Archive for Ease and Disease

Apple Bloom says get with it

Life is too short to spend wallowing in depression, says a 17-year-old singer/actress:

While we’re at it, let’s get a second opinion:

I suspect The Truth Is Somewhere In Between.

(Slightly salty language in the second video.)

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Going before the voters

California has a ballot initiative for statewide single-payer health care, and in terms of ballot language, it is admirably clear. Senate Bill 562, if you please:

The people of the State of California do enact as follows:

SECTION 1. This act shall be known, and may be cited, as the Californians for a Healthy California Act.

SEC. 2. (a) The Legislature finds and declares all of the following:

    (1) All residents of this state have the right to health care. While the federal Patient Protection and Affordable Care Act brought many improvements in health care and health care coverage, it still leaves many Californians without coverage or with inadequate coverage.

    (2) Californians, as individuals, employers, and taxpayers have experienced a rise in the cost of health care and health care coverage in recent years, including rising premiums, deductibles, and copays, as well as restricted provider networks and high out-of-network charges.

    (3) Businesses have also experienced increases in the costs of health care benefits for their employees, and many employers are shifting a larger share of the cost of coverage to their employees or dropping coverage entirely.

    (4) Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans guided by the plan’s economic needs rather than consumers’ health care needs.

    (5) To address the fiscal crisis facing the health care system and the state, and to ensure Californians can exercise their right to health care, comprehensive health care coverage needs to be provided.

(b) It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state.

Okay, that name is terrible. And “rights,” at least the way I learned about them in school, simply exist; they can’t be created out of whole cloth by mere humans.

Still, the Trump administration’s executive order calling for killing off Obamacare also calls for the Feds to “provide greater flexibility to states and cooperate with them in implementing health care programs,” and I figure that if Californians really, truly want this, whatever it might cost them in the long run, I can’t think of any good reason why they shouldn’t have it.

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No carbs for you

There are folks who never get near carbohydrates, and they’re perfectly happy about that. And then there are the rest of us:

My take has long been that if you like low carb — if you find it a pleasant way of eating, feel good on it, and lose the weight you want — then by all means, great. I’ve written several posts explaining that my experience on such diets has consistently been the opposite. I find them tremendously unpleasant, feel physically bad while adhering to them, and to top it all off I don’t even lose weight.

My own rule on such matters is simply this: any dietary advice intended to be all-inclusive will eventually prove to be utterly worthless. For all I know, by 2030 they’ll be pushing Cool Whip as the One Perfect Food, and Cheez Whiz as the Indispensable Supplement. Or they won’t. I don’t plan to give a damn one way or the other.

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News for the pre-deceased

This advice is worth considerably less than what you paid for it, even if you got it for free:

I just get frustrated at all the unwanted health advice we seem to get pushed at us. There’s also a series of PSAs now about pre-diabetes, and there’s apparently a website you can go to if you are wondering “Am I pre-diabetic?” (I suspect it’s just a page with a big red YES written on it, and GO TO YOUR DOCTOR and DON’T EAT ANYTHING BUT VEGETABLES on there)

Well, this is what Wikipedia says on the topic:

The page “Pre-diabetic” does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.

I did eventually turn this up:

Fasting blood glucose levels are in a continuum within a given population, with higher fasting glucose levels corresponding to a higher risk for complications caused by the high glucose levels. Impaired fasting glucose is defined as a fasting glucose that is higher than the upper limit of normal, but not high enough to be classified as diabetes mellitus. Some patients with impaired fasting glucose can also be diagnosed with impaired glucose tolerance, but many have normal responses to a glucose tolerance test.

Allow me to point out that the only people with no risk factors are already dead, and they could not possibly care less about glucose levels.

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The Death Panels approve

The Food and Drug Administration, by law, takes no position on pricing. The advantages of their neutrality are occasionally offset, though, by stories like this:

Here’s yet another facet of the U.S. drug pricing conundrum: older treatments which have been around for years can win label expansions that significantly increase their value, and consequently, their list prices. That appears to be the case with Marathon Pharmaceuticals’ deflazacort, a steroid that has now achieved FDA approval for treating the devastating muscle-wasting disorder Duchenne muscular dystrophy (DMD). There’s a dearth of available DMD treatments (and the most recently approved one in the U.S. was cleared under a cloud of controversy), so it’s not hard to see why the FDA wants to speed treatments to the finish line. But Marathon also decided to price the drug, which is available for less than $1 per pill in Canada as a steroid, at $89,000 per year. And since the treatment isn’t already approved in the U.S. for other, cheaper indications, there’s no risk of doctors prescribing it for off-label purposes to Duchenne patients.

Then again, this sort of news is by now old news:

In recent years, companies that have gotten old or existing drugs approved to treat rare diseases have reaped big financial rewards. For example, tetrabenazine, a drug that was available from abroad and used for years to treat the uncontrollable tremors of Huntington’s disease, was approved as an orphan drug in 2008. In 1998, it cost $42.28 for a bottle of tetrabenazine pills from a European pharmacy, according to Joseph Jankovic, a neurologist at Baylor College of Medicine. After receiving approval as an orphan drug, that bottle of pills — now known by the brand name Xenazine — carried a list price of more than $6,000 in the U.S. in 2008. The price was repeatedly ratcheted up to more than $21,243 a bottle, according to Truven Health Analytics data. Xenazine accounted for $325 million in U.S. sales in 2015, the year it went generic, according to data from Evaluate, a market intelligence firm.

I suppose I should be grateful that none of the stuff I take costs as much as $10,000 a year. (Yet.)

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No way out

When the options are no options at all:

I knew what CGM was, but I’d never seen it in action. Here’s the pitch:

A continuous glucose monitor (CGM) determines glucose levels on a continuous basis (every few minutes). A typical system consists of:

  • a disposable glucose sensor placed just under the skin, which is worn for a few days until replacement
  • a link from the sensor to a non-implanted transmitter which communicates to a radio receiver
  • an electronic receiver worn like a pager (or insulin pump) that displays glucose levels with nearly continuous updates, as well as monitors rising and falling trends.

Some days you can’t win for losing.

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The cost of crowdfunding

Last summer while I was laid low by a wrecked nervous system, a friend who is a legitimate social-media maven suggested turning to GoFundMe; the campaign didn’t quite make its $4000 goal, but the last installment on the hospital bill was only $3800 or so, so I figured I had no reason to complain.

There are, however, some ethical-ish questions raised by this practice:

Medical crowdfunding could have negative effects on equitable access to health care. The likelihood of a crowdfunding campaign reaching its funding goal may depend in part on factors such as the kind of treatment needed and the reason for the campaign. Differentiation by the popularity of the medical cause or sympathy for the recipient goes against principles of treating patients according to the severity of their medical needs or aiming for the greatest good in treatment. In other words, funding according to popularity runs against evidence-based attempts to use our health care funding as fairly and efficiently as possible.

I have always felt that I had more recognition than I could possibly deserve, so I can see this, maybe.

Other factors, such as the recipient’s physical appearance, social connections, ability to get media attention for the story, and online communication skills are also likely to affect a campaign’s success. If those characteristics are correlated with the recipient’s position in society, then medical crowdfunding will have a tendency to benefit mostly those who are already in a relatively advantaged position.

At this one, I shrug; life has always favored rich young pretty people, the sort who get mentioned in Vanity Fair sidebars while still in their twenties, and it would be silly to expect otherwise from their crowdfunding campaigns.

If we had a truly egalitarian healthcare system, perhaps some of these concerns would evaporate. But I think it’s a safe bet that other criticisms would arise, particularly among those who fancy themselves the Official Measurers of legally defined equality.

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Like, cosmic, man

This came in the mail yesterday:

You are invited to participate in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS), an exciting new randomized clinical trial being conducted by Brigham and Women’s Hospital in Boston, MA and the Fred Hutchinson Cancer Research Center in Seattle, WA.

COSMOS is studying the role of cocoa extract and multivitamin supplements in improving health. The trial is conducted entirely by mail, with no required clinic visits. Studies have found that cocoa extract may reduce the risk of heart disease and age-related cognitive decline.

If you’re interested — they’re looking, they say, for men 60 and over, and women 65 and over, who have not had cancer, a heart attack or a stroke — the details are here. I’m still weighing the possibilities.

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And the food just makes you sicker

This cancer patient has enough to worry about, don’t you think?

It took a long time, but thanks to a couple of occupational therapist ladies and a food therapist, the nurses and other staff here eventually noticed that I was was physically wasting away due to a mixture of the poor diet being offered on the menu here and me suffering an almost complete loss of appetite due to said menu. For instance, a side salad consists of two tomato quarters, three slices of cucumber and a few slivers of lettuce. For the past couple of weeks, my daily food intake has been a couple of slices of toast with butter and a small bowl of Rice Krispies for breakfast, a couple of satsumas for lunch and maybe some more satsumas or nothing for dinner.

For “satsuma,” feel free to read “tangerine.”

Anyway, the staff dietician perhaps has cleaned up her act:

Now I’m being given special fruit energy drinks and fortified soups that they say I’ll still be able to receive for free when I return home. Also the occupational therapists and food therapist have said that I should turn the conventional healthy-eating rulebook on it head and eat the complete opposite. Fried meat and eggs. Double strength milk with lashings of cream and butter. Lots and lots of chocolate bars and bags of crisps. They’ve given me a four page leaflet filled with the most unhealthy foods you can imagine and told me that I should now follow this diet. Mind you, I’ll probably then end up dying of a heart attack.

As the late Warren Zevon once pointed out, “Life’ll Kill Ya.” And this is how it’ll do it.

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Advantage: cheapness

Out of yesterday’s tweetstream:

Which ends up here, and to these two paragraphs deemed relevant to my interests:

The blood pressure medication Dean had taken for 20 years was hydrochlorothiazide. It is the most commonly prescribed medication for blood pressure, not because it is safe or effective, but because it is the one insurance companies choose to pay for! Below is an eye-opening quote from an article sent to me by a reader. (Thanks, Joan.)

‘In an article published in Postgraduate Medicine, Saint Luke’s Mid America Heart Institute, leading cardiovascular research scientist, James J. DiNicolantonio, Pharm.D., and cardiologist James H. O’Keefe, M.D., examined some of the most commonly prescribed blood pressure medications and their effectiveness in reducing heart attacks and mortality versus a placebo. In many instances, the research revealed that often the most popular medications are not only not the best, in many instances they are not any more effective than a placebo or may actually cause harm… The most commonly prescribed thiazide diuretic in the United States is hydrochlorothiazide, with more than 1 million people receiving a prescription in 2008. However, this medication increased cardiovascular death and coronary heart disease compared to both the placebo and control in two clinical trials. Alternatively, only 25,000 people received a prescription for chlorthalidone in 2008, even though this medication consistently demonstrated significant reductions in heart attacks and strokes compared to placebo… Currently there is no universal rating system in the United States where medications can be selected by clinicians based upon their effectiveness. Rather, insurance companies ‘pay for performance’ or ‘pay for service,’ but this does not guarantee the selection of effective medications.”

Read the full article here: http://www.prweb.com/releases/2014/11/prweb12291899.htm.

I have always suspected that a drug manufacturer would rather sell you a hundred thousand pills over 25 years for $4500 than sell you a single treatment for $20,000. They evidently make it up in volume.

That said, I have been taking some form of HCTZ — generally in combination with, yes, potassium — for more than a decade. My heart’s fine, if a tad irregular; it’s everything else that’s messed up.

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Why there will be no TrumpCare

David Brooks came up with this howler:

The Republicans are going to try to introduce more normal market incentives into the process. They are probably going to rely on refundable tax credits and health savings accounts so everybody can afford to shop for their own insurance and care.

Nobody actually believes this, of course, least of all the Z Man:

As soon as the phrase “market incentives” comes up, you know that there is no existing market. This is a phrase cooked up by managerial class types so they can engage in central planning, but pretend they have respect for free markets. Incentives are synthetic creations to get people to do things they otherwise would not do. If you want a market, you don’t want central planners dreaming up incentives to warp the market. What would be the point? You want the buyers and sellers to sort things out among themselves.

Pseudo-intellectual posers like Brooks don’t understand this because he does not have the slightest idea how any of it works, but he is willing to expound on just about everything as if he is an expert. That’s a problem we have in the mass media age. The alleged experts that citizens rely on for opinions spend all their time filling the air with laughable nonsense. In health care, for example, most Americans not only think it is a right, they think it is a product that should never be rationed. This is complete lunacy, but you can’t blame people for thinking it. All the “smart” people say it on television.

All goods and services are rationed. The question with health care is how is it to be rationed. Will it be by price or by a monopoly of supply? Progressives want the latter so that their coreligionists on the health care boards can murder enemies of the faith by denying them health care. The alternative should be arguments in favor of free markets, but instead we get magical thinking from guys passed off to us as conservatives by the mass media. The result is an increasingly misinformed public.

Then again, this is a case where the public prefers to be misinformed, because they think it’s in their best interest, be it financial or philosophical. I suspect the one and only way to get rid of government distortion of the health-care marketplace is to entirely remove the government as a player, and this isn’t going to happen so long as someone’s Aunt Tessie needs to go on dialysis. Square One exists only in theory, and practice says that theory will never be tested. I suspect Donald Trump, who has endorsed single-payer in the past, will do so again — just so long as we don’t call it that.

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Drugs R us, eh?

There was a time when “Canadian pharmacy” was nearly as much a guarantee of Questionable Spam as Nigerian, um, just about anything, and I remembered that time well enough to be bewildered when I received a brochure, in hard copy no less, from a Canadian pharmacy. Well, sort of. This is the opening sentence to the Patient Acknowledgement:

I appoint Global Pharmacy Plus to act as my agent for the sole purpose of conveying my order and prescriptions to a licensed pharmacy in India, Europe and/or Singapore.

No chance you’re getting anything from the Great White North, even though you’re sending your order to Vancouver.

The six-page booklet contains one FAQ page, on which I find:

My prescriptions are on file at my regular pharmacy. What should I do?

You can either make an appointment with your doctor to get new prescriptions, send us a copy/photo of your pill bottle’s label, or send us your detailed pharmacy receipt/invoice.

This is not exactly Prescriptions Filled Without A Prescription, but it’s close.

Though the price list gives brand names, most of the products offered are generic equivalents. One of the exceptions is Vesicare (solifenacin), which in 5-mg strength they sell for $200 for a 90-day supply, quoting a US list price of $580. To me this sounds a little low. A 90-day supply through CFI Care (not their real initials) runs me a $225 copay, so I’d save $13 — shipping is a flat $12 — were I to take them up on their offer. On the downside, they don’t take American Express.

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Now, the gut news

The general opinion of the medical profession is that the appendix exists so that we can have appendicitis; it has no other function.

Then again, it might:

[T]he appendix has evolved independently in several mammal lineages, over 30 separate times, and almost never disappears from a lineage once it has appeared. This suggests that the appendix likely serves an adaptive purpose. Looking at ecological factors, such as diet, climate, how social a species is, and where it lives, they were able to reject several previously proposed hypotheses that have attempted to link the appendix to dietary or environmental factors. Instead, they found that species with an appendix have higher average concentrations of lymphoid (immune) tissue in the cecum. This finding suggests that the appendix may play an important role as a secondary immune organ. Lymphatic tissue can also stimulate growth of some types of beneficial gut bacteria, providing further evidence that the appendix may serve as a “safe house” for helpful gut bacteria.

Says Rand Simberg: “I’m always amazed at the hubris of people who think that, just because they can’t figure it out, something evolved in humans has no purpose.”

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Several units of epicity

After running up $160,000 in health-care bills last year, I figure I deserve this particular accolade:

Epic Patient Refund

Apparently “Epic” is not actually an adjective, but the name of the hospital’s accounting system. Still, I needed a laugh, though not as much as I needed a hundred bucks.

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Difficulties ensue

If you can’t fold a fitted sheet, you’re probably normal.

If you can’t fold a flat sheet, you’re probably me. Poor you.

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Rack adjustment

There are several — at least two, anyway — good reasons why a woman might want a breast reduction, but there are traps waiting along the way to the operating room:

Without insurance approval, getting a reduction in New York City can cost you upwards of $10,000.

My J. Crew Factory Store lifestyle couldn’t accommodate such expenses. Even if I did have ten grand lying around, I’d rather spend it on something more exciting than boob deflation, like a very nice kayak or a few of those Volcano candles from Anthropologie.

Insurance approval was a must for me to move forward.

Easier said than done, though:

Even with all my medical documentation, the insurance company itself had to inspect my honkers. And so, I found myself standing topless in an exam room while a surgeon I’d just met snapped pictures of my chest.

He directed me in what was surely the world’s most awkward photo shoot: “Turn a little to the left … Pull your shoulders back … Move your hair out of the way.” It. was. not. cool.

And even then:

After flinging myself back into the hospital gown with all the poise of an ostrich on fire, I asked the surgeon what he thought my chances were for getting insurance approval. Turns out, after all that, he thought my chances weren’t great. When I pressed, he admitted the approval process was extremely opaque, so he was hesitant to give me any sort of assurance.

Of course it’s opaque. They resist the very idea of patients knowing what they’re doing.

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The cycle begins anew

Thursday afternoon, a new insurance card arrived in the mail. Apparently CFI Care (not its real initials) is not dumping me, despite $150,000 worth of claims in the latter half of the year. (You know, 2016 really did suck out loud.) The employer hasn’t divulged what it’s spending for this coverage next year, but it’s got to be a ton of money, especially since I have enough tenure to get them to pay for the entire ball of wax. The ID and group numbers are unchanged, so I suspect the actual coverages will remain as they were.

As if to ratify my new status, if status this be, the County Election Board sent me a blank absentee-ballot application, which will supposedly put me on the mailing list for any ballot that comes down the pike during 2017. Truth be told, I was hoping not to need one ever again — but with my physical condition in No Improvement mode, I may have to deal with them after all.

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Allow for shrinkage

Last trip to the doctor — this would be the last week of November — I was sufficiently gloomy that he said he would refer me to a psychologist.

Apparently the first appointment available is on the sixth. The sixth of February.

Hey, it’s a blessing of sorts that I’m not very good at suicidal ideation.

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Another insomnia update

Having once again brought my sleeplessness to the attention of the medical profession, I have been prescribed two new (to me, anyway) drugs: Elavil (amitriptyline), a tricyclic antidepressant which is occasionally prescribed off-label for insomnia, and Neurontin (gabapentin), an anti-seizure drug which has some unspecified effect on nerve pain. This is probably consistent with everyone else’s experiences: the Wonder Drug of the moment works for a while, right up until the moment when it doesn’t.

I will say that the Walgreens pill bottle, while unintuitive, is somewhat less excruciating to operate than the CVS equivalent. And speaking of CVS, CFI Care (not its real initials) is not the only insurance carrier to dump them; Tricare, provider of civilian health benefits to military and dependents, is also leaving the CVS fold.

I also discovered this evening that I am much less able to pump my own gas after a full day of work: I had to lean up against the car for almost the entirety of 13 gallons (at the scary price of $2.399). This does not happen when gassing up at noon on Saturday, as is my usual wont.

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Insomnia update

Current puzzlement: how it is that no matter what time I get to bed, I don’t seem to actually fall asleep until nearly sunrise. (Experimental range: 10:15 pm to 2:30 am.)

First possibility to be explored: 600 mg of alpha-lipoic acid is too much. I skipped it yesterday, with no discernible effect.

Next: Overdose of melatonin (10 mg). Perhaps it worked better when I was taking 5.

Last: No commercially-available sleeping pills, either over-the-counter or prescription, work for me anymore. In which case, something triggered by sleep deprivation is likely to do me in before too awfully long. I certainly can’t work like that.

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Reversal of course

For a couple of years, I’d taken alpha-lipoic acid as a supplement, mostly motivated by “Well, how can it hurt?” The American medical establishment sneers at it because “Ew, supplement!” However, apparently it’s approved in Germany for the treatment of diabetic neuropathy. When I ran out in late September and my reorder went undelivered — Amazon says it came back to them — I figured I’d see if it made any difference if I did without.

Inasmuch as I’ve been in serious decline for the last month and a half, I decided to start taking the stuff again. Maybe it will work again, if it worked the first time.

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A laugh a minute

I woke up several times before the alarm, and finally dragged myself to the bathroom about five minutes early. I completed the sink-based ablutions with the usual amount of difficulty — a rather sharp departure from vertical — and made for the shower. In my current state of disrepair, I have adopted a procedure: grab one of the two bars retrofitted to the toilet, swing one leg over, grab the windowsill and swing the other leg over.

Not today. I got halfway up and came down hard on the side of the tub. Okay, fine: both those bars are within reach, I’ll just pull myself up. Also not today. I could get a decently firm grip on those bars, but I could not lift myself to standing position, no matter how much I pulled. Finally, with one last tug, I sank to the floor, to the accompaniment of the dreaded Spew Noise that told me I’d just broken the toilet.

Naked and wet, I crawled the entire length of the hallway, about 25 feet, to get to my cell phone, and summoned 911. The EMTs couldn’t haul me up to vertical for more than fractions of a second, and finally I was shipped off to the emergency room, muttering things about “So this is my last ride” and other Darryl Downer quotes.

ER found only one thing that could have caused this: excess fluid buildup in the legs. So they shot me up with 40 mg of Lasix, waited while I passed a couple of gallons of fluid in a mere two and a half hours, and then sent me home. I could stand, though not especially well.

Extra Special Downside: There is more fluid to pass, and, of course, the toilet is broken. The usual plumber has been called.

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Running Deepika

It was expected that Deepika Padukone would become a professional badminton player, as her father was. But being a fashion model paid better, and eventually, she meandered into film, becoming one of the highest-paid actors on the Indian subcontinent. She won her second of three Filmfare awards for Goliyon Ki Raasleela Ram-Leela, a 2013 take on the old Romeo and Juliet story.

Deepika Padukone in shorts

Deepika Padukone promoting shaving cream

She does promote a lot of products, yes.

Deepika Padukone at the MTV Europe Music Awards 2016

This latter is from this past weekend at the MTV Europe Music Awards.

Deepika has been very out front about her battle with depression:

She’ll be thirty-one in early January.

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Some folks do recover

Wikipedia describes one possible cause of cauda equina syndrome:

CES can be caused by lumbar spinal stenosis, which is when the diameter of the spinal canal narrows. This could be the result of a degenerative process of the spine (such as osteoarthritis) or a developmental defect which is present at birth. In the most severe cases of spondylolisthesis cauda equina syndrome can result.

Ann Wheeler, CES suffererI know from spinal stenosis; I had some serious surgery to correct the matter. I did not, however, develop CES. Now I’m starting to wonder if maybe I should have:

A mother who was inspired by a near-death experience to get “body confident” and go on 20-mile hikes in just a bikini and boots is facing a backlash from other women.

Ann Wheeler, from Clayton-le-Woods, Lancashire, suffers from Cauda Equina syndrome — a rare spinal condition that can cause paralysis.

The 59-year-old claims that the post-op experience motivated her to take up walking and wild swimming as natural pain management as she believes it is as strong as traditional painkillers.

Surgery, you may be certain, sucks:

After undergoing a gruelling five-hour op five years ago, Ann explained she technically died after all her bodily functions shut down.

She explained: “A male nurse helped me get out of bed the following day, I said I didn’t feel very well and the next thing I was out. I remember a doctor working on my chest. When I came to he said ‘welcome back, you’re back with us’. I also remember going down a black hole — it was then my bodily functions had shut down. I turned my life around after that — it took six months to get me walking again but now I can walk 78 miles in three days.”

I’m not walking after four months. Maybe I should have had my bodily functions shut down.

(Via Interested-Participant.)

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Issue forced

I have occasionally grumbled at how CVS has handled the legacy of Target Pharmacy, but not enough to get me to change drug stores, and certainly not loudly enough to draw anyone’s attention.

Or maybe it was. Received in the mail:

Beginning January 1, 2017, CVS Pharmacy #16007 will no longer be a part of your pharmacy network. This includes all CVS-owned pharmacies and CVS pharmacies in Target stores.

Why would CFI Care (not its real initials) do this? They’ve hired something called Prime Therapeutics to run their pharmacy-benefit operation, and it turns out that they own a piece of Prime. And there’s already bad blood:

Prime Therapeutics is suing CVS Health Corp. after the drugstore chain claimed generic drug payment changes will cost it more than $100 million annually.

CVS is seeking about $19 million outside of court from Eagan [Minnesota]-based Prime, claiming the pharmacy-benefits manager violated terms of a 2007 agreement plus federal and state laws, according to a lawsuit filed [in December 2015]. Prime disputes those claims and is asking a Minnesota federal judge to rule that it did nothing wrong and doesn’t owe CVS money.

I do not comprehend, however, how it was that the eight prescriptions filled yesterday at that specific CVS location, official copays totaling $103, were turned over to me for a mere $45. Surely they’re not bidding for my non-network business.

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Vertical hold

I try awfully hard to remain upright, even though I’m starting to think that it may not be worth the bother.

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Everything in balance

And that’s the important thing, right?

(Via Steve Lackmeyer.)

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Some hard-headed research

There are minor concussions, and there are major concussions. And they tend to look exactly alike out in the field, which makes this gizmo pretty useful:

“Did your brain slow down? How do we measure that objectively?” said Dr. Nancey Tsai, the creator of the Blink Reflexometer.

She said the device can answer those questions.

In the blink of an eye, she said the device can determine if there’s been any changes to the brain’s processing abilities. CEO Mark Semler and the team at the Zucker Institute of Applied Neuroscience in Charleston helped make the invention a reality.

“The computer logs 20 parameters per eye — all these different subtleties about the blink reflex,” said Semler. Through quick air bursts, the device measures the brain’s reaction time. Unlike other technology, this provides numbers.

Right now, it has one disadvantage:

The Blink Reflexometer is currently hauled around on a cart, but eventually, they’ll make it into a handheld device to use on the sidelines at both professional and high school sports.

It’s probably pricey, but hey: sportsball.

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A shock to the system

All of a sudden, falling on my sword looks like a good option again.

Something called Tiger Neurophysiology P.C., having collected nothing from my health insurance, evidently refiled; 90 days after the date of alleged services, CFI Care (not its real initials) has decided that these are really legitimate expenses after all, but Tiger is out of network, so I have to pay the entire $7300 and change.

Apart from the fact that I don’t have $7300 and change, I don’t understand this at all. So far as I can tell, Tiger works out of Teaneck, New Jersey. I can think of no reason why they’d be here in the 405. (Duplicate names? Possible, but hardly likely.) The EOB includes five separate entries for “Diag. Medical Exam,” which would seem useless, since I was already in the hospital on the day in question, scheduled for surgery.

I left an email for the insurance guys. But I tell you, I can’t take stuff like this; all by itself, this incident has put me perilously close to suicide watch. And a life that is constantly interrupted by traumatic incidents is not, to me, a life I want to live.

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Lately I’ve been losing sleep

I know this situation entirely too well:

My buddy insomnia does nothing fun to offer up as blog fodder. He has no antics, no card tricks, no dirty jokes. He just keeps me awake.

I yawn a bit as I wiggle my rear deeper into the recliner. I close my eyes for a second, but I know I’m not yet ready to fall into the arms of Morpheus. Insomnia and I have hung out many times in the past. I know his ways. In the old days these late night sessions found me at my creative best. That part of my brain withered long ago. I have always had strange sleep patterns. Even as a boy, I often got up for thirty minutes or an hour at a time in the middle of the night. I would walk the house, go outside and sit in the warm months, read or watch TV before heading back to bed. I know it drove my parents crazy. Until I was probably thirty it was rare if I averaged more than five hours of sleep each night.

Which is about the best I can do today on weekdays.

And for what it’s worth, my weirdest dreams are about two or three orders of magnitude more interesting than anything I try to pass off as fiction.

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