Wednesday, April 6, 2011

Stating the Obvious on Medical Costs

In editing this piece, I realize that it is fairly hot and heavy handed. I simply cannot apologize for my vehemence, but now you know that it is there.

Many don’t take prescriptions because of the cost

I saw this on abbyjean's Tumblr.

Wow, LA Times, really?!? Gee, next they will find out that people break compliance with follow up or specialist visits due to money or circumstance. Holy fuck, do folks really have their heads buried quite that deeply up their own asses?

Yes, people want to follow up with their doctor’s orders, recommendations, prescriptions, suggestions, and referrals. This is why low income folks have such terrible compliance levels. Fucking hell. I can think of three big roadblocks right off the top of my head: no money, no time off from work or childcare, and no ride. We can dig deeper: some people are neglected and abused, at home and maybe at previous providers. Have you shamed a patient away because they were fat, slutty, or sloppy*? Did you do it with some snide comment in the hallway you thought they couldn’t hear?

We want to get better, just like everyone else does, dammit! There’s just a lot in the way that you cannot see, because you see a diagnosis waiting to be made, not a whole person. Can you just take one damn minute before you put your hand on the blasted door knob, and deliberately employ a gestalt point of view for just sixty bloody seconds? Are they seeing you on Medicare, Medicaid, or their own dimes? If the patient has transportation programs, sliding scales, pharmacy discounts, and/or drug manufacturer discounts available to them do they even know? Because it is just as bad as having no options if you do not know they exist.

Sure, maybe you and your staff just cannot handle trying to keep track of that on top of every thing else you have to manage. I get that, I really do. So help the economy by hiring someone to do it for you – all they would need is a high school degree, some empathy, and some tenacity. With the additional people you can help, maybe it will even cover an additional employee.

* Fat, slutty, or sloppy were just a few adjectives I have heard office or hospital staff use regarding patients. I offer no judgments to folks that are fat, appear to numerous sexual partners (people suck), or folks who have a hard time bringing themselves around to what their community considers acceptable appearance standards. Neither should their damn medical professionals!

Tuesday, April 5, 2011

On Trigger Warnings

Trigger warning: the explicit statement that a piece is about to discuss topics that some may find difficult or disturbing. For example, a blog post about Roman Polanski’s crimes may read “Trigger Warning: Underage Rape.” Their use (or lack thereof) on the web is sometimes highly debated. A great definition of trigger warnings and an advocacy of their use is here. You should be reading Shakesville, if you are not already.

On one hand, I think trigger warnings are great. It is a good way to avoid inadvertently sending someone shivering into a corner because you have mentioned something that they actually experienced and still haunts them (or any version of that scenario). This should be a default part of trying to be a decent human being, no? I do not want to be the asshole that does that to someone, do you? A lot of sites I read and respect use them, and a lot of readers appreciate them.

On the other hand, the little writing snob that I apparently have in my head says, “Well, if you write like you are supposed to, with a summary at the top and all, then that is the trigger warning!” This, of course, makes me feel like a crappy writer if I use them. Yes, even when you take into consideration that blog posts are far more conversational than formal. Please do not mistake me; I am not in a position to deride anyone’s writing style. That voice derides my writing constantly, as you can probably tell. Most sites that use trigger warnings, given the beginning of this paragraph, do not need the addition of the words “trigger warning” as they let you know what they are talking about right away, anyhow.

This also makes us de facto gatekeepers of each others’ mental health, in an amorphous way. We are our sisters & brothers keepers to an extent. But how are we to know what is a trigger for each reader? Hell, do you know all of your own? Are you sure? This article talks about it very intelligently, and I highly respect the folks that write at flip flopping joy.

If you were abused and that abuse was facilitated by putting a blue pillowcase over your head, am I a monster when I offer my hospitality and the guest sheets are blue? No. I am a monster if when you stand at the door shivering I do not offer my arm, lead you away, and change the damn sheets. But I cannot do that unless I know to do so, and I cannot pretend to know what may set you, the reader, into that particular hell called being triggered.

So, in essence, I will be giving trigger warnings (because it is the correct thing to do), but usually not using that exact label (because of the snob in my head). I do promise to do my best (which varies on any given day more than it does for most folks - thanks, lupus/SLE) each day to write well, and let you know up at the top if there is problematic content. You are welcome to call me out, if you wish, when I fail. This should both meet the needs of people that need to concern themselves with being triggered, and placate the snob in my head.

Monday, April 4, 2011

Safe Space

I have read a lot on the web over the past mumble years. (No kidding, since before it was all connected, e-mail address could be lines long and have things like BANG in them, and pretty much consisted of us writing on clay tablets, smashing them into a fine powder, and sifting them into phone lines for transmit. Maybe I am teasing about the tablet thing.) In the past couple of years, I have gotten involved in educating myself on a subject I had always held dear, but mostly felt I would be alone in: social justice.

One of the things I have learned is the importance of a safe space policy. This allows the disenfranchised to give air to their voice without reprisal from the usual subjects. You will not be told your tone about feminism is too strident here. You will not be told to apologize to the jack hole that stepped on your toes here.

When I first told my friends about Patient C, one very smart one asked me about my commenting policy and why I had it. I responded that the conversations are better on the sites I read that have such a policy. I have seen the tales of threats of rape, death threats, and various evils out there, and I will not allow them here.

Now, on the other hand, some folks view the entire web as their very own First Amendment playground and like no fetters placed upon it. If this is you, you will not be happy here. So take my fond farewells with no bitterness, and may you find what you seek elsewhere. Right up at the top of this page, on the toolbar, you can start your own blog for free and set whatever commenting policy you like. You do not have to put up with mine.

This? This is my little corner of the Internet, and inside the bounds set by my host, what I say, goes. If you post bullshit, I may not publish it at all. I may publish it to correct, ridicule, or maybe even correct and belittle you depending on my mood.

I intend to amplify certain voices over others. I intend to speak to my own experiences, point you towards the experiences of others that may be edifying, and share information in a way that, if not equal, then lifts up the voices that are rarely heard.

On this, and a many other things, am sure I have screwed up regarding the privilege I do have. This will undoubtedly continue, as I try my best to my efforts as mistake-free as possible. It is okay to point it out when I do. I cannot learn and grow if I do not know when I fuck up. I do not expect those with disadvantages different than my own to instruct me, but I would appreciate the occasional helping hand. So if you have the spoons and the inclination, I will do all I can to accept that criticism with grace, learning, and as much of a lack of ego as I can muster.

(Edited - that last paragraph had a ton of grammatical errors!)


Friday, April 1, 2011

SmartAss Commentary: Niaspan Commercials

Niaspan

Oh, how I loathe these commercials for Niaspan. Have you seen these? Wow, these pieces of passive-aggressive, sly, guilt-ridden pabulum are just stunning.

Here is the “brother” version. There is at least one more, but I cannot find a link for it. It is not quite as bad, but still not good. Scratch that, there are three total, and they can be found on the Niaspan homepage here.

I find these commercials to be full of coddling, wheedling, coercive, bullshit. It is hard enough to manage a chronic illness/injury/disability – we really do not need to be badgered by our friends and family. I think the idea that these are “interventions” kind of trivializes the actual purpose of an intervention, you know – giving a loved one a chance to stop and think about what they are doing to themselves and the people around them. To let them know that they are loved and supported, and that this will still be true if they try to change their lives for the better. It is usually reserved for exceptionally destructive behavior.

Take the brother commercial – the speaking brother is chastising the audience brother about the fact that he is not taking Niaspan. Never mind the facts that the brother has made the diet and lifestyle changes that are necessary for his condition. Oh, no – he isn’t doing enough because he isn’t taking this pill! What if he is already taking niacin? Or what if he has a contra-indication, like liver trouble? The speaking brother apparently does not care. He has decided what is best, and damn anything else.

The daughter commercial does not specify what other changes the audience dad has made. But she is going out on an awfully long limb for something that “might” work.

The sister commercial is mind boggling. “I know one more pill… I get it, I do,” No she does not, or she would not follow that with, “I am not taking ‘no’ for an answer.” The gall on display is stunning. Of course she knows best, how it could be any other way is beyond her grasp.

These commercials are demeaning to health care customers. They play into the all-to-common assumption that we, as individual patients, are either too stupid or too lazy to consult with our doctors, do our own research, and make our own decisions.

If you do have a friend or loved on that is dealing with cholesterol issues, it is totally okay to offer your support. As with other health issues, save your advice for when you are asked for it. No, we do not want unsolicited advice – by definition. If we wanted it, we would seek it out and ask you.

While looking for links to the commercials themselves, I found some folks that despise this almost as much as I do at CommercialsIHate.

Niaspan on Wikipedia is here. (This entry is actually about Niacin. Niaspan is apparently prescription strength, time release Niacin.)

Thursday, March 31, 2011

Things that Make My Life Easier: UV Monkey

Here we are again, with another installment of “Things that Make My Life Easier.” Some people with SLE/Lupus are mildly to very photosensitive. I am one of those 'very'  people. Some medications can make you photosensitive or more so if you were already dealing with that situation. I am taking one of those medications.

Recently I was gifted with a UV Monkey, from ThinkGeek.

This is a small, round device with four colored panels around one circular central panel. The whole thing measures barely an inch and a half across. It can be put on a key-chain, but since I am unsure about how durable or fragile it really is, I keep it in a pocket in my purse.

The colored panels correspond to different UV Index ratings, and you are able to determine the reading by matching one of those to the middle circle, which changes color to let you know what the rating is in your current location. Level 1 is a UV Index of 1-2, Level 2 is 3-5, Level 3 is 6-8, and Level 4 is 9 – 11. Once you have been sensitive to UV light for a while, you start to get a handle on what your own particular tolerances are and how to manage them. I may do a separate post on how I manage, but I do not have any really nifty secrets (hell, my skin will burn and blister sitting in a car!).



I have only used this a few times so far, but I see the potential for it and it looks good. Cloudy days are the ones that screw with me, when I forget that UV rays are not blocked by clouds. Sigh. This will help me remember.


If you have photosensitivity, I recommend the UV Monkey if you have $9.99 (currently on sale for $7.99) plus shipping. In the long run, it is probably cheaper and definitely more comfortable and convenient than treating the sunburns, headaches, and nausea that can result from over exposure!


*Note: The UV Monkey is also useful for knowing when is best to charge solar devices.

UV Index





Wednesday, March 30, 2011

Things that Make My Life Easier: Online Rx Refills

“Things that make my life easier” was an idea from Amanda W., and she wrote about it at her home site, Three Rivers Fog. I read about her idea on FWD: Feminists with Disabilities (the site is still there, but is no longer producing new content, which is a shame and I will talk about that soon).

I think that the idea is a really good one, and I would like to lend a hand in helping to keep it alive. So here is my first PatientC: Things that Make My Life Easier!

I use a CVS. Our family has since we moved away from a really great family owned pharmacy. CVS has been convenient for us, and we have been pretty happy with them most of the time. I manage my own ‘scripts along with my husband’s and both our daughters. Unfortunately, that is a fair amount of pills, etc. Recently I have started streamlining our habits and trying to cut out time and effort that is ill-spent (relaxing or goofing off counts as time well spent, unless something else really needs to be done!). So I finally investigated the web site functions offered by CVS.

I could really kick myself for not doing this sooner! They offer prescription refills, transferring prescriptions online, and easy access to your annual Rx records should you need them. I was also able to set up my daughters Rx’s on my account. My husband had to set up an account to give me permission to manage his ‘scripts, but I do appreciate that they do try to keep fraud down.

So setting up the accounts and getting them connected was a bit fidget-filled, but it paid off almost immediately. When I log on to fill a ‘script, it is red if it is eligible to be refilled now, I check the box next to the ones I want, and then click the big red button near the bottom of the page. Depending on your insurance, they may be able to tell you how much it will cost before the next screen. The next screen you can enter when you want to be able to pick it up, just like their automated phone line refills. Once done, you receive a confirmation e-mail, and the stuff has always been ready when we came in to pick it up.

*Note: if you use their customer card for discounts and savings, you can manage it from the same log-on.

*Note: this service is not helpful for refilling prescriptions of controlled substances (painkillers, ADD/ADHD medications, etc…) as you have to deal with the physical prescription, but is otherwise very useful.

The following all have, or as best I can tell, appear to have, online refills available. Some of them also allow you to transfer prescriptions, get e-mail reminders, and whatnot. This is just a quick hit of places that offer similar services based of off a quick mental list and then a scan of their available services. Feel free to add more in the comments section, and I will list them here.

CVS
Walgreen’s
WalMart
Target
Kroger
Rite Aid
Kmart
Meijer’s
Tucker Pharmacy (used to be Tucker State Pharmacy) was bought, but is still around, but if it does have a web page, it is not under that name. Upon a Google street view search, they are still there, but are now a Tucker (Walgreen’s). So they have it.
BioScrip
Marwood Low Cost Pharmacy does not appear to have a web page.
Dr. Aziz Pharmacy does not appear to have it.
Marsh does not appear to have it.

Tuesday, March 29, 2011

There is No Family Cookbook

Yes, I say that with confidence. You see, at the household here, schedules have shifted around, and the only person with the time (?!?) to cook is me. If you know me, you know that I rarely, rarely cook. I make a decent pot of chili, but that is about it. So lately I have been browsing cook books, internet recipe cites, and the cooking brains of friends and family.

There is no family cookbook. At least, there is not a cookbook that adequately addresses cooking around a family. I know this, because a real family cookbook would say things like the following:

"...you must stir the pot constantly for the next five minutes. Sh when Timmy has his daily meltdown, tell him he will have to wait. If it happens on a schedule, try to plan around it..."

"...Here is a good place to stop if Betty skins her knee. Again. Everything can wait - just fridge the sauce if you take more than thirty minutes. Maybe you should get her tested..."

"put the beater in the bowl and now would be a good time to hold Chad. The standing mixer just needs to be watched for six to eight minutes and you know how the vibration and a verse of "Summertime" settles the child quite a bit. Are you sure that is not colic..."

See, now that would be a family cookbook!

SmartAss Protips: Bedrest

I wrote this on a disability discussion board, and thought it would be good to post on PatientC!

I wracked my brain to think of the things I do when I am stuck in bed, and here are a few things I remember. This tips may help you in a temporary bed rest situation, and if you think they will, feel free to use them. If you have tips of your own, please share them in the comments!


Planning - this helps me a lot, as it reminds me that bed rest will not last forever. I take my upcoming projects, write them out and plot each step. If the malady itself will screw with the project (say the project is knitting and my hands are messed up), then I include what recovery milestone I need to reach in order to complete each particular step. If I can, I may go ahead to work on the project up to the point where I cannot anymore, in anticipation of getting out of bed again.


Communicating - I try to get things out of my system. I talk with family, e-mail friends. Feel around, see who is able to get it enough to share with them and then do so. I say that with this caveat: people will surprise you. Some folks you thought would be there will flee and some that you maybe thought couldn't be bothered will come through in amazing ways. Writing works for me when I do not feel like another person is available, or I am trying to sort something out for myself first, or I am having a fit of pique.
 

Change things up - tell folks when you are up for company, if fresh faces help you at all. If I am up to making bathroom trips, I use that to my advantage and change the scenery. Sometimes I will make the morning trip and then retire on the couch. That night, when I make my last trip, I will end it in the bedroom.

Brain play - Got a book you always wanted to have time to read? Heard of a subject you always meant to research when you had the opportunity? Is there a neat but maybe useless-in-daily-life skill you wish you could develop? Video games are one of my favorites here (I less-than-three PopCap games!) and they usually take minimum to moderate mental acuity. I bought my first Xbox right before I had my tonsils removed. It was one of my best calls ever! Volunteering for phone work is a great idea! If you are a mind for it, this is a great time to work on skills like meditation, creative visualization, focus and concentration...


Ask for help - when people say "If you need anything..." let them know that you do. Even if you are not comfortable asking for something big, like babysitting, maybe you can ask for them to bring over a movie your kids have not seen, pop some microwave popcorn and turn watching TV with the kids for 90 minutes into an event! 

All my best for your speedy recovery. This sort of thing can be so much more taxing than a lot of lucky people will ever know.

Monday, March 28, 2011

Bitch on Gaming

I am working on about 22 pages of ideas for this blog, but while I am at it, I want to recommend this article on Bitch: The Games We Play: Access This. It brings up some of the same thoughts I have had about gaming, and great new ones too!

Enjoy!

Thursday, March 10, 2011

SmartAss Protips: Puking

Puking, vomiting, upchucking, worshiping the porcelain alter/goddess/god, driving the toilet bus, Technicolor yawn, horking, chunder, hurling, blowing chunks, ralphing, spewing, extreme anti-peristalsis, spewing, barfing, rainbow gagging, heaving, retching...

We have a lot of names for it, and none of them are nice – because vomiting is never pleasurable (outside of say, a fetishist, but that is not the topic of this post).

Here are some handy tips for those days when food just won’t stay down. This is not your standard nausea battle guide, this is stuff that has worked for me, and may work for you! I had two pregnancies that were full of fail when it came to keeping food down, and it has come up (?!?) again as a new med had me face down on a fairly frequent basis. It took two months to fix the situation: I was hesitant to call, because the pain medication was actually working, the first time I called they assumed the problem was on the other end of my digestive tract, when the medication they prescribed for that did not work I spread out my dosage more evenly through the day and eventually found dosages/times that worked for me (and still had me at or under my allotted amount per day).

Important note: I say this again later, but I want to be clear up here -- this is my own personal advice for handling a bout of puking. If you have any questions at all about why you are sick, you should talk to your medical professional, if possible. This is not meant to be a substitute for qualified medical advice!

Let's get too it!

Put your hair back – ponytail, clips, pins, whatever. My hair is long, so it is definitely a concern when I am throwing down with the porcelain.

Have a tidy bowl – if my stomach contents are already unsteady, one sure path to a speedy exit is a disgusting toilet. So, keep it tidy or ask your partner/caretaker/aid to lend a hand here.

Protect the pretties – if you wear [edit - spelling] long necklaces, consider taking them off until you feel better, or cheat like I do: tuck them into your shirt or bra straps.

Pearly whites – always brush or at least rinse afterwards. You don’t need old food or digestive juices hanging out on your teeth. Post-puke teeth are gross anyway, and you do not need that reminder hanging around while you try to hold something down.

Find your balm – some folks swear by ginger, starches, or mint. I am a shortbread girl myself. Experiment and find what works for you. Ice cream works occasionally for me. My boyfriend swears by drinking a Coke to settle his tummy. Motion sickness pills can help, too, by the way.

Be prepared – if you feel queasy, and unsure of your ability to make it to your bathroom, there is no shame in preparing ahead of time. Keep a basin, bucket, or wastebasket handy. Think about how you want to manage afterwards: are you up to cleaning it out, or would you rather double bag line it so you can tie them up and toss them?

Listen up – pay attention to what your body tells you. Do not wait until the last minute to do what you need to do. This, coupled with the above, can help prevent a lot of accidents.

Get it over with – I have found that when I am dealing with a bout of antiperistaltic movement, sometimes it is best to just get it over with, rather than fighting it tooth and nail. Your mileage may vary.

Talk it out – if you have a partner, roommate, caregiver, aid, let them know what is going on. Do you want someone to hold your hair back, or greet you with a bottle of water when you are done? Have a conversation, and do not be ashamed of things you have little or no control over, okay? Early in my relationship with my husband we both caught a stomach bug so terrible we were both prescribed anti-nausea suppositories -- as you can guess, we worked through the awkwardness then.

Watch what you eat – keep an eye out for how things may come back up when you are chowing down. I tend to stick to soft stuff: pudding, ice cream, apple sauce, flavored oatmeal. You may want to stay away from other foods: popcorn (eck! Don’t ask!), hard chips like potato or corn, spicy foods (if it stings going down, it is going to be a bad scene when it comes back), big leafy foods can be unpleasant, avoid anything that usually upsets your stomach or is uncomfortable (spicy foods at or beyond your tolerance point).

Along these lines, if you don’t already – chew your damn food! Seriously, you should do this whether you are puking or not. Take small bites, and chew thoroughly. Do you ever watch people eat? Even when there is no time constraint, many folks eat like they are in a huge hurry. But when you are nauseated, the idea that a bite could get wedged in your nose is likely to encourage you to develop this good habit.

Water, water -- stay hydrated. Seriously, no matter how frequently you are vomiting, you must stay hydrated. Dehydration is one of the big problems with vomiting as with diarrhea. 

Knowledge is power -- if you have a condition that can be worsened by vomiting (diabetes comes to mind), make sure you know if you should do anything special to keep disaster at bay.

Doctor, doctor – it is always okay to ask your doc for advice and help with this issue. I recommend it, especially if you think that it may be a sign of illness, or intolerance to a medication. Some areas have nurses you can consult by phone. Your medical professional may recommend anything from ginger to an anti-nausea ‘script. Work with them to come up with a solution you can manage.

Have any tips? Feel free to share in the comments! Have a question? Go ahead and ask! Got an opinion? Check out the comment policy, and fire away!