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Another Day, Another $250 Hit… And more to come?

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Once again…not a single month has gone by since the first of the year without at least one unplanned financial hit! And I expect there’ll be more, what with this annoying medical thing. Lots more, no doubt.

Young fellow from Swimming Pool Service and Repair came by. He took the filter apart and discovered that Leslie’s had only replaced half of the DE filter’s eight white filter pad thingies. Their guy charged me $250 to replace all of them. Hm. Looks like I should’ve fired that outfit long before their recent effort to corral me into buying an expensive new pump!

You could tell which ones were fairly new and which were the old ones — the old, tired ones are kinda yellowed with age, mighty sickly-looking, while the newer ones look noticeably whiter. One of the old ones had several holes in it, which explains why the pool has been kinda hazy-looking: DE has been seeping out into the water.

Ducky. That’s going to be another $250, payable tomorrow when he shows up with eight new pads.

He said he’s about to take over his dad’s swimming pool service company — at the age of 57, Dad is recovering from a recent stroke. The kid said he’d provide weekly service for $90 a month. Sooo…if I have to have surgery that puts me out of commission in the heaving-around department, there’s going to be Sickness Expense the First. If I can’t lift things and my arms are effed-over by having the lymph nodes ripped out of them, I won’t be able to keep that pool clean on my own. At least not for quite some time.

Tomorrow morning I’m going out to the Mayo to see my old, OLD doctor, who practices out there. This morning I drove a CD with St. Joseph’s radiology images and the radiologist’s report out there, because I realized I couldn’t be here to wait for the pool guy and out there delivering the data at the same time this afternoon. Fortunately, the dog got up up at 3:30 again, so it was easy to get dressed, fed, and out the door by 7 a.m. A huge wreck closed the north- and eastbound lanes of the two freeways I would ordinarily drive to make this ridiculous jaunt, so I had to take surface streets all the way to the far side of East Scottsdale. However, traffic was light despite the dire warnings on the radio.

While plodding across the city, I reflected that Dr. Daley and I have known each other for almost 45 years! Holy mackerel! Who would think it? At any rate, he’s one of the Mayo’s grand old men now, and so if anyone can help me navigate through the hideous shoals of the medical establishment, he’s the one. Before I got off the phone from his underling, I had an appointment with him this week, like right now! He wanted to get his hands on said images/report early so that he could have a Mayo radiologist look at them. So, with any luck he should be able either to reassure me or scare the bedoodles out of me.

I’m taking the HealthGrades and Medicare.gov data to present to him, because of course the first decision I’ll have to make, should these things prove to be malignant, is whether to proceed with St. Joe’s or to go to the Mayo for surgery. The Mayo has the best safety record for patients — St. Joe’s is surprisingly wanting in that department. And I do want to ask him about St. Joe’s 16.5% mammogram follow-up rate, 2.5% above the level Medicare classifies as “unacceptable” and a pretty sure sign that they’re doing unnecessary procedures.

God! I’ve become such a skeptic in my old age! Take things with a grain of salt? Hell, I take everything with a pound of salt, thank you very much. I just don’t believe anything or anybody anymore, whether it’s a pool guy or a high-powered M.D.

Here are the issues that set off my bullshit alarm with the present cancer scare:

• The radiology tech looked at the second mammogram images and said, of the alleged nodules, “Those aren’t cancer.” Admittedly she’s just a tech — i.e., likely a junior-college graduate — and she no doubt was shooting off her mouth when she shouldn’t have been. But there’s also a bachelor’s degree program for these technicians, and if she has a lot of experience, she may very well have a clue to what she’s looking at. Thirty or forty minutes later, I’m being told there’s a 50% chance the things are malignant. It plants a little doubt, albeit not much.

• By way of trying to persuade me that I need more probing and possibly surgery and radiation, the radiologist asked if I’d ever taken hormone replacement therapy. When I said I had not, she said that was a bad sign — not doing HRT is a risk factor for breast cancer. Well, that is not altogether true. The American Cancer Society reports that HRT using estrogen and progestin raises your breast cancer risk, whereas plain estrogen therapy has a nil risk or even a slight protective effect.

• Then there’s that 16.5% follow-up rate. It’s the highest of any of the area hospitals I looked at. Boswell, out in Sun City, has a 7.7% rate, below the state average of 8.9%. Good Sam’s is 13.7% and John C. Lincoln’s is 13.5%, dangerously close to that 14% figure Medicare considers “unacceptable.” IMHO, Medicare is a cash cow (heh…okay, pun intended). To the skeptic’s eye these diagnostic tools look a great deal like milking stools. We have a relatively simple procedure that Medicare covers; we have a public convinced it should be used routinely; and we have a dread disease that so terrifies women it can be used to herd them toward increasingly profitable extra procedures…from mammogram to new mammogram to sonogram to biopsy to…??? Hm.

That’s not to say I absolutely positively think it’s bullshit. Obviously, it’s best to assume the worst of any suspicious lesion, and then to be pleasantly surprised to find it’s harmless.

You know, that’s why it’s good to be a cynic: you’re always pleasantly surprised!

😆

Question Authority! Navigating the Medical Industry

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Folks, I want you to bookmark and also write down the URLs for these two sites:

Medicare.gov’s Hospital Compare search engine (http://www.medicare.gov/HospitalCompare/search.html)
Health Grades (http://www.healthgrades.com/)
Health Grades’ Hospital Directory (http://www.healthgrades.com/hospital-directory)

Hang onto these. Sooner or later, you’ll need them, unless you drop dead out of the blue.

To get the mammogram that led to the speculation that I may have breast cancer, I went to St. Joseph’s, a vast medical center in downtown Phoenix — only because my gynecologist is on the teaching faculty there. It has a good enough reputation, other than the Church’s having fired and excommunicated an administrator and ethics board member because she approved an abortion to save the life of a patient who was had a 100% chance of dying if the pregnancy continued. And other than the fact that I almost died there some years ago, when I couldn’t even get triaged after showing up at their ER with acute appendicitis. But those, of course, are different stories.

Yesterday, after I finally began to calm down a bit, it re-entered my hot little mind that I won’t even have a dental procedure done without a second opinion. So why on earth would I let someone have at my boobs without a second opinion?

Emboldened by this thought, I called Young Dr. Kildare’s office and asked tentatively if he would be interested in chatting about this. His nurse basically said “uhhhh… I’ll ask him.”

Then St. Joe’s called to set up the biopsy. They only do these at 10:30 in the morning. I explained that I teach four days a week, and that my pay will be docked if I don’t show up. That  left only Fridays, and (fortunately, I suspect), this Friday was taken. So the thing is now scheduled for the 20th.

This buys some time.

Charley woke the Pup this morning as the sun’s first waves of electromagnetic radiation seeped over the eastern horizon, and they started to lobby to get up and play. That rolled me out of the sack at 4:30. More time purchased: I used it to do a little research.

Here’s what I found out:

First, I found this article, reporting on research that suggests mammography can lead to unnecessary procedures, and that some scientists believe women over 70 or 75 should skip the routine screening altogether. For women between 50 and 70, however, routine mammography may reduce the risk of death from breast cancer by 20 or 30 percent.

I’m not 70 yet, but I will be in less than a year.

Following a link in that article, I came upon a risk assessment tool at Cancer.gov that puts my chance, at age 69, of developing breast cancer within the next five years at 2.2%, exactly at the average risk of 2.2%. The site notes that this means my risk of NOT developing a breast cancer over the next five years is 97.8%. My risk of getting breast cancer between now and age 90 is 6.6%.

Hm. Kinda different from the 50-50 chance the St. Joe’s radiologist gave me, isn’t it? Interesting, too, that she qualified her statement with “that’s in my opinion.”

Healthgrades is a site that assesses the safety and quality of hospitals across the land. Out of curiosity, I checked on three hospitals where I might  have the threatened procedure done: John C. Lincoln, because that’s where Young Dr. Kildare practices; St. Joseph’s, because it’s a teaching hospital and it’s where my gynecologist practices; and the Mayo, because it’s the best of a generally mediocre lot here in Arizona.

In “Safety” (i.e., how likely are you to be harmed by some condition or error attributable to the hospital and its staff) Healthgrades ranks St. Joe’s below John C. Lincoln, which used to have a terrible reputation. St. Joe’s gets 7 “below average” dings, 4 “average” marks, and 2 “above average” credits, compared to JCL’s, with a mere 4 “below averages,” 3 “above averages,” and 6 “averages.” The Mayo is far superior, with 3 “below average” grades, 3 “average,” and 7 “above average.”

That’s interesting. Not to say “alarming.”

When you get into Medicare.gov…ah, that’s where it gets seriously interesting. The government has posted a lot of data about hospitals around here. One of the categories the statisticians track is “Use of Medical Imaging,” and they say that in Arizona the average rate among outpatients who have a follow-up mammogram, ultrasound, or breast MRI within 45 days of the initial screening is 8.9%. Now that may not be typical of the US overall, because there’s a lot of poverty here, and also because women who live on the Indian reservations might have a difficult time traveling back and forth for repeated exams and so might be asked less often to return. One never knows, with this place. However, on another page, the site states:

Medical evidence suggests that there may be a problem if a facility has either a very low or very high rate of follow-ups.

Although values for a very low follow-up rate have not been established, a follow-up rate near zero may indicate a facility that misses signs of cancer. Follow up rates around 9% are typical.

Research has established that a follow-up rate above 14% is not appropriate and may indicate a facility doing unnecessary follow-up.

And over at the page reporting on St. Joseph’s, we find the following:

Use of Medical Imaging:

Outpatients who had a follow-up mammogram, ultrasound, or MRI of the breast within 45 days after a screening mammogram: 16.5%. a rate higher than 14% may mean there is unnecessary follow up.

 Whoa! A return rate of 16.5 percent?? That’s almost twice the state’s average rate, and it’s 2.5 percentage points above the rate Medicare says is not appropriate. 

John C. Lincoln is better, though not great: 13.5%. It’s still very high — just a shade under the “inappropriate” level — but it’s 3 percentage points below St. Joe’s.

As for the Mayo, we’re told “Not Available; No cases met the criteria for this measure.” What on earth that means, I do not know. But I do know one may go to a local clinic of the Mayo for a mammogram, rather than having it done at the hospital per se. Maybe they’re able to claim the rate is not the Mayo Clinic’s by a little sleight of hand. In my experience, the Mayo tends to lean heavily on the panic button.

I feel like I’m on a railroad ride to Hell here…

So I’ve called Young Dr. Kildare’s office — got an appointment on the 16th. I’m going to print this stuff out and tell I want a second opinion about whether a biopsy is really necessary. IMHO it’s telling that the mammography technician stated, in no uncertain words, that the two tiny lumps were “definitely not cancer” and then all of a sudden we get a new story from someone with a vested interest in charging Medicare for an extra procedure. The tech may just have been shooting her mouth off. But…she’s in the business, too, and she must be trained to recognize, to some degree, what she’s looking at.

Unfair to the radiologist, of course.

But…in a culture where the profit motive drives delivery of medical care as well as production and delivery of pharmaceuticals, it’s hard not to be skeptical.

Doggy Tunes!

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So this morning it’s off at 5:30 to M’jihito’s house. His luggage, his dog, and he are piled into my car, in that order. Thence, to the airport, where the son and the luggage were unloaded. And now Charley the Golden Retriever is here at my house for a week.

Charley and Pup are hilarious, because Pup brings out the two-year-old Charley’s lingering latent puppitude. Around Ruby, Charley is still, unmistakably, a puppy. A great deal of frolicking takes place, and much mischief is plotted.

One of their Looney Tunes schticks has to do with food. They both love it. They both desire it. They both require it. And neither one can stand to see the other get it.

Pup gets fed inside an X-pen so that Cassie can’t take her food away from  her, but a glance at Charley and a glance at the X-pen will tell you that the contraption is too feeble to keep him  out. Another scheme had to be contrived. As soon as I opened Ruby’s can of expensive urinary tract prescription dog food, Charley knew something was up. He was beside himself with excitement. No way a bowl of the stuff was going to get on the floor without him inhaling it

HUMAN: Come on this way, Charley!

HUMAN walks down the hall.

CHARLEY and RUBY follow human.

CASSIE flies up the hall and dodges into the bedroom.

HUMAN: You stay, Ruby.

RUBY ignores HUMAN but is muscled aside by CHARLEY, who strong-paws his way into the bedroom.

HUMAN dodges out the door and closes it before RUBY can squeeze in.

HUMAN: Dog food, Ruby!

RUBY races toward kitchen, a bundle of joy. CHARLEY slams self against door in despair.

Heeeee! He’s a nice dog. But not the brightest rhinestone on the fancy collar.

Speaking of Looney Tunes, I called the gynecologist’s office to be sure I understood correctly that the radiology department would call me to make an appointment for the pending torture sessions. After punching through two punchabutton nuisances, I get stuck on hold. And hold…and hold…and hold…and hold…and hold…and hold…and hold… This wouldn’t be so annoying if one could wait on the damn phone in SILENCE. But noooo…they have to subject you to vomitous muzak and endlessly annoying blather advertising the many services they would like to persuade you that you need. After a good ten minutes on hold — I’ve answered e-mail, posted an announcement on my class’s Canvas site, unloaded the dishwasher, and am reloading the washer with new dirty dishes — the phone rings through and someone answers and the first words out of her mouth are “WILL YOU HOLD, PLEASE?”

Well, no, thank you.

How much, again, are you folks charging Medicare for this?

 

Oh Goodie! Another Cancer Scare…

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So it’s back from the extra trip to the mammography unit, where the radiologist says she and her ultrasound lady found two “nodules” which she believes to be dangerously suspicious. She explained all the reasons she thinks these things could be boob cancer, and she made good sense. So now they want to schedule a needle biopsy and, if that turns out positive, surgery.

Ducky. As if I didn’t have enough on my mind.

She said the chance that they’re benign fibroadenomas is about 50 percent. That, of course, means there’s a 50 percent chance that they’re cancer. Doesn’t sound like great odds to me. Because these are new growths, because of my age, and because I have never taken hormones, the likelihood that they’re malignant is elevated.

Look into this and you discover that benign fibroadenomas in old bats like me may (or may not) be precursors of actual breast cancer:

Women diagnosed with benign disease do appear to have an overall modest increase in risk for subsequent development of breast cancer, particularly for more hyperplastic or epithelial (the covering or lining) proliferative forms. However, the evidence regarding the risk of breast cancer for non-proliferative conditions is conflicting. Some research found that the risk of breast cancer for women with non-proliferative disease is about double that of women without benign disease (Bodian 1993b), while others find that lesions with no proliferative changes were not associated with an increased risk (Oza 1993; Henderson 1996; NBCC 1999). According to Hurley (1997), atypical hyperplasia is a risk factor, but is not with certainty followed by breast cancer; risk applies to both breasts, with greater risk on the affected side. There is no means to predict which women will go on to develop breast cancer and the effectiveness of current screening and management methods is unknown. Further complicating a physician’s ability to predict a woman’s risk for breast cancer is that most women do not have a history of biopsy for a benign lesion (Bodian 1993c; NBCC 1999).

Isn’t that informative!

Hm. Interestingly,  neurofibromas (a hereditary condition which I happen to enjoy) can also appear in one’s boobs, and they can be mistaken for fibroadenomas. And lo! These things are on the same side as the neurofibromas that infest my shoulder. Wish I’d known that…I would have pointed out the shoulder lumps to the radiologist. Oh well.

What a damn nuisance. You know, the truth is, I don’t really much care whether I live or die. My life is essentially over now, and I’m not at all afraid of dying. Nor do I imagine I have much of anything left to do on this earth: I fill my hours with frantic busywork mostly to pass the time. What does scare me is the prospect of suffering the way my mother did with her cancer…and with her incompetent quack doctors. Truly, I would cheerfully die right now, today, rather than suffer the way she did.

Because I’m all by myself and there is no one here to help me, the hassle factor is almost more than I can bear to contemplate. The biopsy is nothing, but if, as seems fairly likely, they decide these things are cancers, the upshot will be lumpectomy and radiation therapy, according to the radiologist.

That means an overnight stay in the hospital plus God only knows how long to recuperate enough to get back to a normal life. None of the sites I’ve looked at say how long it takes to recover, but I would assume it will be at least a couple of weeks… Evidently long-term pain and numbness of the arm, plus some other uncomfortable and weird manifestations, are possible. The radiologist seemed to be saying they would perform radiation therapy at the time of the surgery, but all of these sites talk about five or six weeks of radiation therapy.

So. At the outset, someone will have to take care of these dogs, since I will be unable to do so for at least several days and possibly longer than that. Someone will have to take care of the pool, which is merrily going green — I have to do battle every day to keep the algae blooms under control, because I was too damn lazy and cheap to drain the thing and refill with fresh water last winter. Probably someone will have to run to the grocery store at least a few times to get me some food. And of course all these little projects I’ve been doing, trying to get books published and the incoming giant index and the various other editorial projects are going to have to go away, to the loss of at least a couple thousand bucks. If I’m unable to function well enough to teach my classes next semester, that’ll be another $4800 out the door.

Ugh. Just what I need to make my day!

A Quarter of the Semester Already GONE!

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ha Haaa! One week into a four-week section, and a quarter of the course is already past!

The li’l stoonts have turned in five papers — really just little reports on assigned chapters, designed to force them to actually read the stuff. They’ve been to the library and listened to the librarian lecture on how to find resources for their papers. A few of them have come up with viable topics for their papers, the first of which is due in a week.

This. is. GREAT.

I fail to understand why most of these de rigueur hoop-jump courses are not taught in extremely short format like this. Obviously, an intense format would be too much for some students — though it must be noted that several of the current classmates are alumni of remedial reading and writing courses. So if we must have these courses, they should be offered in 16-week sections for those who aren’t so fluent at reading and writing. And 8-week sections would probably do for those who feel  less confident but still are reasonably competent — I mean, we’re only talking about three papers here! For those who are good writers and reasonably well organized students, four weeks should more than suffice. That’s one week per short paper and two weeks for the 2,500-word term papers.

Since as a practical matter most students put off writing any paper until the last minute, those periods are probably as much time as any student in a 16-week course would devote to the assignments.

At any rate, from my point of view, teaching a four-week course makes the pay almost reasonable: $2400 for a month of part-time work. The class meets two hours, four days a week. Although I have grading every night, except for the three District-required essays, it’s pro-forma: just glance at their papers, see if they’ve actually done the assignment; if so slap 15 points on it; if not, downgrade accordingly, with as little comment as possible. It leaves the rest of the summer for me to do my thing, and it also leaves about half of every day for the purpose.

And so, to work…to read these exercises in front of Netflix. 😉

Farming Out the Chores: Opportunity Cost Recovered!

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I’m in love with Luz, the marvelous new housecleaner! To begin with, she cleans one heck of a lot better than I do. And to end with, this lady is making it possible for me to spend my time earning instead of scrubbing!

Today opened with a list of 26 to-do’s, extreme even for moi. None of them had to do with cleaning house.

Luz appeared on the scene shortly after I left to teach the high-intensity Eng. 102 section. She worked for about six or eight hours, doing a job that would take me about four hours to accomplish…but doing it about twice as well as I would have done it. Had I decided to do the housecleaning myself today, it would have left time and energy for me to accomplish exactly two of those 26 to-do’s: teach the class and drop by the credit union on the way home.

But…while she was here shoveling out the Funny Farm, I managed to get through all of these:

  1. Download examples of citation and documentation from old editorial documents, to use as demo material for students
  2. Compare diet/cookbook’s table of contents with 150 typeset pages, figure out what on earth the e-book designer is complaining about, and fix it (this, it developed, was a BIG job)
  3. Enter website wrangler’s invoice in Quickbooks
  4. Meet and teach class (with commute time  & item 5, occupied 4 hours)
  5. Drive to credit union; deposit $1150 worth of checks to The Copyeditor’s Desk
  6. Find the lost membership card to the Desert Botanical Garden
  7. Reconnect repaired brand-new pool cleaner (it picked up a rock!); test; run
  8. Read two sets of student papers (another fairly large job)
  9. Walk dogs one mile (actually, did that in the early hours, before anything else came down)
  10. Do physical therapy exercises (ditto)
  11. Cook five pounds of dog meat; store for future processing
  12. E-mail associate editor to coordinate workload while she’s in China
  13. Intercept request for work from dubious client
  14. E-mail associate editor to see if she wants to do work for dubious client
  15. Send proposal to dubious client

Okay. Those last three were not on the To-Do list as of 5:30 a.m. They did surface in the afternoon. But otherwise…not bad, I’d say: 13 out of 26 items. Tomorrow no student papers are coming in, so I may get through the remaining 14 (plus a few regular Wednesday events) tomorrow. If I’d taken it into my feeble little mind to clean the house this afternoon, about all I would’ve done would have been to meet the class and deliver the checks, since cleaning would have occupied the rest of the day and left me too pooped to pop.

 In other words, the opportunity cost represented by four hours of housecleaning was recovered by hiring Luse to do the unproductive scutwork. During all the time she was heaving, hauling, scrubbing, and scouring, I was doing things that either do make money or probably will make money.

A-a-a-n-d…the sheets are clean, the dust in which one could write one’s name is gone from the furniture, the stove is clean, the kitchen counters are gleaming, the bathroom glows in the dark, the floors no longer feel gritty underfoot, the throw rugs have been hauled outside and beaten, the deck and the back patio have been swept, dusted, and cleaned, the Arcadia doors are so clean they look like they’re hanging open… So, so worth it!