or to troll the victim). We worry about other physical attack vectors, like credit-card skimming.

I asked if I could attach a password to my record for pickups, but their software doesn't support that. I didn't ask if I could change my birthdate of record, because if I do that I'm just asking to have to prove it at some point in the future. (My bank, in contrast, has never asked me to prove that my mother's maiden name contains numbers and punctuation and, well, not a recognizable name.)

Is this the norm for pharmacies, or might looking for a different one be productive?

Entry tags:

employer,
health

Ow!

My employer, like many other large ones in the US, assesses a higher fee for health insurance if we don't cough up certain statistics for them. I don't know how much of this is snooping and how much is forcing us to at least get certain tests annually. Distasteful as the former is, we established several years ago that I can be bought on this if the price difference is high enough.

Many locations have on-site "clinics" where you can show up, let them prick your finger, fill out paperwork, and be done. My location is too small for that, though, so we have three choices: go to your doctor, go to a lab where they'll do it, or order a do-it-yourself kit. I didn't want to pay for an office visit just for this and the lab sounded like a hassle, so I ordered the kit. I mean, it's just a pin-prick, right? Even with my needle-aversion I can handle that. I did this through my doctor last year and through an on-site clinic at my previous employer, so I figured this'd be ok.

I will never, ever do that again. Their damned lancet hurt, and I had to do it twice to get enough blood (answering the question of why they sent two while providing instructions using one, I guess). It left bruises on my finger. Hours later it still hurts if I'm not careful when typing with that finger. And the puncture marks are bigger than I expected. This...did not happen with my past experiences.

Nope, not doing that again. Grr. What they learn about my blood sugar better be worth it.

Entry tags:

hacking my body: study results

I drink quite a bit of caffeine, which poses a problem come Yom Kippur each year because of the 25-hour fast (food and drink). Every year I start ramping down the caffeine on Rosh Hashana (10 days earlier), try to reach zero caffeine the day before Yom Kippur, and soldier through. But I always get a caffeine headache anyway. Somebody once suggested that I needed to be at zero caffeine for more like three days, which I haven't managed to do yet. (Yes, I admit my substance addition. Moving on...)

Monday night we were wondering how quickly caffeine leaves the body anyway, and Dani found this article. Lookie here (emphasis mine):

The dosage of caffeine consumed can impact how long it stays in a person’s system. Someone who ingests low dose (especially relative to their body mass) should clear caffeine from their body quicker than someone who ingests a high dose. Though other factors play a prominent role in clearance, the body can only metabolize and excrete a set amount of caffeine at a time; if this threshold is exceeded – metabolism and clearance is compromised. [...]

A heavy caffeine consumer may ingest over 400 mg per day (equivalent to 4 cups of coffee). At this point, enzymes in the liver may be overtaxed and more caffeine (and its metabolites) may accumulate within the body. This accumulation may prevent efficient clearance and result in reabsorption, prolonging excretion times relative to dosage consumed.

Oh really? I had never considered the possibility that one could slow down caffeine loss by overloading. This, I decided, called for science.

Tuesday I drank three cups of coffee, about 12oz of iced tea (equivalent of two teabags), two cans of Coke Zero (Cherry, if we're being precise), about 12oz of apple cider, and about six cups of water. I ate as I normally do in advance of the fast. Then at dinner I had a glass of Coke Zero (maybe 8oz?), followed by a glass of orange juice and a glass of water.

This should be sounding alarm bells to most people experienced with Yom Kippur. All of this is in extreme contrast to the near-universal advice one hears about caffeine and fasting. Possibly that advice is geared more toward the folks who drink a couple cups of coffee a day; I don't know. Also, caffeine is a diuretic so I was concerned about thirst, even with all the water/juice.

But I am here to report that I did not get a caffeine headache today, and I didn't feel any more thirsty than I usually do. In fact, after some thirst pangs this morning, I pretty much didn't notice thirst for the rest of the day. (Also: yes, I slept as well as I usually do on Yom Kippur last night.)

Wow. It's only the one data point, so further research is called for, but initial research results show promise.

(Monday night we also discovered the existence of caffeine patches -- like those nicotine patches smokers wear, but for caffeine -- but there was no way to get some in time.)

Entry tags:

left hand, let me introduce you to the right hand

As I gather is increasingly common in larger US companies, my employer tries to entice people to actually get annual bloodwork by offering a discount on insurance to people who cough up some basic stats -- cholesterol, blood pressure, blood sugar, and a couple other things. (Assurances of confidentiality are made; cost-benefit analysis is left to the employee.) I had a physical recently, so I collected the data in case I want to use it later.

I noticed, after the call from my doctor's office, that he hadn't given me one of the required numbers, so I called back to get it. Oh no, he said, we don't routinely test blood sugar any more, because insurance companies don't cover it as part of preventative care. So he'd have had to charge me for that, and since I didn't present any relevant symptoms he didn't pursue it. I hadn't specifically asked about it up front, so I'm not faulting him for this.

But let me see if I understand this: my employer's health insurance will not pay for a test that my employer's benefits department wants me to obtain. Er, right.

I pointed out this gap to a coworker, who said that as these things go, this is one of the easiest problems to solve on your own: find a diabetic friend and ask to borrow a glucose meter. Yeah, I guess that could work. I can also (since I don't work at the main office) order a do-it-yourself test kit at no charge, but I begrudge the extra hassle (and needle-stick) when my physical was supposed to take care of this already.

But that's all assuming I'm willing to share this data. I haven't decided about that yet; it's a little creepy, and I might be willing to pay a slightly-higher price to retain that bit of privacy. Really, why do they need to know? Wouldn't a receipt from my doctor saying "yeah, saw her this year" be enough?

Entry tags:

brain trust,
health

modern dentistry

Out of curiosity, how long "should" a typical dental cleaning and check-up take these days for an adult with no special considerations? (I mean time in exam chair, not time in waiting room.) My visits got faster when my dentist's office switched (regretably IMO) from hand-scraping tartar to using an ultrasonic gizmo, but even so I was surprised by how quickly I got through a check-up on Monday and I lack other relevant data. Help plug my data gaps, LJ brain trust. :-)

Entry tags:

health,
news

salad-mix recall

Oh phooey -- we ate that yesterday, "possibly" exposing us to listeria monocytogenes (warning: I cringed while reading this). But kudos to Giant Eagle for calling and telling me; store affinity cards do bring privacy issues, but it's nice to know that the tracking of purchases can produce good outcomes too. Unless it were to make the news somewhat prominently, I might not have known otherwise. (Specifically, I might have heard "River Ranch" and not connected it to "Farmer's Market", the local branding.)

Tomorrow morning I'll ask what my doctor recommends.

Entry tags:

signal boost: Purina food could be hurting your pets

Thanks to

siderea for pointing me to this post about problems with Purina pet food (dog and cat, at least). After seeing this I read the last several month's worth of consumer-affiars complaints, and older ones about the specific foods relevant to me. (Warning: can be gross.) This goes well beyond "ew, yuck" to "get that stuff out of the house before it contaminates anything else". Fortunately I don't use their dry food (infestations), but I do -- or did, until now -- use Friskies canned food (toxins) sometimes.

I didn't find anything on Purina's site about this. Since this isn't in the news I don't know how I would hear about a response from them other than searching from time to time.

Entry tags:

yes we talk like this

At the Giant Eagle pharmacy:

Me: Here's a prescription, and a gift card from Big Pharma that will pay for three months' worth. If I mail-order it I can get three months' worth at once; can you do that for me?

Her: I don't know; I'm just the front-desk flunky. Do you want to leave it and we'll give you as much as we're allowed to?

Me: Sure.

After I did my grocery shopping I returned.

Her: Sorry, we're only allowed to do one fill-up at a time.

Me: I understand. Have we completed this transaction, then?

Her: Um, yes?

Me: Will you take as given that I walked out through that exit and then came back in, or do I need to actually do it?

Her: Nice try, but you have to wait a month.

Oh well. I have until the end of the year to use the gift card.

Dani: So you can read on Shabbat; can you use a Kindle?

Me: No, because you have to manipulate the controls. It's like changing the channels on TV; technically you can watch it if it's on but you can't change the channel or volume. (Pause.) I suppose if, before Shabbat, you set in motion a smooth scroll at a readable pace, that would be like programming the lights. But it seems unworkable.

Dani: What about software that tracks your eye movements and turns the page at the right time?

Me: Seems like manipulation to me. Next you'll be bringing up sentient lightbulbs again.

Dani: How good does the programming have to be before your software qualifies as a servant?

I have no answer to that. Halacha geeks?

Entry tags:

health,
vision

pharma mystery

I don't understand the drug industry. Ok, ok, nobody does. Let me be more specific: I don't understand what's going on with one of my glaucoma drugs, Xalatan.

This drug has been on the market since 1996 without a generic option, meaning it costs more than $100 a month if you pay for it yourself (which of course most people don't, but delving into insurance-based pricing in this post would be scope creep). My co-pay is higher for a name-brand drug than for a generic, so I have personal interest in this going generic.

About a year ago word on the street was that the patent was due to expire last September, but something seems to have happened because it's now, according to the patent office, locked in until early 2011. According to my doctor, some insurance companies are applying pressure to ophthamologists, pushing them to use different drugs instead to treat this condition because of the expense. One way or another, it appears that Pfizer has about another year to collect the big bucks from customers before they have to accept that a 15-year monopoly is a pretty good run.

Given all that, I was surprised at this morning's checkup to receive not only a free sample (a month's supply) but also a card that I can use four times or up to $350, whichever comes first, getting my prescription filled. So my next four bottles of the stuff will be free. Before I use that up I'll have another checkup, at which I might score another freebie and perhaps another card. Even if the promotion is over by then, they'll have given up four months' worth of monopoly pricing on me in their final year of being guaranteed to collect it.

How is this in their interest? I'm happy to pocket the savings; I've been pouring money into keeping my glaucoma at bay for as long as I've been paying my own bills. (It was diagnosed when I was a child.) But I don't understand why I'm getting these savings at this time.

Entry tags:

health

weird...

This is the weirdest cold (?) I can remember. It started with a mild cough Saturday night (after I'd performed, fortunately). That continued Sunday, and I applied tea, ginger root, and steamed milk (not concurrently). Nothing productive -- just the motions of a cough. Sunday night I started to get a mild runny nose (non-productive, i.e. the output didn't have any icky bits or colors). I took a 24-hour Sudafed before bed. Today at times I sounded a little hoarse, though my throat feels fine. Nose and cough action unchanged; took another Sudafed tonight. At no point have I had anything resembling a fever, which I understand I would have if I had either flu.

Isn't the runny nose supposed to come before the cough? I mean, the latter is usually caused by the former, right? I discounted the cough as possibly some sort of environmental reaction (dry air?) when it showed up because it was out of order.

Weird.

(I don't particularly like taking Sudafed, but I also don't like getting up every 3-4 hours at night to take more cough medicine, and I can't take most over-the-counter decongestants. And I figured if there's stuff in there, better to deal with it while it's still in my head, right?)

Entry tags:

medicine, drop size, and vampire blood

A recent mailing from my employer's department of reducing health-insurance costs (that's probably not their real name) offered some advice that seemed questionable to me. They suggested splitting pills -- not, they hastened to point out, that we should take half the dosage we need, but rather, we should get pills that are twice as strong as they need to be and then split them. They suggested that a stronger drug doesn't necessarily cost any (or much) more to fill, so you can fill your prescription half as often, saving you half the copay and them a lot on the balance. (Aside: what bright person decided that your cost, if insured, should be per month rather than per some volume? If I take a medicine twice as often as you do, why shouldn't I pay twice as much for it?)

I wonder how the pill-splitting scheme could actually be implemented legally and what doctor or pharmacist would go along with it. I find it hard to believe that a large company would advise its employees to commit insurance fraud (in a manner that's traceable), so there must be a way to do it, but I'm puzzled. (The company self-insures; maybe that's why it's ok?)

I was telling this to Dani last night, and commented that even if it's kosher I can't benefit from it for my prescriptions -- the medicine I take for glaucoma is in the form of eyedrops, and I don't know how to get double-sized drops. (Nor am I going to ask my ophthamologist to write a bogus prescription.) This, combined with some recent TV viewing, led us to wonder how big a drop is, anyway. We didn't have an internet connection to hand; Dani tried to work it out theoretically while I tried to work it out empirically. (Things often fall out that way with us.) A medicine that I take once a day (two drops) comes in a 2.5ml bottle and lasts about a month (maybe a little more). Viscosity matters, of course; this stuff is closer to water than to syrup. So I posited about 25 drops/ml for my medicine. (Google later suggested 20 drops/ml of water as an approximation.)

And that's when we turned our attention to the amount by which a character in the True Blood episode we'd just watched overdosed. The character had a quarter-ounce vial of an illegal substance (vampire blood) that he was supposed to take one drop of at a time. Wikipedia tells me that the viscosity of normal blood is about three times that of water. It has no data on vampire blood. Assuming (and I don't know if that's valid) that drop size is directly correlated with viscosity, this suggests that the character overdosed by a factor of approximately 46. Ouch. :-) (Yes, it did hurt.)

Ok, fine -- what have you done with your science education lately? :-)

Entry tags:

food,
health

food is complicated

My doctor says that my "bad cholesterol" is a smidge high (good's fine) and I should cut down on dairy and red meat. I eat very little red meat (really not much meat at all, though lots of fish), but I did bump up the dairy intake a bit in pursuit of calcium after learning of some family medical history this summer. Ok, fine, I'm perfectly willing to take calcium/D supplements instead, go back to soy milk instead of yogurt for breakfast, etc, but it does raise a question for me.

Presumably it is possible to find the right combination of nutrients in nature, without taking supplements. Sure, our understanding of "right" has changed over time, but for at least several decades I gather that we've grokked the importance of basic vitamins and minerals, and I don't remember supplements being nearly so prevalent a few decades ago as they are now. So how does one get enough good stuff (calcium, protein, vitamins) without getting too much bad stuff (cholesterol, sugar, excess calories), without supplements? What is the canonical modern (wo)man supposed to eat? (The last time I looked at the food pyramid it wasn't very helpful for gleaning details. It also assumed 2000+ calories/day, which a sendentary blob like me shouldn't eat.)

Entry tags:

random bits

I used to occasionally have a problem with an overnight power outage killing the alarm clock and causing me to oversleep, but I've more recently realized that having a UPS or three means never having to fear that again. :-) (Fortunately, today's power outage came after we were up, not in the middle of the night, and only lasted about five minutes. I was just about ready to interrupt my morning grooming to shut down computers when the need went away.)

In the "interesting if true, and interesting anyway" department: earlier this week I learned that the folks who handle disposal of sensitive documents for my company are blind. (Well, not the truck driver.) If I understand correctly, the local blind association arranges this, as sort of an extra guarantee or something. Who'd'a thought?

Signal boost: it looks like someone's testing stolen credit-card numbers on a large scale. Check your statement for microtransactions; they're testing the cards with ~20-cent transactions to verify that they're good before hammering them. Link from

jducoeur.

A few days ago my copy of I Remember the Future by

mabfan arrived. Yay! I'll have some nice reading for Shabbat.

Oldest LOLcat? Link from

siderea.

My doctor confirmed that I should be taking calcium supplements now to (with luck) fend off problems later. Where can I find calcium tablets that are sized for, y'know, normal people and not horses? Most bottles in stores don't even include pictures on the label, so it's hit or miss. The oblong ones I have are scored for cutting widthwise, but I need them to be narrower, not necessarily shorter, and my attempts to do that have all ended badly. What do other women of a certain age do?

Entry tags:

health,
politics

ponderings: health care

In the comments here we were talking about health care in the US. The current system is broken in many ways, but the "nuke it and start over with some nationalized program" proposals are scary too. What incremental improvements are possible? I have to believe that there are some.

One idea I'm interested in is what would happen if we separated paying for routine care from paying for catastrophic care. What would happen if people could be on their own for the former but could buy a policy to cover hospitalizations, major illnesses, and the like? How effective would that be and what would it tend to cost? What would having that in play do to the over-the-counter (uninsured) price of routine care? (Yes, I know that not everyone can afford to pay for routine care out of pocket. I'm exploring a suite of options, not choosing a single one.)

On the flip side, would medical practices or insurance companies be willing to sell affordable plans that cover all your routine care (only), if they were not on the hook for catastrophic losses? Could that get things down to the point where the average family could afford regular checkups, preventative care, and routine tests (which helps prevent some catastrophic issues)? Such plans exist now in niches (vision and dental, most commonly in my experience), but I haven't heard of one for general medical care. Why not? (Am I totally misunderstanding where the profit centers are in the insurance business?)

Both angles are important. What I'm labelling catastrophic incidents are (as the label implies) financially devastating if you don't have sufficient coverage. Outside of elder-care issues I'm not sure how common they are, but it's the sort of thing I wouldn't want to take a chance on. I insure my car and house, after all -- how much the moreso should I insure my health?

What I suspect has a bigger impact on the poor, though, is the routine care. If you don't have insurance, you're looking at a three-digit number to walk into your doctor's office. Throw in some kids and you're in trouble. (This is why I asked what would happen to those costs if catastrophic care were a separate factor.) Could plans that just cover routine care be made affordable enough for most people? This doesn't solve the other problem, but neither does the current system -- we rely on hospitals' obligations to treat (which is a legitimate public demand while they pay no taxes), or medicaid/medicare/SSI in some cases, to get through those. Remember, incremental improvement.

I'd also like to explore the effects of reducing drug regulation, letting people buy from anywhere that's selling and reducing barriers to getting things onto the market. I know the standard argument against this (those high prices pay for R&D), but I'm not sure how much I believe that. What are the other considerations?

Where else could we look for incremental improvements?

(In case you haven't figured it out, I am not a medical professional, an economist, nor part of the insurance industry.)

Entry tags:

random bits

The most recent gathering of the Transarc doc group was Saturday afternoon at a home half a mile from mine. (While I don't remember the hosts from Transarc (I don't think we overlapped), I did share a Hebrew class with them once.) At one point a person I've worked with twice, and tried to recruit, asked me "are you still loving your job?". I gestured toward another person sitting there and asked "have you met my grand-boss"? I then explained that any answer I gave under the circumstances would be perceived as either untruthful or unwise, depending, so I couldn't answer that question just then. I also pointed out that another attendee now works for me, so she shouldn't ask her about it in front of me. :-)

It took a couple weeks (after making an online reservation), but I finally got my confirmation for the NHC summer institute (Jewish learning program). So now all I have to do is decide on an airport and make reservations. Trains do not go there efficiently. That's a pity; I would like to be able to take a train somewhere someday. Doing the "airborne sardine" thing is over-rated. (Hmm. I'm taking it as a given that no one else from the Pittsburgh area is going, but I should check. Driving could work with the right group. But there is no way I'm taking such a road trip myself.)

Erik saw my vet tonight for a followup after his visit to the emergency clinic last week. He is eating but (still) not as much as he should be. I am to give him fluids for a while. We are waiting for an appointment for a consultation with a specialist, who'll look at the ultrasound and advise on options, including surgery. Poor guy. He's active and otherwise happy near as I can tell, but he does seem to have a case of ADR (Ain't Doin' Right), and I hope they can figure out how to fix it soon.

It's a little disconcerting to realize that my cat has better health care than many people who can pay (but live in places where there's none to be bought).

What does "X% chance of rain tonight" mean? Any rain anywhere in the region at any time during the night? That X% of the region will be wet by morning? That the whole region will get rain for X% of the night? Inquiring minds want to know, and empirical evidence is decidedly lacking.

Short takes:

As rjlippincott says, sometimes a product name says everything you need to know. Moo Doo, indeed.

For SCA folks: jducoeur's rules of water-bearing nails some of the current bureaucracy square on the head. Go. Read.

This kitten pile from kittenbreak is adorable. Assuming that's one litter, I'm surprised by both the number and the uniformity.

Entry tags:

random bits from the news

An article in my local dead-tree news reported on something I'd been wondering about for a while: are allergies and asthma more prevalent than they used to be (versus just being diagnosed more), and, if so, is it because of lifestyle changes? Yes and yes, apparently; research shows that more sterile environments mean our immune systems don't have as much to do, so they go off and find other ways to keep busy. (I couldn't find the local article online; Google found me this one from half a year ago.) I'm glad my parents let me play in the great outdoors and eat anything, and that we had pets, when I was growing up; I do have some allergies (environmental, not food), but they're mild. I feel sorry for one of my in-laws: his parents are hyper-paranoid about food allergies and are attempting to build a shield around him. They didn't come to our wedding because we couldn't guarantee that none of a long list of foods had never passed through the hall's kitchen. That kid is going to be a mess when he grows up, and he's probably going to think this is normal when he has kids of his own. Ugh.

Via Slashdot: daylight "saving" time actually increases energy usage. ("Saving" is a misnomer; we should call it "daylight shifting time", which is all it accomplishes. There are not, after all, storehouses in which we collect excess sunlight for use during lean times; nothing is saved.) The researchers were handed a great data-collection opportunity: they did their work in Indiana, where until recently some counties did DST and others did not. So they not only had before-and-after data, but also a control group nearby to factor out weather and the like.

A few days ago a house in Plum (near Pittsburgh) exploded, apparently from a gas leak. (I actually saw this on national news before I saw the local news.) This made me wonder whether it's possible to build a detector (other than the human nose) for household use. We have smoke detectors and carbon-monoxide detectors; why have I never heard of a gas-buildup detector? Granted that such incidents are extremely rare, but they are potentially much more devastating than fires and CO buildup, so if an inexpensive household gadget could provide some potential warning, that'd be great.

In lighter news:

You know that "who do you want to answer the phone at 3AM?" ad the Clinton campaign is running? The little girl in the ad was stock footage; she's now an adult and working on the Obama campaign (via insomnia).

Headline of the day, from thnidu: Skywalkers in Korea Cross Han Solo.

Entry tags:

fasting while sick

Wednesday I caught the beginnings of the crud that's been going around and started taking Sudafed aggressively to kill it before Yom Kippur, because fasting with a cold would suck. That didn't work, alas. Thursday night/Friday morning I noticed the first of two second-order effects: near as I can tell, the Sudafed -- whose job, after all, is to "make the emissions less bad" -- was having a dehydrating effect. So I stopped that before it could do more damage. The other effect was that the cold was sapping my appetite, when I should have had a large lunch and good-sized dinner on Friday.

It actually wasn't as bad as I had feared. I did make one concession: on Friday I bought a bottle of "throat spray" to deal with the soreness (or at least numb it away), and I took that to shul with me. I reasoned that while this might technically be in the same category as applying lotions, it's not food or drink and it's medicinal, so it was ok. (You spit it out after gargling with it. I would have taken pills if I'd had anything that I knew to work and be non-dehydrating. I wasn't going to experiment.) Beyond that, I took tissues, tried for aisle seats in case I had to run out, and did my best to minimize contact with other people.

Friday at Kol Nidre I was sweating like mad. I know that our HVAC has unintended climate zones and I was sitting on a supplementary chair in a place in the sanctuary not normally used for seating, so I figured I was just in a bad place. It happened again this morning (in a regular sanctuary seat not known to be bad for heat), and only then did it occur to me that perhaps I had a fever. Well, either the fever broke or the AC kicked in at the beginning of the torah service, and I was fine after that. The sniffling was not bad for the rest of the day and my voice is getting less froggy-sounding. Let's hope I've seen the worst of this.

As for the fast, I found that by about hour 19 I had stopped caring. I expected to be desperate for water by then because of the cold (and wouldn't have been too surprised if my rabbi had ordered me to the drinking fountain). But it wasn't an issue. Yay.

Entry tags:

cats,
health

doctors say the strangest things

A couple days ago, while changing the needle before giving Erik his fluids, I accidentally jabbed myself with the used needle. I called my vet to ask if the kind of hepatitis that Erik (likely) has can be transmitted to humans. She said she didn't think so but I should consult my doctor. (She said that he doesn't have the human strains, like B or C.)

So I called my doctor, and he said he didn't know but he would check. I gave him my vet's name and phone number so he could get anything he needed from Erik's medical records. I kind of figured that he and my vet would talk in medspeak not meaningful to ordinary humans, or something.

He called back the next day and said that he'd gone on the internet and he didn't think there would be a problem, but if I saw $symptoms I should give him a call. Err, ok, I could have done that -- and did, but found nothing conclusive. I think he was trying to be reassuring ("you can find anything on the internet"), whereas I see "going on the internet" as, at best, comparable to "going to the library". (It might also be "going to the local bar and trading gossip", of course.) If you went to the Johns Hopkins medical library, you probably got good information -- but you could have gone to the children's section of some backwater library for all I know, and been reassured that the Cat in the Hat would have said something if that were possible. I trust my doctor (if I didn't he wouldn't be my doctor), and I'm confident that he found reputable information, but his way of presenting that was not as helpful as he thought it would be. :-)

Entry tags:

health,
viz

I don't think so...

Dear $health_insurance_provider,

I am in receipt of your letter, sent on your behalf by my employer, urging me to fill out a "health risk assessment" so that you can provide me with an "action plan for [my] health". It appears that you are proposing to make recommendations for my medications, lifestyle, diet, and, for all I know, hypothetical affinity for skydiving, all on the basis of a questionnaire.

You are, of course, aware that as a condition for acquiring your insurance services, I designated a primary-care physician who is responsible for overseeing my care and who is, you know, an actual doctor. If you care to open up your file on me, you will see that I do in fact avail myself of his services on the conventional, recommended schedule. In other words, I already have a source of sound health advice, and I do not need to augment it with a source of less-sound advice offerred absent any actual examination of me. I understand that some of your customers might not be availing themselves of their doctors' services, but perhaps your effort would be better spent encouraging them to change that instead of offering medical opinions via email.

While you do, of course, influence my doctor (through your decisions about what you will and will not cover), I think my doctor is more likely than you are to prioritize my health over your costs. So if it's all the same to you, I plan to stick with my current plan for continued good health.

Entry tags:

health,
vision

eye exam

I saw my opthamologist for my regular checkup today and was surprised to learn that medicine's understanding of glaucoma has changed since it was last explained to me. I guess I think of glaucoma as an old, well-understood disease that doesn't change much.

For the first time ever, while my eyes were numb anyway they applied a second gadget. After the round of "heywaitaminute, tell me what you're doing before you do it", I learned that this gadget measures the thickness of the cornea. (The technician doing it didn't know the mechanism and I haven't gone looking yet. I wonder if it's sound-based; how else would you measure the thickness of something like that?) She noted that my corneas are thicker than normal but would not pronounce that good or bad.

My opthamologist pronounced it good. Well, not good in absolute terms, but it turns out that people with thicker corneas tend to measure higher for eye pressure, which is what the glaucoma test measures. So my pressure might not be as high as they think it is. Hey, I said, my pressure has always been borderline anyway; is high pressure the sole detector for this disease and do I really have it?

She said that contrary to what I was told when I got the diagnosis (and several times since), high pressure isn't the definition of glaucoma. That's just high pressure. Glaucoma is a condition of the optic nerve usually caused by high pressure, though there exist people who have low pressure and the optic-nerve condition (and people with high pressure without effects). I do have damage to my optic nerve, though she hasn't noted it getting worse (which is both good and expected).

I should have asked her to describe what the medicines I take do, just to satisfy my own curiosity. (And, well, my co-pays just went up again...) My impression is that one is about lowering the amount of ocular fluid produced and another is about venting it, and I'm not sure what the third is. Oh well; I can ask next time. She said that she is not going to change the treatment at this time based on the cornea thing because that's speculative, which sounds right to me. There's plenty of time to ask later if I'm actually taking the right mix of drugs; it sounds like, at worst, I'm taking something ineffective. I'd rather not waste money on something known to be useless, but when in doubt, my eyes are a heck of a lot more important than saving some money.

She also suggested that it may be time to get pictures of my optic nerves taken. I gather that the philosophy is similar to that of the mammogram: at a certain point you start looking and from there on you're looking for changes. She described the process for the eyes as "sort of like a CAT scan but without radiation", which doesn't tell me directly (I don't know from CAT scans) but I can apply Google. She said it can wait until summer, when I'm next due for a visual-field test, and they can do 'em together. Ok, whatever.

I'll be interested to compare notes with my father, from whom I inherited the glaucoma, to see what his doctor has been doing lately.

Tidbit picked up in passing: my opthamologist has been practicing for 13 years. I've been seeing her for about 8; I hadn't realized she was so new when I started going to her. When choosing a doctor there's an interesting trade-off between recency (more up-to-date education) and decades of experience (seen more "in the wild"); I'm pretty happy with her, though I got her semi-randomly so that's just luck.