Yeah - funny what we get used to and stop thinking about until someone else comes in and points it out. When n school I had a wooden coffee table with a round top and square base. I had it for years and honestly it never occurred to me not to line the base square up with the sofa. One day my then-boyfriend put it with the base diagonal to the sofa and it looked so much better! I just never thought of it lol.
Not much new here. I put the teal slip cover and new pillows on the sofa and it looks much better - I can definitely live with that for a while.
CMM got another month’s reprieve from chemo, which is nice - his CT scan showed slight enlargement of some nodules but they were less dense and radiology seemed to think it was due to a treatment effect.
I’m still advocating for that young man with the rare disease. We are trying to get his HMO doctors to order the next antibody test so that we can speed up the process of getting his diagnosis confirmed.
UGH - despite me writing a letter laying out all the reasons why they should order the blood test before his specialist appointment, the regular neurologist still wouldn't do it! I'm so beyond frustrated. This poor guy has to take two naps a day just to function as it is!
He belongs to the same large staff-model HMO that I get my healthcare through (ex used to work for them) and they are great at routine stuff and emergencies but can be bad at anything out of the box. My son had similar problems with them getting his own less-rare disorder diagnosed. As I approach Medicare age I'm thinking more and more about maybe changing to a (more expensive) plan that lets me go anywhere. Not that I need it now, since I'm quite healthy and can manage much of my own stuff. But having seen so many people I know go through cancer treatment recently, plus one friend get a heart transplant, I'd like to know I'd have the option to go where I wanted if something bad or rare did happen to me in the future. Staying with my HMO in a Medicare Advantage plan would be the most economical choice (especially in the next few years, since I'm still working my income puts me in a bracket where I pay more for Medicare). My costs would actually go down a fair bit from what I currently pay for my high-deductible plan and the deductible would go away. If I choose the more expensive course my costs would probably stay the same until I retire but coverage would be better. I have pre-existing conditions that make it important that I choose what I want the first time out, as I may not be able to afford to switch in the future (they can rate you for pre-existing conditions if you change plans more than 6 months after turning Medicare age. )
Grrrr......getting more and more steamed at the doctors caring for my son's friend. After-visit notes on his visit to the neuro-specialist to his neurologist included (accidentally I'm sure) the specialist saying that the patient "apparently consulted with an outside doctor (I have no idea what type, but I'm guessing webmd)".......
You can bet I wrote her a scathing two page letter about my certifications and clinical experience, (no, I am NOT "webmd") about the ludicrously inaccurate things his doctors there have said to him, and thanking her for finally referring him to someone who should know what they're talking about but suggested that she should treat patients with the same respect that she would want for a family member.
Honestly some doctors are such jerks. And if this woman (looks to be in her mid-late 30's) has such a dismissive attitude to patients who are smart enough to research their own conditions NOW, how bad will she get in the future? (This kid is super bright and has accurately interpreted all the information on his probable illness online, understands well that it's not a definitive diagnosis yet, and can clearly see the stupid inconsistencies in what these doctors have been doing. For instance - the eye specialist writes that the problem with his eye is intrinsic to each eye but sends him for eye exercises that do NOTHING for that problem or the problem we think he has either. )
That old paternalistic view of medicine ("I'M the doctor and just listen to what I say - god FORBID you look anything up yourself") just ticks me off and to see that BS coming from a young female doctor is really even more infuriating. I'm sure she thinks she knows more about this disease than me because she's the specialist - and she SHOULD know more but clearly she DOESN'T!!!!!
It reminds me of an incident in my residency. As senior family medicine residents, we took turns being Chief of Service for the patients admitted to us in the hospital. One of my fellow residents was Chief that month. We had an old Japanese doctor in town who admitted all of his patients to our service, where the residents cared for them. Normally when patients were admitted to the ICU, they were under the care of the Pulmonary Fellow, but when they were moved to the floor they became ours if they were a patient admitted to our service. (The Pulmonary fellow is someone who completed their residency in internal medicine and is now doing years of further advanced training in pulmonology. Much higher ranking than a Family Medicine resident).
Anyway - one day the old Japanese doctor calls my friend and asks her - "would you go look at my patient? He was admitted to the ICU with chest pain but I don't think they know what they're doing with him".
She went to see him and as soon as she entered the room, the wife asked her - "Could this be tetanus? We have a lot of tetanus in Japan" (they were from Japan). My friend examined the patient, did a little reading, and came to the conclusion that this could, indeed be tetanus. But of course, SHE was just a lowly Family Medicine resident. The notes in the chart read something like this (more detailed, of course, but this was the gist):
My friend: Looks like tetanus! Pulmonary Fellow: Ha! Nice diagnosis but I DOUBT it! Infectious disease specialist called into the case: "Absolutely CLASSIC case of tetanus!"
Now, I often tell this story to demonstrate a point. I can pretty much guarantee that if you had given them both a multiple choice exam, the pulmonary fellow would have known more about tetanus than my fellow family medicine resident. BUT my friend had two skills he didn't have - she knew how to LISTEN TO THE PATIENT and how to LOOK SH!T UP! Extraordinarily valuable skills that too many physicians don't seem to have anymore.
I know it's a rare commodity today, but having a family doctor who knows you and will advocate for your care is really valuable. And I'm sorry so many doctors out there are insecure a-holes.
Life is just rolling along here. CMM is enjoying his break from chemo and noted this morning that his mustache - which had been thinning from the chemo- is growing back in. We worry of course about the tumors growing but I think on the whole this break has been good for him. Too bad we can't get out and do things to make the most of this time, due to the pandemic.
Saw a new patient yesterday who at 62 is having signs of dementia. For any of you out there dealing with a loved one with this, there's a fantastic couple of books written by Dr. Dale Bredesen, a neurologist and neuroscientist, on his work reversing mild to moderate Alzheimer's disease. I've read his studies and seen him speak - it's really great work. Ideal prevention too for those of us who carry ApoE4 genes.
This patient I think will fall into the "toxic" subtype - his work history suggests exposure to mercury and to various other toxic chemicals, which can trigger dementia. He's getting bloodwork to help determine what's contributing to his early onset. It's a good challenge to be working on. I do believe I can help him.
Whenever I think about retiring - which theoretically I could do now, if I cut back, although I'd like to be more financially secure - I think about how much I would miss working on cases like this. I'll probably never retire, just cut back to very part time eventually. It's good to have work that you enjoy.
(Of note - re: that patient - I had him draw me a clock face, a common test for organic brain disease. His, not surprisingly, was wonky, with 4 numbers on one half and the rest all squished into the other half. My sister pointed out to me that this test will be worthless in 20 years as the younger digital generation can't read clock faces!)
I had the very same discussion with my class about clock faces last semester. During our labs on mitosis, meiosis, and genetics, we talk about inherited diseases and diseases that are caused specifically by gene mutation. I even give them a list of diseases to select one to research, then we have a roundtable discussion about that disease, causes, symptoms and we even discuss whether a viable treatment option either exists now or will in their lifetime (supposition, but gives me insight into how their brains work and what really matters to them). I use a Nova science program that I found a few years ago about Alzheimer's and it gives a great explanation about the causes and actually ties right into my lesson on mitosis and meiosis. There is a part in the program where they show a woman meeting with her doctor and one of the things he does when he is going through some tests with her is has her draw a clock and correctly label it. Much like you described above, it is clearly not what most of us would draw. When that part came up on the video and we discussed it, one kid said he didn't know how to tell time on those and a discussion ensued about how that might affect that particular test when people his age are older. It was a very organic and interesting discussion. It had never even occurred to me.
Me 51, H53 Bomb drop 9/29/2014 Divorce from XH final 12/17/2014 Marriage #2 12/31/2019 5 adult (step)daughters (3 from XH's first marriage, 2 from current H's previous relationships) 6 grandkids
Yeah! Me neither until my sister mentioned it. Don't know what we'll use in its place, its such a helpful test. (This was the test that first clued in the doctors of the woman who wrote Brain on Fire that she wasn't schizophrenic but was having some other organic brain disease, which turned out to be NMDA receptor antibodies causing psychosis in her case).
I LOVE genetics - it's what first interested me in biology in high school. In another life I'd be a genetic counselor or one of those genetic genealogy people who catch criminals. (If you haven't watched The Genetic Detective show on ABC you MUST watch it. ) It's truly amazing what we can do now.