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Sunday, November 06, 2005

WE'VE MOVED!

Yes, we have found a fine new home and fabulous new software. A Fine Whine has grown up and is now known as GAG! A blog taking full advantage of the first amendment. You can find us http://gag.judyanddan.com/

:) see you soon!!!!!!!

Friday, November 04, 2005

Work Place Blues

More frequently than in the past decade I feel I see articles and books on the toxic workplace, dysfunctional management, and even articles claiming that the entire fault is that of the corporation, becoming more money hungry and ruthless with their budget. There was an interesting article on MSN today on difference office types worthy of a Dilbert cartoon. The sad thing is that many people do not know how to act at work. Perhaps it is the fault of fast food and TV dinners as we no longer learn the behavioral skills we once did with the family around the dinner table. For what it is worth, here is the link http://lifestyle.msn.com/MindBodyandSoul/CareerandMoney/Article.aspx?cp-documented=67058>1=7386

Wednesday, November 02, 2005

The Magical Bean

Today, I was brought back to thinking about several episodes in my life where I have encountered someone who achieved a difficult goal and now owns a magical bean. Their magical bean is now the cure-all for all situations. In fact they will tell you about their magical bean, gloat, preach and practically try to force that bean down your throat.

Once, years ago I was doing weight-watchers. I followed their program to a "t". I measured EVERYTHING, exercised and....nothing happened. I cut back. And NOTHING happened. So I went to the group leader to ask what should I do next, as what I was doing now wasn't working. This paragon of intelligence held up her palms and said, "Look, my palms are yellow!" "Yellow?" I inquired. "Yes, I eat carrots, I eat carrots all the time, that is what you should do!!!!" She crowed presenting her vitamin A toxic yellow palms at me again. Of course, being intelligent, I quit.

Later I approached my MD du jour. I told her about how I was having difficulty loosing weight. She also had a magical bean. She went to a drawer and pulled out a mini baggie with A carrot stick and A celery stick. "Eat less," she crowed. "I only eat this and it keeps me going all day." She isn't my MD anymore.

Then there are the bad food police magical beans. I was out to dinner with some of my husband's friends. We were at a lovely restaurant. They conferred over the menu and decided on a caviar plate that came with fresh vegetables. A lovely little appetizer. They tip-toed through the menu trying to avoid the mine field of carbs. Carbs that could explode onto their thighs at any moment! As they carefully divided up their paltry fish eggs betwixt them they regaled us with how much they enjoyed their diet.

Life is for living. If you have a magical bean go grow a beanstalk!

Tuesday, November 01, 2005

Obesity In America

I find I've tried this diet and that diet and they never seem to work for me. So I decided to dive into the hard core scientific literature and find out what science says works.

The sad thing is that we are basically clueless on how to manage the obesity problem in just about any county. There is a high correlation between economic success and obesity. But sadly, encouraging poverty is not a feasible cure.

There are many studies out there that say exercise and diet works. But not the same for all age groups due to differences in metabolism. The other result is that many individuals as they age are not able to keep up the level of activity required to maintain their weight loss once achieved, and study after study reports back sliding.

One of the key facts that does arise time after time, is the reduction in caloric use with age. Also there is a reduction in muscle mass. If muscle mass is increased, caloric use increases. So rather starving, perhaps encouraging muscle development exercise is the way to go.

Currently, I'm upping my aerobic exercise and seeing if I can't develop a bit of muscle mass as well, to fight that metabolic slide downhill.

Sadly, many studies also reported the medical doctors were reluctant to address the obesity problem when it was at manageable level in their patients. It would seem that we need a three pronged approach to manage this problem at the nation and world-wide level as well as help us personally. One would be to encourage food manufacturers and food purveyors to develop healthier foods. Work places should be required to have an exercise room as well as a lunch room. Medical doctors should be required to give workable programs to their patients that are obese and to follow up on their progress. As we work longer and longer hours, eat more fast food to manage our time, and by the time we actually get home, are too tired to hop on that elliptical.

Well, I'm going to crank up the exercise and cut back more on the food. Updates to follow!

Tuesday, October 04, 2005

Dr. Do-Little

A week or so I remember reading and hearing about mice infected with plague getting loose from a research laboratory. A few days later I read of some army trained dolphins that were accidentally released into the Gulf during the recent hurricane. The one catch is that the dolphins were surgically implanted with darts they could fire and were trained to fire these darts at enemy scuba divers. And they were lost while loaded. Well, they don't have a handler now. I haven't heard anything more about these animals after the initial hype. I really believe we are overlooking the next terrorist problem. If you think there are a lot of Muslims on the planet start counting the fish and rodents.....

The Supreme Court

Our new Supreme Court Nominee, Harriet Miers, apparently has her own blog. Read all about her in her own words. http://harrietmiers.blogspot.com/

Signing off

Tongue in Cheek



OK. I'm back. If you want to read some comments about her appointment, one blog is http://www.proteinwisdom.com/index.php/weblog/entry/19125/ Protein wisdom. This blogger does bring up a few rather relevant issues, such as the fact the Miers has no experience as a judge and is a close friend (and hero worshipper) of Bush.

I swear I'm a republican, I really am. But anymore....

Thursday, September 29, 2005

Kids Break Your Brain

Last night I was talking to a friend that just got home 8:30 at night. And she told me both her boss and one other person were still at work. Why? Was it urgent? No, but they both have kids. Our first anniversary came recently, and most of our close friends sent sweet cards. Except my husband's best man. But he has kids. There is only one conclusion about all these people, forgetting to live and have friends. Kids break your brain. One of my co-workers was chatting with a visiting friend who used to work where I work. She came by with her baby to visit. (WHY-this woman must have no life and no friends?) The baby cooed cried and caused general disruption. My other co-worker babbled on about not letting young babies eat honey and how long did the baby sleep for about 2 HOURS. This used to be a smart man. There is only one answer. Kids break your brain. The CDC should issue an urgent alert on this problem.

Friday, September 02, 2005

Biodiesel and Gasoline Price Gouging

I'm tired of the gasoline companies reaching into my pocket and price gouging. I'm tired of the politics that come with oil. Its time for biodiesel. We can make it from cooking oil or soybeans. It is biodegradeable and we can buy it and power cars for more mpg of biodiesal than gasoline. I vote no more oil. Biodiesel. We can create an entire new industry employing Americans, using American products, and rescuing family farms at the same time.

My next car WILL use biodiesel.http://www.biodiesel.org/

Wednesday, August 31, 2005

Pilates II


Well I've been doing a pilates tape for a couple of weeks now and I do notice that I can do a bit more of the exercises each time I do it. The first few times I did it I was relatively sore, but now its getting easier and I'm finding it relaxing.

I'm using Stott Pilates Tapes
and I like the fact that they have a series of increasing difficulty and the tapes are rated at different levels. I'm using the mat only ones, but they make them for the reformer or with home use with various rings and balls.

How long do I think this is going to take? I found this on another pilates web site-and its a general saying:

There is an often-quoted saying in the pilates world within ten sessions you feel different, within twenty sessions you look different, and by thirty sessions, you will have a whole new body. Our experience pretty much backs this up. But consistency is everything.
Our number one results based formula: three times a week, for three months, and two times a week thereafter.

So I'll get back to this topic in 10 to 30 sessions and let you know how it is going and whether I do get an entirely new body. Well, I think that is a little overly optimistic....but we'll see!

Thursday, August 25, 2005

Neighbors and MDs

We have a new neighbor. He is a young divorced MD with kids. He also has an English girlfriend. My husband is English. We dropped in when he moved in and gave him a bottle of wine.

So five or six loud summer parties and about six months later he invites us over for a BBQ. (After we installed an outdoor stereo system). We accept. Even though the invitation came over the back fence and gave us three hours notice (obviously we were a D list replacement for a B couple). But he doesn't know us. So we go. We sit for hours. His mother makes some Indian Corn dish and they put out two dishes with two spoons in it. His kids are swimming and making noise. Eventually he tries to put some chicken on. Another friend of his arrives and his friend's wife goes upstairs and goes to sleep with the kid. Eventually we leave. Nice people but we don't plan to return soon.

Last night we put some music on and he calls. His majesty just went outside and would like it to be quiet. We lowered it but I thought what incredible nerve to think he can dictate our lives and yet we have to put up with his noise. Well I think its time to hit the deck with a glass of wine and a selection of Sheryl Crow.

Amazing how blogging out something that bugs you can destress you.

Once again, I think MD's should be made to work for a set yearly wage rather than how many patients they can get in an hour and make tons of money off people like parasites.

Thursday, August 11, 2005

What's in your garbage?

According to a recent ruling posted by a Montana Judge, its perfectly OK for them to go through your garbage and seek to find things to use against you in court. What would you fear the police finding in your garbage? How about going to hotmail and setting up a one time use anonoymous E-mail and letting me know your greatest fears? If you don't do this I will go into blog depression!

http://www.boingboing.net/2005/08/05/cops_can_dig_through.html

Blog Depression

Weblogs, which everyone knows are blogs now are the hottest phenomena since bubble gum. Everyone has a blog. Many aspire to become blog stars, few succeed. What happens when you never get a comment no matter how many hits you receive, you never get ranked on boing boing or ping ping or blogstars local. Even your mother doesn't read your blog. Then Blog Depression can hit. Here is a link to a public service pamphlet on how to handle your blog depression crisis.

http://thenonist.com/index.php/weblog/permalink/a_nonist_public_service_pamphlet/

I hope it tickles your sense of irony.

Wednesday, August 10, 2005

Evolution


I have always been the black sheep of the family, some members of which are..ahem cough staunch Christians. My husband and I are Episcopalian, and further qualify ourselves as non-evangelical Christians. We don't believe in distributing leaflets, having services on TV or the handling of snakes.

Furthermore, I also firmly believe in evolution. There is just so much evidence for it. That evolution actually occurs can be shown in rapidly reproducing populations.
For some additional reading http://www.evolutionhappens.net/

But I have finally found an argument for intelligent design that makes some sense.
It is even an approach that is culturally sensitive to my Italian heritage.
http://www.venganza.org/

Go ahead...clickit..read it. I have gone to pray to the great noodle.

Special thanks to Bobby Henderson for allowing permission to use the art at the top of this entry from his webpage. Praise all to the Pasta.

Tuesday, August 09, 2005

Breaking News at the CIA

Since I sprained my ankle, I'm surfing the net more than usual. I was browsing through released CIA documents at:

http://www.foia.cia.gov/search.asp

When I discovered the truth about our government in one of the titles...


ADCI MEETING WITH SECRETARY OF STATE WARREN CHRISTOPHER. ALSO PRESENT WERE ASS

*************************************************************************************



Truth, Liberty, Freedom!

Monday, August 08, 2005

Noodle Aerobics

This is a saucy and fun workout. OK I couldn't resist the pun. But if you have achey knees or sprained ankles or just want an alternative this is a great one. My physical therapist recommended I try water aerobics (as I have a badly sprained ankle). I love pool noodles and this was great fun. One of the best things about this is how efficient working in water can be. If you are working with weights on land you need to do one set of curls up with a weight to exercise the biceps and then another set of curls backward to exercise the triceps. However, when you push a noodle down in water you exercise the triceps and as you resist the noodle's buoyancy as it comes back up the biceps is engaged. In one motion you do two muscle groups. Since I didn't have to contend with knees or ankles aching, I found I did a much longer workout. Some of the balancing for the moves was a little harder than it appeared on the tape and I haven't mastered or tried all of them yet. I didn't realize how much hunching over I was doing and how I was twisting my body as I was limping. This allowed me to stretch out my entire body and I felt much better physically after doing this workout.

My only criticism about the tape is that it is in "real time". I don't have a TV/VCR at my pool and therefore must watch it to learn the moves and remember what I can. I think having a segment at the end where they just go through how the moves are done sequentially would be helpful. But aside from that I'm hooked on water exercise. If you'd like to browse one of many water aerobics sites selling tapes and equipment here is the one I used http://www.waterworkout.com/products.amp?product=nw

I've Got a Secret

A friend of mine's nephew has a site that ranks and lists blogs. So I submitted this one and surfed the other blogs. I found one that is amusing, sick, depressing, wonderful and horrible all at once. The concept is that people send in a homemade postcard with a secret written on it. Here is the link. http://postsecret.blogspot.com/
I have been finding the community of blogs to be a wonderful source of information. I have found free patterns for knitting, information on pilates, recipes, and unbiased reviews of books and products (i.e., not marketing).

Well I tried my noodle aerobics tapes over the weekend and found exercising in the water a perfect fit for someone with a sprained ankle. I'll list those tapes and what I think of them in another post.

Friday, August 05, 2005

Dance Fever

Finally, a friend was getting married. I had something to look forward to. I went to the wedding and the old disco favorite was playing, "We are family". All the gals got up and danced. My first mistake was letting the other woman lead. I happily did disco moves I hadn't done since 1980. I spun out, I spun in, I spun out and out and out and over.

So now, a few weeks after re-starting my exercise program...I'm not having a good year...I have a cracked bone in my foot and a badly sprained ankle. So what is a girl to do?

Well as I got tired of sitting, I ordered a tape on Noodle Aqua Aerobics. In the pool last night I announced to my husband that we could do it together. He broke up laughing and said, you'll do it, I'll laugh my a** off! I promptly bopped him over the head with my noodle. I also ordered a series of Pilates tapes. I've done Pilates before and was really impressed at how well it worked. Its also rather difficult. But as I can do "mat pilates" laying on my back, its a way I can keep from degenerating into Jabba the Hut.

I can't wait until my husband opens his birthday presents to find among the fun stuff a specialty Pilates tape for bad backs. Hee Hee.

So any other broken winged aqua aerobics fans out there? What about Pilates fans?

Sunday, July 03, 2005

St. Luke's Cornwall Hospital Newburgh New York

St. Luke's Hospital (and many other local hospitals) proclaim they service the local community. For instance, look at St. Luke's engaging in multimillion dollar construction to get a joint surgery wing in place, one that will make millions, perhaps more, in quick in and out knee, arm, tennis elbow surgeries. A service to the community, right? But when my mother (and your mother and your father and your grandmother) end up in a complex care situation where they need ventilator and dialysis they cheerfully try to ship your loved one off to a place so far away you will never see them again. Medicare even prohibits them from doing this see


Location of Alternative Facilities.--A UR committee considers what facilities are available in the community or local geographic area in deciding whether the patient can be cared for effectively elsewhere. It is not possible to define community or local geographic area with any precision. As a general rule, a community or local geographic area is not defined in such a way as to require a patient to be taken away from his family and transported over great distances.

The above was found in:
http://www.cms.hhs.gov/manuals/13_int/a3420.asp

One alternative a hospital has is to designate a few of their beds skilled nursing beds, for which they can receive Medicaid and I believe Medicare reimbursement. When I spoke to the social worker at St. Luke's, she said they knew of the option, were not planning at any time in the future or now to designate any of their beds as such. Community service to the entire community? I think not, only to what they can bill the highest insurance rates for. What happens when the one you love is unfortunate to require both a ventilator and dialysis and you try to keep them at the hospital? First they make sure all your insurance is cancelled, then they bill you at 3X the rate they accept from Medicare. Then they call you at odd times and leave messages to call them but when you try to call them back you only get an answering machine. Then they start to try to get a guardianship case together where they legally can then make decisions for your loved one because you are being uncooperative. Actually a guardianship is supposed to be in the best interests of the patient. But they would decide the best interest, because you are no longer a profitable patient, is at a facility out of their hospital far from any friends or family. Just off their budget. Indeed. A fine hospital.

They also seem to lie, as documented by the local paper. The link and a bit of the paragrah is included below.

April 18, 2004

Hospital claim not as it seems

By Beth Quinn
Times Herald-Record
bquinn@th-record.com

On both buildings of St. Luke's Cornwall Hospital, a giant sign proclaims, "One of America's Best 3 Years in a Row – U.S.News & World Report."
On its Web page, the hospital prominently reiterates the claim: "For the third year in a row, we've been named one of the nation's best hospitals by U.S.News & World Report."
Its ads in the Times Herald-Record frequently repeat the claim.
Problem is, the claim is, at worst, dishonest and, at best, misleading.
The inclusion of St. Luke's Cornwall in the U.S.News' annual "best hospitals" edition is nothing more than a "statistical fluke," according to the magazine's editor, Avery Comarow
For the rest of the article see:
http://www.recordonline.com/archive/2004/04/18/bqstluk0.htm

Your local representative even has helped get money for the hosptial to expand, but not a single bed for grandma or granpa. It's going to hurt you. Let people know you are displease. Write some letters, make some phone calls. If you look at my past entries you will find one where St. Luke's actually gave my mother antibiotics to which she had a known allergy to and claimed that happened because they did not keep records in the emergency room. There are so many things that need to be addressed that speak to patient care that are not happening at this and other hospitals.

Hinchey Secures $250,000 For Expansion Of St. Luke's Cornwall Hospital
Funds Will Pay For Enhancement To Accommodate New State-Of-The-Art CT Scanner

Newburgh, NY - Congressman Maurice Hinchey (D-NY) today announced he has secured $250,000 in federal funds to help pay for facility modifications that will enable St. Luke's Cornwall Hospital (SLCH) to install a state-of-the-art CT scanner in its recently renovated and expanded Kaplan Family Center for Emergency Medicine in Newburgh.

"These federal funds will enable St. Luke's Cornwall Hospital to enhance its facility so doctors and other medical staff can examine and treat patients with the most cutting-edge technology available," said Hinchey, who used his position on the House Appropriations Committee to secure the funds. "In addition to helping save lives, these federal dollars will further establish St. Luke's Cornwall Hospital as an invaluable community resource that provides much-needed health care services to the residents of Newburgh and the Mid-Hudson region. I'm proud to bring home federal funds that help support the organization’s ongoing efforts to improve its facilities and services, thus eliminating the need for those in our area to leave the region for quality care.”

This initiative will put advanced imaging technology in the heart of the Emergency Department, enabling physicians to quickly and accurately confirm various diagnoses including stroke, and orthopedic and brain injuries. Acquisition of the advanced, six-slice CT scanner also is important as SLCH works toward New York State designation as a Stroke Center.

Friday, July 01, 2005

Coming Soon to Your State


Lookie what I found on Google images.

My Favorite Dress



This is a picture of my favorite dress. A dress I never expected to wear, but at the same time my mother became ill I met a wonderful man, who supported me throughout every crisis. When other men would have run, he stayed. When I cried, he hugged me and when things seemed to be at their worse, he asked me to marry him. Of course I did!!!

I was thinking today on how much of our life is created by choices. And how those choices create our reality. Day to day we have the ability to change the course of our existance step by step through small actions. Watch out healthcare. Here I come!!!

Happier Times Ahead Some of My Favorite Pics

Thursday, June 30, 2005

Spirit of Determination

The one reason why I think we need to take better care of our old folks is their spirit of determination. Their ability to remain happy no matter how poor the situation. Take a look at this blog and you'll see what I mean. Dribble.

Wednesday, June 29, 2005

Death

June 20th Mom died. She died by our hand, so to speak. St. Luke's Hospital racked up bills and more bills. The billing agent called me multiple times a day, and when I tried to return her calls it always went to voicemail. They then said I was being evasive, and yet they never requested information that I could respond to. The hospital cancelled medicare, even though my mother continued to have complex medical treatment, including the replacement of her trach tube set up, vomiting and Clostridium dificile infection and IV treatment of the bug. Her MRSA septiciema returned. The dialysis caused extreme skin itching so she had to be tied down so as not to scratch off her skin. I was dealing with medicare appeals and the hospital trying to evict my mother that I did not have the time to contact outside experts, as I so wanted to.

The family finally decided, after being told by the doctors nothing more could be done that they would release her to Wingate Hospice. I still wonder, if that was true or if the hospital wanted to be rid of her that badly. Euthanasia is illegal, unless the insurance stops paying. The hospital private pay rate was more than 3X that of the medicare rate.

When she was released to Wingate they called to say they were bringing her back to the hospital as she had orders for IV drugs and also they "heard" I wanted a consult for hospice. They did not release her to hospice, with their services as promised. I had to spend two days on the phone yelling and begging and crying to get pallative care in place to make sure my mother's end would at least be as comfortable as possible. Again, they lied.

She died alone and quietly (or so I'm told) after I and my aunt spent the weekend with her.

Medical science, health care regulatory agencies, and health care service itself provided my mother with two years of hell, as they did not practice medicine but insurance.

Thursday, May 26, 2005

A Deer in the Headlights

Today I found out how a deer feels in the headlights of an oncoming car, frozen, seeing a ton of unthinking machinery advance with the purpose of its destruction in mind. Continuing on the delightful theme of my mother's illness, having progressed to a ventilator and a dialysis machine I discovered an entire new level of how hospitals practice insurance rather than medicine.

First I received a call from the nursing home where we were holding a room by paying for it privately to the toon of $700 a day. They cheerfully informed me that they did dialysis OR ventilator but not both. I found on another blog a note written by a respiratory therapist saying the reason many dialysis centers did not take on ventilator patients was a liability issue. I called the nursing home and offered to sign a wavier of liability. In turn they countered that they could not release a nurse from the vent unit to travel with my mother. I countered with I'd hire a nurse from a visiting or other private nursing service for that purpose and pay out of pocket. They called the dialysis center who refused to have my mother enter as a patient as they did not do dialysis on ventilator patients. They want patients who are only sick enough to pay well but not too sick to cause any liability.

Then the hospital called and told me that they had a room for me in a place that does ventilator and dialysis. It was NYC or the Catskills. Neither are near and neither could be visited regularly. I forbid them to move my mother who has multiple other problems aside from the vent and the dialysis ...but apparently is just stable enough to get her tossed out.

Next I get a call that since I refused the first available bed open all medicare benefits were now discontinued. So I started an appeal to medicare and my mother's secondary insurance. Well the secondary insurance turned down the appeal within 30 minutes.

In a nursing home, my mother has to pay privately until she spends down her account for medicaid. So it can be the same with the hospital. So she is staying. Perhaps, indefinately. There is a gap to provide many services to our elderly and I think it is time that we just stand up and protest, that medicine is there to make our loved ones better, to help the entire family cope at a terrible time.

Sometimes when a deer is caught in the headlights the car smashes into them and makes a bloody mess. But once in a while, a driver will turn off his lights and the deer will leap gratefully away. To solve this, that is all I need, a blink of cooperation.

Wednesday, March 16, 2005

Greater Odds: Death by Car Accident OR Death by Medical Malpractice?

I really have to credit my friend Stef at work for pointing this out to me. But first, which statistic do you think is higher? Death by auto accident, you know bad weather, too much to drink, mechanical failure, bad driving, falling asleep at the wheel and at least a dozen more factors or death by sober medical practictioner with years of schooling and preparation for his trade. BZZZZZZZZZZZZZZZZZZZ (rude noise buzzer). Yep, the medical establishment kills more people than car accidents. Try this link on for size http://www.centerjd.org/private/mythbuster/MB_medical_malpractice.htm

Amazing isn't it?

I still like to go back to the idea that a lot of this could be prevented if there was better data management. For instance, going back to my experiences as my mother's health care proxy, when she was last admitted to St. Luke's in Newburgh not only would they not give me any information because they didn't have records in the ER (see HIPAA rant) but they gave her an antibiotic she has a known allergy to. Not only was this information with the transfer records from the nursing home, but on a special medical bracelet I had made for her that had more extensive medical information than usual. But I guess you need to hire people who can read for that to be useful.

One argument might be that perhaps the problem is too big. That there isn't a way to handle this. But wouldn't it be simple if each person carried with them, on their keychain perhaps, a little button of information????? It could carry basic medical information, when and why you were last hospitalized, any allergies and other important life saving data. I'm dreaming right?

No I'm not. Try this link out for size. http://www.maxim-ic.com/products/ibutton/ibuttons/index.cfm

I'm sure there are a dozen variants of this small data system. Even most people carry with them on vacation tiny data cards that can record hundreds of photographs in a square inch. The technology is out there in many forms.

And just think if there was "write only" for hospital records. No information vanishing, no mistakes being deleted at the first hint of a law suit. Ohhhhhhhhhhhhhhhhhhhhhhhhhhh. Geeeeee why didn't I think of that. Paper records are so easy to mis-manage. Perhaps that is why our medical system is lagging so far behind in data management.

An update as of August. Everybody blogs. Even doctors blog. Doctors even blog about their medical errors. Take a look from the other side. http://redstatemoron.typepad.com/red_state_moron/2005/08/medical_narciss.html

If you want to read a little on how medical establishments might prevent MRSA try this http://www.consumersunion.org/campaigns/learn_more/000861indiv.html

Friday, March 11, 2005

Death and Dying in America

Today my husband received some sad news from abroad about a dear friend, only 42 years old, who died of complications from her diabetes. He joked, darkly, on how they did it right over there, as she was dead from a heart attack and various other complications a few days after being admitted from the hospital.

Here in America with our incredible technology, we can keep people alive forever it seems. And even after they want to die, beg to die, we deny them because we can keep them alive. It smacks of an incredible arrogance, not that we can do this, but that we do this.

But then there are also the cases where even with this incredible technology, wealth, and highly educated staff mistake after mistake after mistake is made and swept under the rug. The recent HealthGrades study summarized in an article on MSNBC http://www.msnbc.msn.com/id/5536730/ reports 195,000 that is ONE HUNDRED AND NINETYFIVE THOUSAND US deaths PER YEAR were caused by easily preventable hospital errors. To quote directly "If the Centers for Disease Control and Prevention's annual list of leading causes of death included medical errors, it would show up as number six, ahead of diabetes, pneumonia, Alzheimers disease and renal disease." In another article, MSNBC reports a doctor is sued after 50 botched surgeries http://www.msnbc.msn.com/id/6945667/ kind of amazing that nobody noticed something was being done wrong after the first two or three. The National Center for Policy Analysis estimates that cost of these errors runs about 9.3 billion in extra charges each year http://www.ncpa.org/iss/hea/2003/pd100803c.html. We worry about medicaid costs and social security costs, but if not the costs of stupid mistakes. And this does not even begain to measure the costs of personal pain and suffering or the loss of a family member. But it seems no one gives a damn.

The health care industry has been slowly killing my mother through a series of errors and just lack of caring. They say one person is a tragedy. One thousand a statistic. Here we have a huge statistic but let's blog a little about a tradgedy.

My mother entered the Westchester Medical Center in New York State for a simple test. One that used an iodine dye. She had previously know dye sensitivities. She walked into the hospital, simply with some angina and today is lying in a hospital two years later with septicemia, and pneumonia on a ventilator. My mother had the angiogram at Westchester Medical Center and soon developed a fever and rashes on her skin. The rashes turned to blisters and daily her doctor, Dr. Cohen of the cardiac cath lab, would come in, look at the worsening skin and go "OH that looks better". She asked for a dermatologist and the nurse told her she didn't need one. Let's remember she had previously known iodine dye sensitivities. Finally one came and took a skin sample which was never processed. She had an IV by this point and a friend who was also an RN noticed it was compromised and it took 24 hours to get it changed. I should have just ripped it out myself. By the following Friday her kidneys failed, and her skin was peeling off in sheets and she was moved to the burn unit (allergic reaction to the dye) and she was not expected to live. Next she developed MRSA, drug resistant Staphylococcus aureus, possibly from that compromised IV and Clostridium dificile. She had a hard time breathing. Oh and by the way they diagnosed that she needed a quadruple bypass. This was all in November. By Christmas Eve she was moved to another floor, as her skin was growing back, still under treatment for Clostridium dificile which caused such pain in her gut that she begged me to die.
Well, mom could no long stand by herself. She was too weak and the hospital was chronically short staffed from budget cuts. So when a lone nurse tried to move her, because she could not find help and my mother's arthritic spine had her in incredible pain from sitting in a chair in one position for so long, she dropped her on the floor. In her medical records, no such detail is provided, my mother simply fell. After this I complained to the New York State Department of Health and the Hospital Regulatory Agency JACHO. While I didn't expect the DOH to find everything, I expect them to find SOMETHING. Six months later I received a letter back from them saying that they could find nothing wrong with the hospital and no wrong doing on the part of the staff. JACHO doesn't share its information. The hospital patient relation people never solved anything for me, only tried to placate me and make things go away, rather than using my complaints to identify and resolve potentially dangerous problems. Its no wonder the HealthGrades study reports the new estimate on hospital deaths associated with errors has doubled. Its a crime. Even those supposed to regulate simply make the complaints go bye bye. Why not, its easier that way. And no one gets involved. I'll skip the nursing home nightmare, but by June my mother had another heart attack and was rushed to Westchester Medical Center. Dr. Cohen showed up again and the look of shock on his face that my mother was still alive was criminal. He rushed her back out of the hospital to the nursing home without treating her saying..oh she is too weak and has so many allergies we don't want to do anything. In short, go away and die. Let's get you back to a minimal care facility where that is very likely to happen.

I contacted Columbia Presbyterian. Dr. Oz took my mother on and did surgery. He is a kind and wonderful man. Her recovery was not smooth and by December of 2004 mom was back in the hospital, her chest wound infected. She never came completely off the ventilator from the chest wound infection. If you see my previous posts on the HIPPA rant you will find she has been back in the hospital twice for pneumonia now. They fear the heart valves are infected. Somehow, this has all been a downward spiral, subjecting my mother to test after invasive test and painful time after painful time. This has caused a syndrome called critical care myopathy where her muscles have just quit working. In time, they say things can recover. But her protein levels are constantly low, as she is on a ventilator she is fed through a tube in her stomach, and her nutrition is low and the spiral down continues. I can only wonder, if she had not walked into the doors of Westchester Medical Center, if she would have a decent quality of life today. I blame her condition on medical errors and both the hospital and the New York State Department of Health that did nothing to prevent more errors from occurring and to treat her medically after the second heart attack and all of the errors. But in the end, no one cares, until they are under the knife or dying themselves because of these errors and then it is just too damn late.

Shrug your shoulders if you will, if something isn't done, it is likely you will loose function and quality of life through medical error.

Thursday, March 10, 2005

Health Care Does Not Compute

In an article in the New York Times http://www.nytimes.com entitled "Doctor's Journal Says Computing is No Panacea" by Steve Lohr, a report on computer systems in hospitals is summarized.

http://query.nytimes.com/search/query?query=steve%20lohr&date_select=full&srchst=nyt

Major hospitals have found that computer systems are so poorly designed from a user standpoint that simple information, such as patient medications are scattered across 20 different pages. Reviews, which sing the praises of these systems have often been written by the developer of the system, rather than a user. It seems that a new hybrid technologist is needed. One that is part computer programmer, part medical expert and systems architect. I do wonder how many of these systems, in part or entirely, were designed by outsourced labor in countries unfamiliar with our culture or medical system.

I use a number of systems where I work, that were designed and programmed piecemeal, by individuals who are far from expert in the field. The systems are slow, user unfriendly, cumbersome, and seldom reflect much, if anything that we write in our paper reports. Aside froms statistics for program fund allocation, they really are useless.

The one thing that is irksome, is that medical establishment seems to have a smoothly running computerized billing system. Funny, but when they put a priority on something, they seem to be able to make it work.

July 5, 2005
This just in...record keeping could get better...

The e-Health Revolution

How a bipartisan bill from Hillary Clinton and Bill Frist could help jump-start a new kind of health-care reform

By BILL SAPORITO

Jun. 27, 2005

Once before in his entrepreneurial career, Glen Tullman was standing at the threshold when technology transformed an industry. In the '90s, he helped figure out a system that allowed insurance claims to be recorded and processed on computers, not paper. It made him a bundle.

Now Tullman heads Allscripts Healthcare Solutions, which sells a product that lets doctors run a paperless medical practice--including booking appointments online and creating e-prescriptions and, most important, collecting X rays, lab results and medical histories in one database, accessible to physicians and patients. He thinks he's on the doorstep of another transformation. "There is less penetration of information technology in health care than any other major industry," says Tullman. "Someone has said the advent of electronic health records will be as significant as the discovery of penicillin."

It's medicine that the health-care system needs desperately. Backed by the Bush Administration, prodded by employers and under pressure to contain costs and improve service, the medical community is finally--and rapidly--plugging into the new world of electronic health records, in which your personal health information shows up wherever you do--at your doctor's office, the emergency room, the MRI machine, even your home. "Resistance is at an all-time low," says Neal Patterson, CEO of Cerner, an e-health company based in Kansas City, Mo. Cerner and Allscripts are racking up quarter after quarter of double-digit sales growth.

Underscoring the new urgency to shift to e-health was the joint press conference held in Washington last week by Senators Hillary Clinton and Bill Frist, two potential presidential candidates who otherwise rarely get near enough to pass a communicable disease. They've got together, however, to introduce legislation that would provide seed money for local health networks and eliminate the biggest hurdle to beaming medical records to where they are needed: the lack of interoperability among the myriad systems now in use. Medical record keeping in the U.S. is in the "Dark Ages," Clinton complained. "We need to have the information easily accessible."

The U.S. government is leading this charge into the medical information age--robustly and, by most accounts, effectively--because it pays 46% of the nation's medical bills. Dr. Mark McClellan, former head of the FDA and now director of the Centers for Medicare and Medicaid Services, is making paperless medicine mandatory for physicians who want to participate in the agency's potentially remunerative pay-for-performance scheme. The aim, sensibly enough, is to pay doctors for keeping their patients healthy, as opposed to the current fee-for-service basis that simply rewards patient throughput. A priority for McClellan is to improve the treatment of diabetes and other chronic diseases, which absorb a disproportionate amount of health-care dollars. That requires better data collection--uploading and monitoring information from glucose meters, for instance--and more communication with patients.

"McClellan has made it clear. They are not going to pay the same whether you leave horizontal or vertical," says Dr. Don Rucker, head medical officer of Siemens Medical Solutions, one of a handful of large corporations, including IBM and General Electric, that are betting billions on the market for health-information technology.

Driving all this are some frightening statistics. The U.S. is No. 1 in the world in terms of health-care expenditures--a total of $1.8 trillion last year and rising at a rate more than twice as fast as our incomes--yet it ranked no better than 16th in a study of 22 industrialized countries in what medical professionals call outcomes. That's in part because so much of the care delivered is unnecessary--as much as one-third, according to a Dartmouth study--and in part because of the inefficiency of a system in which tens of thousands of patients die each year as a result of medical errors.

"We have to do this; there is no other choice," says Dr. Alan Wasserman, president of Medical Faculty Associates (MFA), a 270-doctor practice affiliated with George Washington University Hospital in Washington that happens to treat many members of Congress. MFA recently converted to a system made by Allscripts called TouchWorks. Before the conversion, the practice employed 23 people whose sole function was to collect, store and maintain paper files that filled several rooms.

TouchWorks is vastly more efficient at such mundane medical tasks as booking appointments and renewing prescriptions. About 90% of renewals can be processed within an hour and, because doctors' handwriting has been eliminated, with far greater accuracy. There are enhancements in the back office too. Because automation improves documentation, the group's "lag charges"--the cash tied up in the fee-collection process--have dropped to $1.5 million from $2 million. MFA gets paid in 63 days on average, as opposed to 102 days before TouchWorks.

At the heart of the TouchWorks system is its "tasking engine," a piece of software modeled after physicians' standard 10-step diagnostic approach. Test results from outside labs pop up on the doctor's screen, allowing him or her to plot, say, cholesterol levels over time and present the information to the patient. If a physician writes a script, the system will flag possible interactions with other drugs the patient is taking or question dosing levels that are out of the norm.

Automation has also created what Dr. Ryan Bosch, who directed MFA's TouchWorks project, calls stickier patients, borrowing an Internet measure of loyalty. "I spend less time gathering information and more time being proactive," he says. "Delivering good-quality health care is about a relationship."

It's not surprising that a big urban practice such as Bosch's would get wired. Most health care in the U.S., however, is delivered by small practices with fewer than 10 doctors, and these physicians don't yet see any payoff. That's because so far there is none. The cost is high, about $10,000 to $12,000 per doctor, and most of the benefits accrue to other players in the system, such as hospitals, employers and insurers. Doctors in small practices, many experts believe, won't link up unless their patients demand it. At least that's the assumption behind a company called Medem, which introduced a website in May called iHealthRecord.com The site lets you store all your family's medical information--prescriptions, allergies, health histories, etc.--and share them with physicians, as long as the doctors are on the system. You can also download vital information onto a smart card to carry with you. The software is free; Medem charges doctors who get the benefit of the record keeping. Linked to insurers, these so-called personal- health-record systems could also pave the way for "mouse calls," arrangements by which doctors can consult patients over the Net for a fee. "It's so much better than our main competition," says Medem CEO Ed Fotsch, referring to the data-collection device still used by the vast majority of doctors: the clipboard.

There are risks involved in computerizing anything, of course. Privacy advocates are especially concerned that once patient records are online, it will be that much easier for sensitive information to fall into the hands of, say, insurance companies or potential employers. "It's not about being scared of technology; it's about the appropriate safeguards," says Marc Rotenberg, executive director of the Electronic Privacy Information Center. To Rotenberg, the push to automate is running way ahead of the legal protections. Even Newt Gingrich, a longtime champion of health-care reform, sees the need for updated legislation to protect medical privacy as technology evolves. But, he adds, it's important to keep the relative risks in perspective. Should you get into a car wreck, he says, "if you're an absolute privacy addict you can always say, 'I'd rather die.'" Identity, in fact, could be a far bigger issue than security, given the vast number of Americans with common names such as Smith, Sanchez and Lee.

The growth of regional health information organizations (RHIOs) is another step at dispelling the Big Brother scare. Although only a few RHIOs are operating, some 500 locally controlled information networks are being built, and the Clinton-Frist bill would put money on the table to help get more of them up and running. In New York's Hudson Valley, the Taconic Health Information Network and Community serves 600,000 patients along with area doctors, hospitals, labs, pharmacies, insurers, employers and consumers. If a resident makes an emergency-room visit on a Saturday, the ER doc can pull the patient's records from his personal physician.

The bottom line is that better health care may not happen in the U.S. without better health-care information technology. Sooner or later all of us will probably be carrying around our medical history in a key-ring device or an ATM-type card or maybe even a surgically implanted chip. The benefits could be extraordinary. IBM sees opportunities to apply massive computing power to help doctors make diagnoses and treatment decisions. New standard practices could be communicated to doctors within months rather than 15 years, the current lag between discovery and practice. Pharmaceutical companies with access to anonymous health data could improve and speed up drug development. There may even be a buck or two in it for consumers from what has been called information liquidity: If you want access to my data, pay me. Best of all, we could finally throw away those damned clipboards.

Wednesday, March 09, 2005

An Angry World

As I was driving in today, sliding on the ice, my windshield encrusted with salt and my window wash frozen I wondered why are people so angry today. Road rage, drive by shootings, and workers going postal. All of which never seemed to occur in the past. Yesterday, I called to make some complaints to the hospital about their information mismanagement. People called me back, in essence to make me go away. To smooth things over. I was told, regarding the fact they would not give me information in the emergency room over the phone, not only was it HIPPA, but they did not have the information down there on who was next of kin etc. As my mother was only there two weeks ago, all this should be available information. According to them, it was not the fault of the ER. Unfortunately this was left as a message so I could not point out it was their information mismanagement, that caused the problem. A short trip to the computer database should have solved the problem. What computer database? I'm sure they have one for billing! Recently, I canceled my Sprint Cell phone contract. They charged me a $150 dollar early cancellation fee. They didn't tell me upon cancellation there would be such a fee. I would not have cancelled the policy if I had realized it was not completely over. I spoke with a supervisor. WELL! Their computer records reflect I was told and it was all my fault. So I wrote a complaint letter to the FCC. The FCC sent me a form letter saying I need to complain to my "local state regulatory authority for cell phones". If I knew what my local state regulatory agency for cell phones was I would have complained to them. Frustration mounts.

Today, instead of solving problems, people are placated and told to go away. And then they encounter the same problem again and again. Whether it is mail sent to the wrong address, outrageous fees, bad service or just rudeness, the mentality of the day is "make it go away" not solve the problem. A funny note on this I still get mail for a dead woman at my home, and they've told us only she has the authority to stop this mail-how funny is that? I was angry yesterday as I went around in circles and waited for response and finally received "now now its all OK and its not our fault we are just totally inept" platitudes.

I think we've forgotten our pride and now we scrabble to hold jobs that don't pay the bills as we've outsourced so much for cheaper labor. People don't care about their jobs, they just want to get through the abuse of the day. Their infrastructure is such that they can't solve problems, so complaints pointing out these problems are just made to go away. But this just stirs the pot of those wronged. And the world becomes angrier and angrier. And the problems remain the same.

I wonder if Hallmark has a sentiment for this. A big frowning clown on the outside of the card with a "Sorry your complaint was ignored today" on the inside.

Tuesday, March 08, 2005

HIPPA Lite for Health Care Insurers

I was musing over my HIPPA adventures of the past 48 hours, when my thoughts turned to yesterday's mail. In it, I received from my HMO a newsletter, that they signed me up for, on "Managing YourAsthma". So let me get this straight, if I have a medical condition, they can write and distribute through the mail, newsletters, letting secretaries and others know of my medical condition. These are people not involved in my direct health care. So, newsletters, advertisement OK. Keeping patients and patients families as ill informed as possible so hospitals can cover their butts and continue their astronomically high death and injury rate by provider error is OK. Having as many informed eyes as possible (read informed family members and friends of a patient during a hospital stay) would alert medical providers to potential errors, need for medical attention and so forth would probably reduce the high error rate and improve care. But, for our own protection (cough) we have HIPPA. Right. Yeah. I'm still mad.

HIPPA Rant


Health Care Administrator Attempts to Comfort and Smile

My next project will be to write to every congressman, legistlator and politician that I can. My mother, after a long ongoing illness is in the hospital again. I am her health care proxy and next of kin. I call, " Can you tell me why she has been admitted?"
" No HIPPA."
"But you saw me just a week ago."
"We can't release information over the phone."
"My health care proxy is in her file"
"That didn't come with her from the nursing home"
"But..."

"HIPPA"

HIPPO Turds.

I had just gone over my mother's file with the nursing supervisor that afternoon. All sorts of medical details. I had to yell and scream at her to get an update (this afternoon she knew I was the health care proxy). My mother had a fever of 101.1 F. Wow. I could see them being reluctant to tell me my mother had picked up a sexually transmitted disease while in the nursing home, but just a fever??? Her case has been long and complicated and I have used up all my sick leave, family medical emergency leave and so forth. So there is a point where you need to start managing things from the phone. You need to know - is this a crisis or not.

This morning I tried to get was she stable, critical etc out of them. No go. I could understand if they didn't want to release so many mg/L of some metabolite, but stable vs critical...? Come ON! I called the hospital administrator's office and left a voice mail. It's hours later and no answer. I called the covering physician. No answer. I left a message for her. No call back. My mom has been ill for over a year and a half and I have taken all sorts of time off to be with her. But I now have to manage my time and really only take time off for major crisises.

My generation has been labeled the service generation, the first generation to be caught between taking care of children and elderly parents who are living longer than ever before. Medical advances allow them to live longer and with more complicated medical problems (read costly) than in the past. This may not be a good thing, for although life may be extended, the quality is diminished and it is at great emotional and financial cost to the family.

Ack...I need a vacation..........whineeeeeeeeeee.

Monday, March 07, 2005

A Fine Whine Diets...Again

Well it seems to work. Good news. Let's start with the diet industry. The latest research (and book of course) is on volumetrics. According to this theory, we eat the same volume of food a day, and if we consume lower caloric density food of a high volume (read blueberries instead of Brie) we will loose weight. Sounds good, also sounds like what was said years ago, drop the bread and the dessert and eat more salads. Actually of all the diets out there, this one actually seems to be based on some common sense and fits in with our current ideas of what foods have benefits for you health wise (high fiber, high antioxident levels and so forth). It also does not violate the laws of thermodynamics where the number of calories in must be less than the number of calories out to actually cause weight loss. But will it make me magically thin? Probably not. There have been hundreds of diets out there, and the insurance industry has statistics as to what weight provides maximum life span, that few seem to be able to attain. But how much does culture slant our interpretation of the data? Recently there was a study that actually demonstrated that elderly people convalescing from surgery that were above the optimum weight level survived longer and healed faster than those who were at or under the optimum weight level (this was done at Columbia and I'm sure their webpage will avail you of some details). This flies in the face of the expected results. While I am not advocating that people should weigh in at 300 lbs, I do wonder if some of these optimums that we strive for and most miss, are not necessarily the be all and end all of what can be healthy. Perhaps our study design is overly influenced by our culture.

A Fine Whine

Just setting up for my first whine. Its so hard to decide where to start, the diet industry, the war in Irag, the status of health care in America, whether the news media is biased, but I'm sure I'll find the right one. But before I start, let's make sure that this program actually works..

Review A Fine Whine
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