Sunday, December 10, 2017

SCANXIETY - HOW I HIDE FROM IT Midnight Special

When I left the medical bldg after my very, very tardy Prolia shot (talk about being allergic to the world for some weeks) I was handed a fistful of orders for things to do.  And I knew one of them was for a new breast exam - typing this I get a mental blind spot...oh yes, it's called a....mammogram.  I blame the blind spot on my age not on voluntary amnesia'.

Another order was for bone density, but I was only curious about that one.  The annoying part is getting no results until I see my oncologist, who handles my bone stuff these days.

I've read a lot about scanxiety today to see......what?  To see if my pushing mammo thoughts out of my head is normal.  It's normal:

To think of my friend in another state, and how she hasn't told me yet if she really is refusing treatment from now on.

To think of my best friend from my beach days, who died too young of breast cancer that the mammo of those days did not find. Or was it no different from the one I get tomorrow?

And to realize some things I'm doing that I didn't want to do, and sorta did want to - like some drawing.  I can obsess on that and forget that I'm maybe hiding from the mammo.

To make these days more interesting:

We've had bad weather lately, the kind women formerly from CA do not drive in willingly. Like there were still sturdy hailstones on my car the second morning from snow storm two days ago.  But now it's balmy forecasts for this week.

I scheduled Onco Dr.  for Thursday, so if the mammo people tomorrow think they see a problem, I only  need to wait from tomorror to Thursday to talk to him.

I remember I may have been the only person who really, really hated the stereotactic biopsy that revealed the DCIS, the only good thing about it was meeting the ultra-qualified imaging guide for that, who is from CA and super nice.  And going to Starbucks afterward.

But also I remember how much I hated the phone manner of the doctor who said "there was cancer."

I have good thoughts, like: the lumpectomy surgeon is a good guy and I don't even know if he's still practicing,

And my oncologist is kind, friendly, respectful, and....the first day I was filling out paperwork to meet him, a woman next to me said You got the good doctor!  And he is.

ChaChing Queen.com advises us to accept a result we may not like:  If I don't like tomorrow's findings, I couldn't have a better doctor, better friends, a wonderful daughter here in town.  But Money for miracle drugs ...not so much. 

I've had some really kind , really skilled doctors so far.  And I know some amazingly kind cancer survivors here.

That's a start.


Saturday, November 18, 2017

OVERTREATMENT - Who's guilty/? Who suffers?


Rich Duzak, MD on TW referred to this article/study:

https://mobile.nytimes.com/2017/09/06/well/live/health-care-overtreatment-doctor-survey.html?utm_content=buffer0dd92&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer;

Overtreatment is Common, Doctors Say, which referred me to;

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181970 Findings were that "over 20% of all medical care" was unnecessary"

Their numbers were specific enough to make me examine some of my past care memories:

"22.0% of prescription medications",  
Yes, I did leave a doctor due to too many RXs for pain killers, and no RX for physical therapy.  Have you ever left a doctor for prescription reasons?


"24.9% of tests"
Cancer has come into my life more than once, but I'm inclined to believe the endless biopsies I've received were probably all necessary, and so was a slight surgery performed during one biosy.

One of my current MDs agrees with my negative opinion of a certain test I took, and agreed with me Rabout another that I don't want.  Recently my primary MD gave me a chest Xray because my allergy cough was so bad I couldn't drive.

Have you ever left a doctor because you felt you were getting too many tests?

And here's no surprise:  The doctors responding to the study were not the first to blame part of the #s of tests on pt demand.
Have you ever "forced" your doctor into a test he didn't think was needed except to let you win or calm you down?

 "and 11.1% of procedures."  
This one made me a little queasy:  More than a little.  Most procedures are just plain NOT reversible. More scary, they can leave us in worse shape than before, or (face it) dead.

Then the AHA! moment:  "More than 70 percent of doctors conceded that physicians are more likely to perform unnecessary procedures when they profit from them,"

And they give specifics, like unnecessary spine surgery (I think mine was probably necessary, but I've read often of others that were not and are not necessary.)

The study senior author, Dr. Martin A. Makary, a professor of surgery at Johns Hopkins., mentioned a couple other typical surgeries that may often be unnecessary. 
In all my reading, better training is all I remember ever seeing suggested to lower these figures.

In a strange town, or after an accident, we may need more safe choices.  
Has your doctor ever mentioned this overtreatment problem?  Has he ever told you that a surgery you suggested (or insisted on) for yourself was unnecessary?

But surrounded by familiar faces, how do we know what's necessary?   Oh...

The Second Opinion?




Friday, October 27, 2017

ATTITUDE ADJUSTER COFFEE BREAK

New in town, I sulked my way thru a huge grocery market.  Why don't they have the food I always bought at home in L.A.  You know, regular food!

Then, out of the corner of my eye, I noticed a pair of silver shoes - not your ordinary silver shoes. Not silver sneakers.  Glittering, new, company-for-dinner-flatware, blingding, fairy-tale movie, smooth leather slides.  I wanted to laugh, sneaked a look at the wearer to see if I might get slapped. We both smiled, then laughed.

The gorgeous young woman said "I was almost afraid to wear them." 

I assured her it was the perfect decision, and insisted:  There are times when it takes such a completely unlikely, unimagined, fun perspective to blast away a clunky, who-needs-this kind of a morning.

I wish you smiles.

Tuesday, October 17, 2017

MAYBE WE WON'T GET THE DOCTOR WE NEED




  Writing the Surgery post, I got a short reprieve from the real picture. I thought those steps and sources and questions would help us get the doctor we want.  Then a 5 yr old NY article re-issued re  Twitter, from one of our most famous doctors, threw cold water on my hopes.

Dr. Atul  Gawande sees our chances of getting an excellent doctor as definitely not guaranteed.  The article, THE HEALTHCARE BELL CURVE is subtitled "What happens when patients find out how good their doctors really are/"  And as I read on, it seemed to I had to face ..or how good they aren't.  Dr. Gawande, as he makes clear in his book, BEING MORTAL does not sit in an ivory tower and tell us what to think.  He travels to the places where medicine is or is not practiced in excellence.

He draws us in with the first chapter of a story of  a sick little girl, Annie; who we find has been taken to the famous hospital that is the very wrong one for her. 

Then we learn why it's so tough to find a find doctor:  The Bell Curve--how does it look?  "What you tend to find is a bell curve: a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle."
 He doesn't expect complete perfection nor movie miracles in impossible situations.
  "What one really wants to know is how we perform in typical circumstances.   After I’ve taken out a thyroid cancer, how often do my patients have serious avoidable complications? How do my results compare with those of other surgeons?"


How can we stay away from the poor or worse ones?  He tells us it's not easy to get the facts: 
The results of their treatments is hard to get - in some cases hospitals and specific illness groups don''t always keep track.  And keeping track is hard to do, in part because of privacy laws.

Attempts to keep score by number of deaths also doesn't impress him--there are emergencies and uncommon variances.  But sometimes differences by hospital, for example, are unexpectedly dramatic.  "A Scottish study of patients with treatable colon cancer found that the ten-year survival rate ranged from a high of sixty-three per cent to a low of twenty per cent, depending on the surgeon."  And that's not the only disease with scary differences.


Maybe the doctor we're considering doesn't even know where he is on the curve - so what will we get when we ask? 

WHAT TO DO WHEN WE SEE HOW FEW MAY HAVE RIGHT ANSWERS?

If you don't want to read the whole story of records & and improvements in CF, Annie's disease, at least you might like the story of how a CF doctor in Gawande's "good" example, deals with a very young patient who's been backsliding, and how he makes a deal with her, and gets her back to safe self-care.

It's a happy ending.  Shows us in an action what can be done.  But where does such care fit into  our  fifteen-minute MD visits?

Of course, we want good hospitals,and good doctors who have the best knowledge, and who can think. 

We can't just hold on, live with that cancer or whatever we suffer from, until our medical schools turn out more greats, and the answers:  my brother died while doctors admitted they were keeping him alive until a better cure became available.  We want more hospitals that let the best doctors do what they need to do, when they need to do it.  

Please. 

Sunday, September 24, 2017

SURGERY? WHO YOU GONNA CALL? Real help



Surgery!     .  You may already be a surgeon's office.  You called  because something is very wrong. .   The surgeon who is talking to you now may already have a plan.     .He (or she) starts talking about what will happen.  This can make us think it's decided. But we must ask our questions, answer some of his, and be prepared

 To say that's all we can handle for today
 To tell him we will want a second opinion.  
To stand up, thank him and 
Walk out.

Surgery for most is permanent and risky.  Do-Overs do not fix what's been done, and we won't get 0ur money back. If you don't read all this, please at least read the last section.

A recent AARP  article "PICK THE RIGHT SURGEON subtitled Act as if your you choice is a life or death decision--because often, it is."  convinced me to work on this.  The writer, Linda Marsa emphasizes that any thing with knives can have "life-threatening complications."

Some state medical groups police their doctors.  My state medical board has punished some.  But doctors don't always police themselves.   A pub-med article lately said some doctors don't reveal bad doctors because they think... nothing would be done about it, or there's a "fear of retribution." https://www.ncbi.nlm.nih.gov/pubmed/20628132

The good news: her quote from ProPublica:

  "One group of 756 highly active surgeons
 didn't have a single complication over five years."

Later Marsa suggests such great results should happen oftener, quotes a study for one kind of surgery, death rates 4xhigher for those who performed fewest of a certain surgery compared to those who performed the most.  (Doctors have even tweeted that doing a certain number of times counts.)

Also she ssays MBJ finds that specializing in one demanding complex surgery type "significantly cut the risk of complications and mortality."  So we ask a lot of questions like: how often, and is it your specialty?

She also has other places to search:

For credentials, the Federation of State Medical Boards has fsmb.org.  Click Consumer Resources
     For reprimands -for $9 they will give you disciplinary history
     Some state med boards have doctor profiles fsmb.org/policy/contacts
For  surgical board certification, certification matters.org, or call: 866-ASK-ASMS.
For specific errors, Consumers Checkbook or Pro Publica.  Remember some doctors take on very difficult patients which may affect their success numbers, while others take the easy ones. 

MD Referrals:  With the spine surgery - my primary doctor  knew everybody. I took his suggestion, and the spine has been great.  But another time I didn't take his first choice because I had met that surgeon and didn't like him. And my rule is:

Nobody I don't like is cutting me!  Period. 

 If you are new in town, you may not even have a doctor or a few friends to ask for recommendations.  If you're working, there might be someone you could cautiously ask.
A co-worker led me to  my beloved L.A. doctor.

 At the dentist, in the mammography place, in the drug store, keep your ears open:  I was lying on a gurney in the hospital hall once when a nurse saw the ticket on my gurney: Ooh!  You got Dr. G.  He does fancy!   Yes, Marsa admits - hospitals don't always kick out bad surgeons.

She suggests "Identify surgeons approved by your insurer."  I haven't tried that.

So it is possible to get a good one.  One more suggestion:

The hospital referred me to the solo lumpectomy surgeon. He did a good job, answered questions, told me I didn't have to do anything further, showed me my path report, gave me referrals including the oncologist I love.


Once you've got a name or three,  Do Not Skip This Section.  This is where we pin down the surgery facts way before our Yes or No.

 HOW TO INTERVIEW A SURGEON.    
Ask and persist until you get answers:

Can this be done with minimally invasive surgery - like laparoscopy or...?
What percentage of these involve open surgery?
What percentage of these have complications?
 Is hospitalization involved?
Do you specialize in this surgery? 
How many of these have you done?
What are my risks?  And above all...

DO I NEED THIS SURGERY AT ALL?  

Then as Dr. Cedrek McFadden's Tweeted:
"If no common ground or respect is found, move on." @cedrekmd


Sunday, September 17, 2017

A QUOTE I WILL KEEP - MIDNIGHT SPECIAL



Engineer, Air Force brigadier general, and surgeon: Michael Yaszemski, M.D., Ph.D., re time after last rites as he awaited surgery:

“I flipped a coin and it stayed up on the living side,”



 Mayo Clinic Discovory's Edge This week



Saturday, September 16, 2017

COLD MEDICINE - what's in it, good or not so good - COFFEE BREAK

On twitter this morning:  on a site Compound Interest

A picture chart (whatever they call them now) on what's in cold medicine and how does it work by Andy Brunning

You can see the picture on..... click this:







http://cen.acs.org/articles/93/i45/Periodic-Graphics-Chemistry-Cold-Medicines.html

I wish you health