Category Archives: Health

Meaningful Usage

What has meaningful use done for you lately?

I first heard the term when my son was trying to share what he did at work. He’s in nursing informatics and I was curious. It’s a field I had spent maybe five minutes considering.

What he said came across as gibberish to me. I’ve been retired from nursing for almost a decade. You don’t forget what you know, but it’s a dynamic profession and things change rapidly.

Though I didn’t quite grasp what he said, I didn’t question him about it. I just let myself enjoy the moment of conversation with him. I figured it had nothing to do with me anyway.

Well, color me wrong.

This past November I had my usual rheumy work-up done prior to my visit. Other than having my arm bleed out because I lugged in groceries immediately after, nothing out of the ordinary happened and I gave it no further thought.

In January, I received a bill from the lab. My insurance had denied the claim.

Remember the chasm that Indy has to cross in Indiana Jones and the Last Crusade? There is no visible bridge, but he has to believe that there is so after steeling himself, he puts out his foot to take the first step into nothingness.

That’s exactly how I felt when I picked up the phone to speak to my insurance. When I finally got to a live person, I was told they’d denied it because they did not cover treatment for obesity.

What?

They also mentioned coding for high white blood cells, pneumonia and some other diagnoses, but by then I’d tuned them out and was patiently waiting for my turn to speak. Obviously, I’d been mistaken for another patient.

But, no. There was enough evidence pointing to me. Talk to your doctor they said.

I called the office and he himself called me back. At 8 p.m. The only time doctors ever called me back at such an hour was when I’d been on shift. I was surprised by the late callback and I was even more surprised that it was him.

I quickly explained what was going on. The man has RA as well; he needs to not work so late.

“It’s Meaningful Use,” he said. “We have to put the weight down and then they go by the BMI.”

My son’s words rang in my ear: “Now we have what’s called meaningful use.” I didn’t realize at the time that the words took capital letters.

Before I spoke with the doctor, I’d been a little mad at the nurse practitioner who, per the office, had added the “obesity coding” to the lab order. We’d never discussed my weight, or any issues related to it.

I felt that I had been diagnosed (misdiagnosed) behind my back. I’d been betrayed, judged, found lacking, or rather overabundant, and worst of all, billed for $250.

But now I understood what had happened and my options raced through my mind:

Option #1 – Refuse to be weighed.

Option #2 – Refuse to let the office add the “obesity coding” to my lab order

Option #3 – Get my BMI within normal limits.

Option #4 – Do all of the above.

At my next appointment, we discussed the problems and options we faced in dealing with this new facet of going digital. I well understand the hiccups that come with changes, the fits and starts of instituting a new way of doing the same old thing.

BMI is not the most useful way to determine weight status. Muscle weighs more than fat, so that alone skews the numbers. With a present BMI of 29, I fall into the “overweight” category.

The BMI formula takes into account your height and weight. Per last year’s bone density study, I am still 5’ 2” in height. The office has my height listed as 5’ 1” tall. That one inch is probably what threw me into the obese category. Shorter = fatter.

What would be truly meaningful is if the whole picture of the patient was taken and not just a couple of numbers. My primary, documented diagnosis is Rheumatoid Arthritis. And part of the treatment for it is the use of corticosteroids, which tends to affect weight.

Of course, that is not the only reason I am carrying around some extra baggage, but still, it seems unfair, or at least not well thought out, to devise a system that singles out one statistic and ends up penalizing a patient for their very illness.

Perhaps this quirk in the system can be revised or overwritten. At this point all it’s done in my case is cause confusion and aggravation, plus adding to the workload of all involved.

My doctor is now working his magic to retroactively code the November lab order appropriately so that the insurance will cover it. For this latest appointment, I crossed the chasm in good faith that he had indeed revised the coding for February’s labs. I suppose I will find out in a few weeks whether or not the bridge materialized.

 

 

 

 

 

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Essay Writer

I’m packing again. Seems I just got home and here my name is on another plane ticket.

At least my sciatica flare-up is calming down just in time for that five-hour butt-in-seat marathon. It mostly hurts when I do pelvic lifts, so maybe I won’t do them.

Unfortunately, my physical therapist has other ideas. She makes me do thirty of them and hold them for a count of five. To strengthen my lower back and hips, she says.

OK, then.

I tell her it feels as though someone is stabbing me with a knife right in the gluteus maximus every time my behind goes airborne. “Just go as high as you can then,” she says.

So understanding, she is.

Today she had me start on the stationary bike. During the last session, while lying on my side on the table doing leg lifts (she’s big on the lifting) my eyes lit upon the bike parked right next to me. And as I lifted my bent knee toward the ceiling, without letting my hips rotate with the movement and holding my tummy in, I started to drool.

bike

Oh, I wanted that.

As soon as I was done, and before she could say, “Let’s do the standing leg lifts,” I moved toward the bike. “You like that?” she asked.

“Yes,” I said as I slipped my left foot onto the pedal and swung my other leg over the seat. “Let me just see how it feels.”

“Oh, yes,” I breathed as soon as my tush hit the seat. Automatically, my feet began pedaling, telegraphing the message they weren’t going to stop any time soon.

“Do six minutes and then you’re done,” she said, caving.

It sure beat standing at the counter lifting my leg sideways and then backwards for three rounds of ten each.

Today I got out of doing them as well.

“Since you liked the bike so much last time, we’ll start on it,” she said the minute I came in. “Ten minutes.”

I climbed on happily. Oh, yes. I definitely like!

We’re shopping around for this bike since I hate the one I have and rarely use it. I miss my old one, which was similar to this one, but I broke the poor thing. This one is off the charts in price so I will have to do some more copyediting work, write/edit some more essays to help pay for it. And I will, soon as I can sit for long periods again.

Lift, one, two, three . . .

Soup For Life

The meat, the meat must be beef shank, preferably with bone in; it makes a much better tasting soup. Set it to cook in a large pot three-quarters full of water. You add the spices at this stage. Salt, black pepper, garlic. The amounts are not measured; taste is what matters.

You must watch it closely at first. The fat will rise and needs to be scooped out, a spoonful at a time, making the broth leaner, clearer. Then you let it simmer as life simmers, gently but persistently, bringing memories bubbling to the surface.

“Papa, when do you add the vegetables?”

“I don’t know, Mijita.”

You know he does, but you say nothing and instead turn back to the stove. The meat is soft now and curls around its round flat bone. The bone is white as white can be, the marrow nestled in its center. You poke at it with the spoon, breaking it up into pieces, allowing its juice to mix with the broth. Meanwhile, you have chopped an onion into large chunks and added it to the broth in progress. Its layers float to the top, shimmery, translucent, adding their own juice.

It is you in the kitchen this Sunday morning. Your mother is sick, a migraine keeping her abed. You feel a deep sense of desperation. You want to fill in for her, but you can’t. You are not her and your father knows you are not her. He walks through the kitchen and steps outside, leaving you to divine the next steps. You know what the soup looks like when it’s done, but not how it gets that way.

With the fat scooped out, you can step away and leave it alone for an hour, or two, being careful not to let the broth cook away to nothing. This simmering will cause the meat to shred, making it so tender you barely have to chew it.

This soup was a staple in your home. Every other Sunday the house filled with the aroma of its cooking. Your mouth waters at the thought and you are helplessly transported back in time. You see the tall clay pot sitting on the stove, flames licking its full rounded bottom, its flared top opened wide, gaping at the ceiling, its middle pinched in like a waist.

It resembles a woman’s shape and you wonder what the potter was thinking while he shaped it. It doesn’t appear to hold much, yet your mother makes sure everyone eats their fill. You can never figure out how she does that.

Once the meat has cooked through, it’s time for the potatoes. Scrub them well and slice them crosswise into thick slices, unpeeled. While they cook, chop up the rest of the vegetables, carrots, squash and cabbage.

Take a fresh corn on the cob and slice off the tip, then shuck the corn peeling back the husk to its core. With a firm grip, snap off the cornstalk. Under running water, work out the silk tucked into the rows of kernels. Score the center of the corn with a sharp knife and then break it in half and add it to your soup.

The corn was your favorite part. You looked forward to it. There seemed to be so few pieces in that pot, but your mother always made sure you got one. Those firm yellow kernels glistened sweetly as you inhaled your soup, leaving the corn for last. There was no need to salt it or add anything to it; it was perfect as it was. You ate it row by row, slowly working your way down the length of it. When all the kernels had disappeared, you siphoned out the succulent broth from within that cob, again working your way along it lengthwise, making sucking noises that made your siblings laugh.

When the potatoes are done, fish them out and place them in a covered dish. Add the rest of the vegetables and continue cooking. In approximately thirty minutes it will all be done.

There is not enough room in your deep stainless steel pot to hold all the ingredients at once. It makes no sense to you. It seems so much bigger than the clay pot of your memories. Nevertheless, you set the potatoes aside before adding the vegetables. You’re not sure when you figured out the sequence to this, if you were shown it or if it just came to you, but it matters not, now.

 

*Eat soup. It’s good for you.

**A version of this appeared on my blog, Prose and Possibilities.

My Mother’s Kitchen

I am always looking for my mother’s kitchen. The scents, the sounds. The tastes, the textures.  The colors, the flavors. The love she used to stretch each meal so that we were all left satiated once again. Each meal a true labor of love, whether it was a simple dish of eggs scrambled with tortilla bits, called Migas. Or a grand presentation of Mole Poblano, chicken in a spicy chocolate-based sauce.

I doubt I will ever find even a semblance of it, not even in my kitchen as my own table pales by comparison. She is cooking in heaven now and I am left with memories that propel me to keep looking so that every time I walk into a Mexican restaurant I wonder, is this it?

Chips and salsa

An occasional treat. If I eat too much corn, I notice swollen hands the next morning. RA imposing its limitations. The salsa has several health benefits, but what is salsa without chips?

wine

White Zinfandel. Something not found anywhere in my mother’s kitchen. Or my own actually. I keep Moscato around, and I found a strawberry Moscato that hits the right spot after dinner. Who needs dessert?

avocados

Guacamole. Avocados were a mainstay of my diet growing up and are a frequent part of my diet now. Avocados are loaded with vitamins and minerals, plus they are delicious plain or mixed to make guacamole.

Beef Tacos

Beef tacos. Another thing I don’t indulge in often, red meat, especially when it comes in a corn tortilla embrace. Another staple from my childhood was rice and beans, though  I gave up white rice a long time ago. The beans (B vitamins and Folic Acid) remain an important part of my diet, minus the sour cream and cheese topping. 

Pinata lanterns

We were enchanted with the star-shaped hanging lanterns. When we asked our server where we could buy some he said, “Guadalajara.” Hmm, that’s a ways away; maybe I’ll check online. 

Though this was a lovely place, the food delicious, and we received excellent service, it was not quite my mother’s kitchen. I know it no longer exists, but I can’t help wanting to find it.

***One of my favorite novels: Like Water for Chocolate, (Como Agua Para Chocolate) a luscious love story with a bonus of delectable recipes preceding each chapter, written by Laura Esquivel and translated into English by Carol Christensen and Thomas Christensen

 

An Apple a Day

I mentioned before that I’ve been studying foods for a few years now. When I decided I would write some food-related posts on this blog, in my own roundabout convoluted way of course, I surprised myself with just how much information I had gleaned.

I was also surprised to find composition books filled with neat penciled, cursive writing. Such patience. Such yearning. Such neatness. Such legibility. Such heartache. Running my fingertips lightly over the words as I read, I felt the me of so long ago. The me who had written them, as if the careful writing down of this vital information would somehow help my pain go away.

Fear not. I do not plan to impart solely the clinical. More so the personal, and share what I believe has helped me. The main objective for this study of foods was/is to combat inflammation. That to me is far more important than thwarting fat. Because having a few extra pounds of fat on board is not as lethal as having a few extra ounces of liquid on board.

I learned that the hard way a few weeks before being formally, officially, definitively diagnosed with Rheumatoid Arthritis. Prior to that event, I ended up in the ER with fluid squeezing my heart and lungs to the point that I presented as an MI patient.

I’d known there was something wrong with me for a while. Something that rest and sleep (hard to come by with a job and kids) and regular doses of OTC pain killers couldn’t seem to touch. My primary care physician mentioned the possibility of RA and handed me over to a rheumatologist.

Unfortunately, this rheumatologist turned out to be the wishy-washy kind. “It could be this. It could be that.” I don’t remember him laying a finger on me, not to examine me nor even to offer a bit of sympathy. And not surprisingly, he never came up with a diagnosis.

But he did treat. Vioxx, right before that blew up. Advil, yeah, like I hadn’t thought of that already. Paraffin wax baths for my hurting hands, hah! I’d read about those in my Fundamentals of Nursing textbook in 1978. This was 2004!

I thought we’d come a long way, baby, but apparently he hadn’t. In August of that year, I went to my PCP and spoke my mind. “That man is going to kill me.”

Little did I know.

He referred me to another rheumatologist and I was given an appointment for mid-October, new patient and all. I tried to think positive. Help was coming. I could see the light at the end of the tunnel.

On Oct 3rd, what I saw were the bright overhead lights of the ER exam room where at least ten people floated around me, sticking needles into my veins, needles into my radial artery, pills under my tongue, O2 onto my face, leads onto my whole body for a 12 lead EKG.

And the funny thing was that I didn’t care! I didn’t care what all they were doing to me because when you can’t breathe you don’t give a crap about anything else.

After 24 hours of very expensive testing, it was determined that my heart and lungs were fine. As the ER physician put it as he sat next to my hospital bed, “It’s your inflammatory condition.”

It was not his place to diagnose a specific ailment and then come up with a long-term treatment plan for me, to do the job of the specialist who should have. It was his job to pinpoint the obstacle to my heart and lungs functioning as they should right then. I returned his wry smile with my own. We both knew why I was there, why my status had deteriorated to the point where he and I ever had to meet at all.

I immediately envisioned chest tubes being inserted into me to drain the fluid. I’d lost track of how many times I’d assisted a doctor with their placement in critically ill patients. Had I been thinking clearly I would’ve realized that had I needed that particular intervention, I would already have a Pleurevac hanging off the side of my bed.

Though I lay amidst wires, lines and tubings, which made for one very restless night, it was only IV lines, heart monitor leads and an oxygen sensor clipped to my index finger that held me captive to the bed. That, and my yet-to-be-diagnosed disease.

I was sent home on oral steroids to treat my pleural and pericardial effusions. That’s when I first met up with my buddy, Prednisone. We’ve had a rocky on and off relationship these past ten years. Mostly off, but I like to keep my buddy handy, or as I tend to think of him, my frenemy.

Our first dalliance lasted till the following February. By the time I got to see my new rheumatologist, I’d gone through the one week’s worth of treatment prescribed by the ER Doc. The first thing he did was to put me right back on the steroids. “We don’t want it happening again,” he said. No, we sure didn’t.

The next five years were a blur of pain, but at least I knew why.

Come 2009, something happened. I’d left my job several years before and my youngest child had flown away to college.  I began to feel better physically. The fog was lifting and I began to look around. And I thought wait a freaking minute. There’s gotta be more to this than pain and drugs. And so began my journey, into exercise, into foods, into love. Into me.

“What’s Your Donkey?”

A few months ago, I attended a business conference and one of the presenters, a videographer, told a story about filming in a small village whose name I can’t pronounce nor remember. She asked the women what would make life easier for them in that remote village and they said, “A donkey.”

At first she was surprised at such a simple request, but they explained how a donkey would help them till the soil and then carry their produce to market. There were other reasons as to why a donkey would make such a difference in their day-to-day existence so they organized a means to get the village women their donkey.

That talk, in reference to setting up a business and figuring out our needs, made quite an impression on me and it got me to thinking. What’s my donkey?

In my stand-off with RA, there are several inflammation markers I keep track of. As far as I remember, my sed rate has been normal or close to normal. (I am now the proud owner of my medical history for the last nine years. I asked and I received a CD of my chart. I will peruse later.)

The other marker, the one that more closely reflects how I feel physically, is my CRP. That has spiked more often than not over the years. Last fall I was feeling a little crappy and sure enough my CRP was 16. At last month’s visit it was nine. When it’s close to normal (4.9 or less) I feel terrific. Nine is good, awful good.

When my CRP is normal or near normal, I feel 20 years younger and just as spry. A while back we had to replace the water filter on our fridge and without even thinking, I went into a full squat, my tush almost raking the floor by my feet. My husband stood by my side, confident that I could not dislodge the filter from the bottom of the fridge without his muscles.

This is a man who road and mountain bikes, surfs (when there’s a swell, he once got kicked out of a surf spot because he was catching all the good waves. He’s used to Pacific Ocean swells; the Atlantic doesn’t quite cut it) and is younger than me. Since he was annoying me, I ignored him until he cried out, “I can’t do that! Squat like you’re doing now.”

I pressed on the end of the filter and it popped into my hand. I stood up, coolly handed it to him, then left him there, transfixed, with his mouth hanging open. This is also a man who had seen me at my worst, when I thought the fight with RA was lost or would be.

But, I said no, not yet.

And so, that is my RA donkey: a low, or normal, CRP.

And the continued flexibility to do full squats whenever I darn well feel like it.

 

 

Ride

What does it mean when I don’t even feel hot until the 28th minute of my 30-minute workout?

Does it mean I should pedal faster, or pedal longer to get the cardio I need, and to lose the dreaded extra pounds? My short-lived goal of ten miles in 30 minutes has been, oh, so met.

I had decided that for the sake of consistency, I would limit the time on my stationary bike to 30 minutes and do it at least three days a week. Once I’m on the bike I revel in it, but it’s the getting on it that sometimes gets lost in the course of the day. There are so many other things to do! So I told myself: It’s only 30 minutes!

But the deal was that I couldn’t just meander through my bike ride enjoying the blue skies and puffy white clouds seen through my patio’s screen enclosure. I had to make it count. I had to make it comparable to my Tai Chi exercise, if not in length, then in sweat equity.

Tai Chi class is an hour and a half long; granted we do break for tea and cookies, and live chatting. And we spend almost half of the rest of the time watching the instructor go through the moves, which we then try to copy. She is poetry in motion; we are discordant verses.

Tai Chi is a real workout even though it’s slo-mo martial arts. By the end of class I’m usually sweating and my legs are crying out for a chair. Any chair. I used to get the same workout reward from my bike. The endorphins would fly as the sweat would pour. It was awesome.

But apparently, the three-minute mile is not good enough to even get a bead unless I do a whole lot more of them. Lately, I’d been having fun just increasing my speed, beating my personal best, 18, 19, 20, 21, 22, 23 miles per hour. Whooeee! That was fun; now it’s time to get to work.

I’m feeling good and as usually happens, when I feel good I tend to work out more, or should I say, harder. Which then makes me feel even better, a win/win. For I see exercise as money in the bank. If I put in a little bit each day, or almost every day, I will accumulate a mighty reservoir of health to dip into now and then as I ride this roller coaster called RA.

The Change

Over the years my fingers have gone through what I call “The Change.”

It would start with a stabbing pain, like a needle being repeatedly inserted into a specific joint. I’d be working and go to do something and the pain would make me suck in my breath and wince internally. I would not let on how much it hurt. I didn’t like letting others know of my pain (something I plan to write about later, my misplaced stoicism).

In those moments, I would squeeze the offending knuckle with my other hand to make the pain stop. The pain didn’t prevent me from doing what I had to do, accomplishing all the fine motor functions required of me. But it did make me angry that I had to deal with it.

And the worst thing was that I had to deal with it over and over again. One sad knuckle at a time.

I knew what it was before a doctor confirmed it. It was Father Time knocking. It was the life-clock ticking. It was Osteoarthritis setting in.

Once the change is complete, the knuckle looks swollen, has less mobility and it doesn’t hurt. But while the change is happening, the pain is oh, so exquisite. I don’t know why OA  picked my hands to strike first, but it did, it has. And still is.

This time it’s attacking my poor little pinkie. For the second time. Can’t remember when it got the first knuckle, but it now is engaged once more. photo (78)

The pinkie ring I used to wear can no longer traverse the length of the finger to settle where it once belonged.

The knuckle is tender all the time and filing my fingernail was a study in stoicism. But I will do my nails, dammit! RA or OA, or RA and OA, will not restrict what I want to do.

Ouch!

The I’s Have It

I chose a very ambitious path for myself this year and I have been mulling over my decisions while keeping my finger on the pause button. I haven’t exactly been idle, mind you. My brain has been working at a furious pace, while my body’s given the impression of languid ease. 

There are so many things to consider as you set forth on a new journey. Even if it’s a journey you imagined taking for years and years. You must visualize the twists and turns of the road up ahead. The inevitable forks in the road, forks not yet taken. Be ready to confront all, or almost all, the obstacles that will plop down in front of you like newly fallen trees. Find a way to sail over them. Wings, you must sprout wings.

Wings of knowledge. Wings of courage. Wings of faith.

I’ve been thinking about all this the past three weeks as I allowed myself to be consumed by a work of science fiction. While I let the story overwhelm my consciousness, my subconscious was left free to think, and to plan.

I was doing all my reading on my devices, laptop, tablet and even my phone. Wherever I was, wherever I went, I had my story with for me. But this method of reading provides one benefit that reading hard copy doesn’t: it allows you to increase the font to your liking, to increase reading ease.

And it reminded me that I needed to deal with one foggy issue. My eyes, or rather my eyesight. At my last check-up I was given a clean bill of health. Mechanically speaking. Everything was working fine, or should have been if not for one chemical variable, Gabapentin.

It was prescribed for me to treat nerve pain when I was diagnosed with shingles back in April. (Can it be almost a year? Where does the time go?) I was to take it three times a day and I did. Initially.

I was copyediting a manuscript at the time and racing to completion when all this occurred. It was through sheer grit that I managed to complete the project on time, although the author was quite supportive and understanding.

As time went on, I noticed things were starting to get really blurry. Until one day (duh), I decided to check the prescription flyer for the side effects. And there it was, in the tiniest print possible: may cause blurry vision.

Aha!

I cut my dosage down to once a day, and since it also said it caused drowsiness I took the dose at bedtime. Things seemed to clear up after a while, but not as clear as I would prefer. I blamed eyestrain, too much reading, too much computer time.

But here I was facing even more computer time, even more writing, rewriting, revising, editing and proofreading on hard copy. So while I read the sci/fi saga, my brain said: Stop.

And I did. I stopped my nightly dose and have solely continued the B vitamins also prescribed for the nerve pain. Nerve pain that by now occurs only rarely, knock on wood. Shingles leaves you in fear of its recurrence. But I say fear begone, because now on a clear day, I can practically see forever!

***

What have I been reading?

 

****

Ooops report: I was scrolling through and mistakenly hit the “like” button. I didn’t know you could “like” your own posts. Now I don’t know how to cancel it. Anybody know?

A Little Bit

Today is my sister’s anniversary. 51 years of married life. I can hardly comprehend that. That’s almost as long as I’ve lived on this earth.

We don’t keep in touch. She lives far away. All my sisters live far away. We don’t keep in touch, ever.

Sometimes that feels strange to me, and at other times, I don’t think about it at all. It just is.

But this wasn’t what I planned to write about. 

I planned to write about guilt. One type of guilt, for there is always a variety of it to go around.

As I go through my entries on this blog, and  compile those I might possibly use, all sorts of memories are being triggered. Some memories have nothing to do with RA, while others send me headlong into the world of constant pain that I lived in for what I assumed would be forever.

There’s no denying that RA changed me. It changed my outlook on life. It changed my ability to function, productively as well as effectively. It changed my career and career focus. It changed the trajectory of my future.

But looking back from ten-plus years, for I really do not know when this dis-ease arrived, I cannot say it is a bad thing. Not entirely.

I have benefited from the care of a wonderful doctor, who puts up with my self-treatment and self-diagnosis. Perhaps my intimate involvement with my treatment process has meant the difference. For though I no longer practice in the field, I cannot stop being a nurse. I cannot stop wanting to bring wellness to those whose lives I touch.

I have seen the depths and I have seen the light, to use one worn out cliché. And because of that, I feel guilt.

Guilt that while others suffer excruciatingly from this ailment on a daily basis, I am forced to agree with my doctor’s mantra. “You are doing very well,” he says to me after every visit.

And I am. I feel better and more mobile than before RA checked in.

I’m not really sure what I have done to make this happen. From the research of my writings, both posted here and those still tucked away in my journals,  I suppose I will find out, glean some sort of insight. Is it diet? Is it exercise? Is it love? Is it companionship? Is it finding like-minded friends to talk to? Is it knowing that people out there care about me? Is it caring for others? Is it all of the above?

I know that the treatment for RA is not a one-size-fits-all. But perhaps my story might help. Just a little bit.