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Health care

Dispatches from Hell…

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Day after day after day after day has been yet another Day from Hell, lo! these several weeks. Why don’t things get better? Why does everything break, bust, explode, crash, or die? Finally figured out the explanation. These are not days from Hell. We are actually in Hell. Hence: these are not blog posts. These are Dispatches from Hell.

Case in point: The least of today’s hassles, only because it’s a hassle left over from a week ago…I’ve tried twice to re-up my subscription to The New York Review of Books, one of my favorite broadsides. First time was my fault: I used the credit union’s bill-pay function, but paid for it from my personal account (which, oddly, did have the the NYRofB’s listed as a previous payee). Of late I’ve been making the S-corp pay for it.

That payment bounced. Why, I do not understand: what do they care which account pays for it? Ohhkay… Eventually they sent a desperate “Don’t Leave Us” ad in the snailmail. I replied to that by filling out the form and entering the S-corp’s AMEX account number. This no doubt would have worked if I hadn’t indulged in a moment of stupidity.

As you know, the ‘Hood is not the best of all possible neighborhoods. We’re inundated with drug-addicted transients, who support their habits with petty theft. Including mail theft.

The payment envelope in hand, I raced out the door to run a bunch of errands and get someplace on time. In a hurry, I really did NOT want to drive to the Post Office to deposit the thing in one of their mailboxes. That would entail waiting half my lifetime for the blightrail signal at the interesection of Conduit of Blight and Feeder Street E-W to turn green, then waiting the rest of my lifetime to get back across the damn blightrail tracks to get to my various destinations. So instead of traipsing to the PO for this one small item, I stuck it in the outgoing slot of the Fort Knox Mailbox and flipped up the red flag.

Bad move. Very stupid indeed.

Two or three days later, I went out to get the mail (it’s almost all advertising now, so there’s no hurry to pick it up) and noticed the red flag was still up. Whaaa? Did the mailman not come by? (He often doesn’t….)

Check to see if he’s failed to pick up the outgoing: no envelope in there. Days go by. A couple weeks go by. No payment at NYRofB’s.

Shit. That means someone has stolen the thing and now has my name, the name of my business, its address, and its AMEX credit card number. I wait a few more days to see if the payment goes through. Today I call NYRofB’s phone reps and they say they never heard of it. I need to pay the thing on my corporate AMEX card over the phone. Then I need to cancel the card and order a new one, ASAP.

But ASAP ain’t very AS…because I’m waiting on the PostalPerson to deliver a new personal AMEX card. Yes. Somehow I managed to LOSE a whole cardholder full of cards!!!! The personal AMEX card, the Safeway card, the new Medicare card with a new Medicare number on it (the one that doesn’t work at the pharmacy), the old Medicare card bearing my Social Security number….GONE, every one of them.

I believe they’re somewhere in the house, because I paid the AC guy to fix the thermostat and the leaking roof with my personal card, and I did not leave the house between the time he drove off down the road and the time I realized I couldn’t find that cardholder. Since I’ve habituated that locksmith for a good 12 or 15 years and Steven (locksmith dude) has worked for them for 7 years and he’s a fine upstanding workingman, I don’t believe he walked off with it. Without a doubt, I set it down in the house somewhere and managed to lose it…same as the pair of prescription glasses that got tangled up in a knitted bed throw and disappeared for three months.

Fortunately I have photocopies of the Medicare cards. And fortunately, I had the sense to black out the SS number on the old Medicare card. The AMEX card has been canceled and a new one is on the way, but the weekend coming up, I don’t expect “tomorrow” (no kidding: that is what she said!) to arrive much before Monday. And fortunately, my debit card, corporate AMEX card, and Costco cash cards are in a different card holder. Which is not, after all, lost. Yet.

So what other dispatches from Hell since I had to pay $40 out of pocket for a flu shot?

  • The dog got better off the fluconazole, then worse.
  • Dog continuing incontinent, I ask the new vet if they’ll test her urine for a UTI.
  • Wednesday after volunteer receptionist duty, I race the refrigerated pee up to 40th Street and Thunderbird and drop it off there. I drive up there through the rush-hour traffic, drive back in even worse traffic. Changing lanes to maneuver into place to turn right into the ‘Hood, I misjudge the length of a flatbed trailer being towed behind a pickup in the lane next to me and clip the goddamn thing. The driver doesn’t even blink. He doesn’t slow down, he most certainly doesn’t stop…I think he may not even have noticed that I bumped his trailer. My car sure did, though. Pulled over to find the front bumper was half pulled off, scratched and gouged, flying in the breeze. Shee-ut!
  • Back here, I walk in the door and find…NO Charley! He’s freaking GONE! A worker has been here in the afternoon; I’ve left strict orders not to let that dog slip out the back gate. But he can go in and out the dog door…dollars to donuts that’s exactly what he’s done. He’s old, he’s sick, and now he’s LOST. Try to reach said worker: no answer. Totally, utterly panicked. My son is supposedly in Colorado, which is why his dog is here. I think maybe he got back while I was out and picked up his dog, but he won’t answer his phone, either. Neighbor texts him (I have no cell phone). No answer. I am in utter despair. After a bit I calm down enough to notice that even though the dog’s food is still sitting on the kitchen counter, the dog’s leash and collar are gone. SOMEONE took the dog on purpose…at least he’s not roaming around the neighborhood and ambling across Conduit of Blight Boulevard.
  • Eventually the kid calls and says yeah, he picked up the dog but was too tired from driving in from southern Colorado to bother to leave me a “thanks for keeping my dog” note.
  • Now late for choir, I feed the dogs and fly out the door without any dinner of my own.
  • Get home about 9:15 p.m. and go to enter the (locked) office.
  • It’s been raining for a day and a half. The solid-core door is swollen tight. The key goes in but I can’t turn it. I get a wrench, try to open the thing, and…SHEAR THE KEY OFF level. with the fucking deadbolt! All my computers, all my financial stuff, all my credit cards, all my cash, even my cheesy little clamshell phone are locked behind that door.
  • Call the locksmith’s emergency line. He says he’s sure he can fix it. For a hundred bucks he’ll do it right now (pushing 10 p.m.). I say if he’s sure it can be opened, I’ll be able to sleep at night and so can wait till tomorrow. Otherwise I’ll be wanting to break the front window and climb in to get my computer, which I’d druther not do.
  • Next day have real difficulty getting them to come over — but because I’m an old customer who’s spent a lot of dollars at their shop, they squeeze me in.
  • Steven comes over, takes a screwdriver to the thing, flips out the stump of the key: takes him all of 30 seconds. I’m in love. This love affair costs me 70 bucks. And now I have to go take the fancy key over to the shop to get a new one made. That’ll be another 20 bucks. Later. But not much later.
  • Somewhere in here I lose my credit-card holder. I search from pillar to post, empty out the trash cans, go through drawers, look under the furniture: no luck. I’m sure it’s in the house, probably, but when I can’t find it the next day figure to be safe I’d better cancel the AMEX card. Two or three days without a personal charge card. Yeah.
  • Insurance guy says I’m in luck. Because he bought me a “prime” policy, I have a one-accident-no-fault deal: get out of jail free. AND because I haven’t tried to kill any of my fellow homicidal drivers lately, I also have a zero deductible. He asks me to get estimates from a body shop but suggests that if it doesn’t cost much it may be better to foot the bill and not let the company know about this little fender bender. My son, also an insurance guy, recommends taking the money and running: he thinks I should go to the best body shop in town (which is 20 miles from my house) and have them do a decent job fixing it.
  • The vet’s office calls to say something’s out of whack with Cassie’s pee and they want me to bring her in Saturday morning. I say “wrong”? Like what? Well, like it might be a UTI. Ooookayyyy…
  • I take the car to my mechanic to check for damage under the hood. They find no structural or engine damage, AND they manage to wrest the bumper back into place and secure it with the car’s clips and a few extra bolts. It now looks dead normal except for a scrape on one side, as though maybe I got too close to a guard wall. The men of Chuck’s Auto also opine that it would be best to hide this incident from the insuror. However, they do find a nick in the tire’s sidewall and recommend replacing the tire soon.
  • I call my insurance guy with this report and with the advice from my son. He reiterates that his thinking coincides with the mechanics’ but he will support me whatever I decide to do. (He’s not a sales agent: he’s a broker.)
  • Cassie seems to be getting better. By yesterday I observe that she’s about back to normal and surmise I must have been right that she didn’t have Valley fever.
  • At 3:30 this morning she wakes up and pees in the bed before I can set her on the floor. In doing so, she manages to miss the double layer of pee pads I’ve laid down on the bed: three more loads of laundry!
  • In a flash I haul off the sheets, the bed pad, the blanket, and the dog blanket. Fortunately this five-layer barrier keeps the dog pee off the mattress. Dazed with exhaustion, I toss the sheets and blanket into the washer and start the thing running.
  • Cannot sleep, so go back to reading 8000 words of Korean-accented scholarly writing.
  • Somewhere in here it dawns on me: this lesion that developed on my hand, the one on the same arm that got the ferocious Shingrix shot, is not a zoster pox. Noooo….Y’know what that is? THAT little fucker is ringworm. Look it up and find ringworm image after ringworm image that looks just like it. And ringworm being not a parasite but a fungal infection, y’know what the treatment is? Ohhhh yes! Fluconozale, the same damn stuff that made my dog so sick I thought she was going to die! TWICE!
  • Shit. Well, you can get a topical treatment over the counter. The standard course of treatment, if you believe the Internet (yeah!), is first to try to get rid of it with an OTC ointment. If that doesn’t work, then you move on to poisoning yourself.
  • Eventually I go out to move the bedding from the washer to the dryer and…can you guess? Somehow I’ve missed two of the pee pads! The inside of the washer is now chuckablock full of shredded, wet puffed-up paper stuffing crap! HOLY shit!!!!!!!!!
  • I go inside to finish reading the client’s paper.
  • Eventually go back out to the garage. Realize I can’t put this stuff in the dryer. Haul each piece out into the driveway and shake, shake, shake, shake, snap, shake, snap, SHAKE, shake, shake. This covers the driveway with snow-like stuff but doesn’t get all the crud off the bedding. Hang the sheets, blanket, and mattress pad on the clotheslines, hoping most of the rest of the stuff will shake off when it’s dry.
  • Clean out the washer. Yeah, right.
  • Take the shop-vac to the washer. This clogs the shop-vac but apparently gets most of the crud out of the washer, except for the stuff I have to dig out with a coat-hanger wire. Use the rest of the vacuum’s capacity to pick up the white snow off the driveway and the garage floor.
  • Haul the vacuum tub and two baskets of garbage out to the alley trash bin. On the way, pick up a bum’s fast-food cup out of my yard. On the way, observe that the mess the city water guys made of my front landscaping is pretty well fixed, after I shoveled and broomed gravel back in place. Hope they didn’t fuck up the plumbing under there. But don’t have much hope.
  • Brush out and wash the shop-vac’s clogged filter; set it aside to dry.
  • Finish the Korean professor’s paper. Interesting guy, interesting subject. Learn a lot about international law on freedom of expression and journalistic privilege. That’s good, anyway. Run it past a prospective intern, am impressed with the kid’s response. Ship the edits & clean copy back to the client.
  • Decide I cannot bring myself to do the Costco run that was planned for today.
  • Realize that isn’t gonna do me any good, because I still have to go out to a Walgreen’s and try to find the anti-fungus stuff (miconozale) to treat the frantically itchy lesion on my hand.

And so, away. Let’s see what I can do to my fellow homicidal drivers on the way…

Shingrix: Walgreen’s 0, Safeway 1

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Welp, Safeway wins the Shingrix vaccine competition by a mile.

Earlier this week I went by Walgreen’s to see if they had the shingles vaccine, which is famously in short supply. They said they did. I mentioned that I’d put my name on a list to be called when the vaccine came available again and never heard from them. She checked her list and found (surprise!) I wasn’t on it.

However, having heard that this stuff can make you mightily sick and facing a sh!tload of work that couldn’t be put off, I asked if they had enough that I could come in Sunday (today) to grab the first shot. She said sure, and put my name on her list.

Today after church I darted down there, as planned, to subject myself to the vaunted shot. By now I’ve heard so many reports of side effects ranging from unpleasant to awful by way of painful, I was mightily dreading this encounter.

Was my name on the list, asked she? “They told me to come down here this afternoon.” She checks the list: nope.

“Well, I can have one available about 1:00 this afternoon.” This, after I’ve stood in line behind some woman for a good 15 minutes while the clerk diddled around and diddled around and diddled around and diddled around.

What time is it now? Around 12:30. What, I wonder, does she think I’m going to do with myself, hanging around a Walgreen’s for half an hour or forty minutes? I say I’ll come back another time . (Maybe in some future lifetime...)

Get in the car and drive across the street to the Safeway, cattycorner across the intersection from the Walgreen’s. March through mobs of customers (is there a reason the Walgreen’s is almost empty? hmmm?), bounce up to the pharmacy counter and ask if they have any Shingrix shots available.

“Sure enough! Come on over to the cash register and I’ll ring you up.”

Uh huh.

In under 10 minutes, I had the shot and was out the door and back in my car. Also had a 10% off coupon for my next grocery shopping expedition.

So. That will bring a permanent end to my getting flu shots — or much of anything else — at Walgreen’s!

Little drawback, though: They charged a $160 copay!!!!!!!

That, of course, is ridiculous. Tomorrow I’ll probably call Humana to ask WTF. But on the other hand, Humana’s Part D plan is so economical that they’ve saved me far, far more than that in premiums over the several years since I signed up. So I don’t feel too exercised. Plus any day I’d cheerfully pony up $160 to avoid the shingles!

As for the horrors of the Shingrix vaccine? So far, nothing like the tales we’ve been told. The pharmacist said most people experience some mild arm soreness and a few enjoy flu-like symptoms, which pass quickly. Me? No pain so far. Slight vertigo and mild headache — which I’ve experienced in the past with ordinary flu shots and are hardly debilitating. And very possibly attributable to stress, since I’ve been flopping around trying to figure out how to fit two to five days of being sick into a very busy schedule.

I wonder if they’ll gouge me another $160 for the second shot…

In Pursuit of the Elusive Shingrix…

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Raised red bumps and blisters caused by the shingles virus

The latest shingles shot, that is. Since no one seems to want to enjoy a bout with shingles, the new Shingrix vaccine has been in short supply.

Now, however, our neighborhood Facebook group reports that the local grocery store pharmacy has it. I went by the Walgreen’s, where supposedly my name was on a wait list, only to find they’d never heard of me. 😀 WHY am I not surprised?

Well, this stuff apparently has some moderately fierce side effects. And the coming week is going to be pretty busy.

Tomorrow I spend the afternoon down at the church on receptionist duty. This will leave just enough time to fly home, feed and wring out the dogs, and bolt down dinner before flying back down there for choir rehearsal.  Friday three friends are coming over for dinner, and then we’re spending the evening gadding around downtown for the First Friday festivities. Sunday morning of course there’s singing.

Since we’re told you could be out-of-it for two to five days with fever, chills, shivering, and pain, I decided to put it off until Sunday. The pharmacist thinks they’ll still have enough to dispense shots this weekend. If not, then over to the Safeway, up to the Walmart or down to the Costco. Or all three. Apparently there’s not a huge shortage anymore.

So the plan now is, I’ll fly down there after choir on Sunday, then plan to spend the rest of the day moping around.

Monday I’m supposed to traipse across the city to the Mayo again(!), but the issue is nothing pressing, so if I’m unfortunate enough to number amongst the 1 in 60 who enjoy truly unpleasant side effects, I’ll just cancel.

And it’s almost inevitable: Doesn’t matter what the drug is. Whatever bizarre side effect it can inflict, I will absolutely get it. The rarer and the more atypical, the more likely it is to afflict me. So I’m expecting to be sick for at least two days. Hope not for five. Ugh.

BUT…five days under the weather is one hell of a lot better than a case of shingles . Holeee mackerel! Several friends and acquaintances have experienced bouts with this fine epizootic, and it is passing nasty.

The first person I met with the disease — which is a recrudescence of chicken pox — was a wildlife biologist. She and her husband had retired to the idyllic semi-wilds of Portal, in southern Arizona’s Chiricahua Mountains not far from New Mexico. She had had it for two years! And it showed no sign of going away soon. The rash around her rib cage was so excruciatingly painful that it literally disabled her. She could do little more than lay on the couch and suffer. And as you can imagine, she had been an active woman before this thing hit her.

That was when I thought…uh oh! Whatever you do, don’t get old, ’cause you really DON’T want to get that stuff! In those days, there was no vaccine. And getting old was considered the main risk factor. Well, that and having had chicken pox as a kid. Which I certainly had: a particularly ferocious case of it.

But it kept me out of school for ten days or two weeks. So…I appreciated that. Nice little virus. 😉

Mercifully, by the time I finally did get old, they had developed the early shingles vaccine. As soon as they would let me take it — you had to be 60, as I recall — I darted into the Safeway pharmacy and signed up. Insurance wouldn’t cover it, of course — you expected a bear? The cost was $150. A lot of people refused to pay that, but having seen that biologist with the bug, I was happy to pony it up.

So of late, our young doctor at the Mayo says the old vaccine is not especially effective — better than nothing, but not good enough. She strongly recommended I get the two-dose Shingrex vaccine. But o’course like everyone else at that moment, the Mayo was out of the stuff.

Apparently Medicare Part D will cover it. But if it doesn’t: big deal. I’ll take out a loan against the house if I have to.

If you’ve ever had chicken pox — and you may have even if you think you haven’t, because some people get it without much rash and conclude that they’ve had a cold — you should get the Shingrex vaccination. It has a much higher likelihood of blocking a shingles episode than the earlier stuff did. And you should get it, too, if you’ve already had a case of shingles: it will protect you from a flare-up.

Woo hoo! Lifestyle change WORKS on blood pressure!

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Dayummm!!!! You’ll recall that in response to a recent test indicating  mildly elevated liver enzymes, I decided not only to lose a few pounds but also to go totally, completely on the wagon?

Well, I’ve been riding that dietetic wagon for a little over a month. Lost about five pounds. It’ll be the middle of August before we know whether the present frolic has an effect on one’s liver enzymes — the medicos like to wait three months before retesting.

But… In the absence of my favorite potables, something amazing has happened to the blood pressure: the average — yes, average! — is down to 117.4/79.6.

Holy mackerel!

After 18 days off the sauce, I decided for the heck of it to check the BP numbers again, even though I hate it and even though MayoDoc said to knock that off. Thought I’d take a look about once every ten days or two weeks.

So.

18 days into the Wagon Ride: Average = 127.2/87.6  (This, after discarding the initial reading of 142/91.3. Two systolic readings were in the 130s.)
24 days off the sauce: Average = 124.8/83.4 (all readings)
32 days booze-free: Average = 117.4/79.6 (no discarding of anything!)

A-n-n-d this happens at the time of day when my BP is normally at its highest.

Is that ay-mazing or NOT?

The BP did drop the last time I lost weight…but five pounds is not very much. The last weight-loss gambit associated with this flap was thirty pounds.

The difference is…last time I decidedly did not get off the sauce. A glass of wine or beer with dinner — the big meal of the day — is one of the very few small pleasures remaining to me. I do not drink myself into a stupor — very rarely do I drink enough to feel even faintly high. And there is a limit to the array of lifestyle blandishments I’m willing to do away with.

But apparently…if you believe there’s a connection…apparently even two glasses of wine a day is enough to push your BP upward.

Maybe the Christian Scientist relatives had something.

The Ah Hah! Moment: Claritin and Liver Toxicity

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Ever have one of those moments when you wake out of a sound sleep thinking, “Ah Hah! Why didn’t I think of that before?” This morning I enjoyed just such a moment, when along about 4:30 I woke up with one single, crisp thought in mind: I wonder if there’s a connection between all that Claritin I’ve been taking and the elevated liver enzymes?

An hour later, I stumble out of the sack, let the dogs out, trot into the office, turn on the computer, and run a little search: loratidine and liver. And hallelujah, brothers and sisters…wouldn’cha know it?

Loratadine and desloratadine use are associated with a low rate of liver enzyme elevations which are usually asymptomatic, mild and self-limited even without modification of the dose.  In addition, rare instances of clinically apparent liver injury attributed to loratadine and desloratadine use have been reported as isolated case reports….

The mild and asymptomatic elevations in serum aminotransferase that have been observed during loratadine and desloratadine therapy are usually transient and may resolve even without dose modification.  Clinically apparent liver injury due to these second generation antihistamines, however, generally calls for prompt withdrawal of the agent.  Severe injury is uncommon and most cases resolve promptly upon withdrawal. 

Thus saith the National Institutes of Health, hardly a source of woo-woo.

Well…Helle’s Belles. You may recall that the doc at the Mayo decided it would be safe for me to double the normal dose of loratadine for a short time and then continue taking the recommended dosage. We soon discovered that emptying my head of allergic stuffiness caused the light-headedness and heart palpitations to disappear. Completely. Gone. That is even though tachycardia and palpitations are among the drug’s common side effects. Unscientifically, we concluded that the presyncope-like phenomenon likely was affected or even caused by inner-ear congestion. So, we calculated, it would be good to keep on taking the stuff.

Which I’ve done. I did stop taking two a day, at least on a regular basis. But some days I forget whether I’ve dropped one in the morning and so will take one — very probably another one — before bed. And sometimes when the wind has been whipping up the allergens, I’ll take two during the course of a day just to fend off the usual miseries.

Hm. So brought on a new misery. How interesting.

Y’know…if a drug has a rare, weird side effect that appears in 1 in 10,000 people, I am invariably No. 10,000. It never, ever fails.

Given this discovery — why didn’t I think of it before??? — now I feel a lot less neurotic about passing on the liver scan until after the next blood test. God help us.

Round and round she goes…

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…where she stops, nobody knows… Yup. Spent yesterday going round and round and not stopping anywhere very productive.

Working on the “Drugging of America” project — a proposal for which I hope to send off to the chosen university press by the end of this month — I located 10 important-looking books on the subject. Need to see these before writing said proposal. Several of them are 15 or 20 years old.

I locate half of them in the GDU library. To get them, I’ll have to traipse to Tempe through the homicidal traffic, fight for a free parking spot on the street (my crip-space hanger lets me park in any off-campus metered parking, gratis), trudge across the campus to the library, and try to find the things there. One of them is in the law library, a fine hike away from the main library. Or I could go out to the West campus, ask to have them sent out there, and do battle with West’s parking twice.

The City of Glendale evinces no generosity to us crips, so parking at the West campus is exorbitant, unless you stash your car in the credit union’s reserved spaces. Which is likely to get you towed.

As you can imagine, the last thing I wanted to do was go out to either of those campuses.

So instead, I decided to renew my card with the Phoenix Public Libraries, go down to the main library, and ask to have the things sent over through Inter-Library Loan.

Heh. Sounds easy, doesn’t it?

Well. The main library was flooded out when someone incompetently installed a fire sprinkling system. A couple years ago, this system shorted out during a storm-induced power outage and flooded the entire structure, destroying books common and rare and causing gerzillions of dollars worth of damage. Consequently, that august institution is doing business out of the basement of a decrepit shopping center that is now under renovative construction.

Once there, I find some very lovely folks manning — sorry, make that “personing” — the desks. Reach a patient and intelligent librarian, who offers to track all these books down and help me order them through ILL — which these days, thanks to the “convenience” brought to us by the Internet — is pretty much a DIY operation.

For a DIY job, it is extremely complicated. She bounces through stage after stage after digital stage of ordering up each book, along the way remarking that this was the first time she’d ever tried to order anything by Interlibrary Loan!

So we were both learning how to use the system.

Along the way, I also learn that the library has a boatload of movies that you can stream, for free, just by signing on for a library card. Ditto music, and of course ditto ebooks. Many of these videos appear to be things that you’d actually care to see, unlike the offerings at Amazon Prime and Netflix, which are largely dominated by extreme violence or extreme boredom.

Eventually I arrive back at the Funny Farm and go on about my business.

Couple hours later, I’m sitting around feeling pretty pleased with myself when the phone rings. It’s our young librarian. Timorously, as though she thinks I can bite through the phone lines, she explains that she just learned you can’t order e-format through ILL. Eight of the ten works we ordered were available in PDF, which, needless to say, I would rather get because I can copy & paste passages to quote.

😀 This strikes me as so hilarious I can’t even manage a modicum of crabbiness.

So now all this stuff needs to be re-ordered. The Park Central incarnation of the PPL is moving back to its digs in the now-refurbished Burton Barr Library, starting on June 8; they won’t re-open till June 16.

And that throws another monkey wrench in the works.

I have a friend/former colleague at the West campus, a librarian with whom I copublished one of the early studies on on-line learning. E-mailed him yesterday to ask if he can help me acquire these books — he usually has a graduate student underling upon whom work can be foisted, so I’m hoping he’ll get someone to look them up and order them for me, allowing me to make just one trip out there, instead of two or three.

Failing that, I have another friend who is a librarian with the community colleges. He has been very helpful in the past and I think he would find the current project very interesting. Trouble is, the community college library pretty much shuts down during the summer, so I don’t even know if he’s around. He may be on vacation now. But if I don’t hear back from the ASU guy, I’ll pester him.

At any rate, essentially I wasted the entire afternoon yesterday. Since I’ve set a deadline of June 30 to finish the proposal, that was extremely annoying. Excessively so, one might say.

At the crack of today’s dawn, I was supposed to traipse to the Mayo for a liver sonogram. Day before yesterday, though, I canceled this, on the grounds that I do not wish to engage in any more fishing expeditions.

The cause of the proposed exam was a very slightly elevated reading of liver enzyme levels. This, emanating from one of those damned annual “check-ups” that you have to subject yourself to if you’re a Medicare patient at the Mayo. The Mayo, understandably enough, does not especially welcome Medicare patients — even though a large proportion of its patient population consists of the elderly — because they can’t extract enough pay for their services. So if you’re well and you don’t show up at least once a year, they drop you off their rolls and you can’t get back on.

Annual physicals have been shown to be counterproductive, something that has been known at least since about 1980. My ex- was a Stanford alum; one of the perks was a subscription to a series of plain-English research studies by Stanford faculty members. And one of the books we got in that series was written by a full professor of medicine at Stanford’s School of Medicine. This was back when the “annual physical” was so popular that corporations would pay to send their execs to “retreats” at expensive resorts, where they would be jumped through a battery of tests and exams.

The good professor noted that annual physicals may and do harm patients in several ways. One of the most important is the prevalence of false positive and false negative medical test results.

• False positive tests harm the patient in the obvious manner: by leading to increasingly invasive tests that show nothing while making the patient sick, distracted, worried, and by wasting the patient’s and the doctor’s time.

• False negative tests harm the patient by creating a false sense of confidence. The result: if you have symptoms, you’re likely to ignore them, leaving an ailment that might be treated successfully to grow more and more dangerous.

He and his colleagues strongly recommended that one forego the annual physical and see a doctor only when specific symptoms arise.

So…I did not want to undergo an unnecessary physical exam this spring, nor do I ever wish to do so. But the only way to stay in good standing with the Mayo seems to be to subject yourself to one.

The reason I feel I need to have access to the Mayo is that the Mayo hospital is the only hospital in the county that consistently ranks high in quality assessments, such as Healthgrades. In the Healthgrades safety ratings, many of the hospitals in the Phoenix area score poorly.  In patient satisfaction, most score in the 70s (about a “C) or lower. Much lower. It was St. Joe’s, for example, whose pathologist called me at 7 p.m. on a Friday evening, said “I’m sorry, you have cancer,” and hung up. Thankyouverymuch.

This is the reason and the only reason I drive halfway to Payson when I need to see a doctor. As it developed, the drive was worth it: at the Mayo one of the most prominent breast surgeons in the country informed me that I did not have breast cancer. Thankyouverymuch.

So when the new GP they’ve assigned to me said I must have an annual physical, I acquiesced, so as not to rock the boat.

Naturally, back come results saying the two tested types of liver enzymes are high.

Naturally: because I have been drinking daily since I was about 22 years old. It has been my habit to have a beer or wine with dinner for my entire adult life. And, during the 20 years I was married to Dear Ex-Husband, we had one or two cocktails before dinner every day, as well as one or two glasses of wine with dinner.

You expected a bear, doctor?

Well, the readings for these enzymes — ASL and ALT– are not very high. Each is only a few points above the threshold at which it’s regarded as “elevated.”

So now she wants to do a liver sonogram, which, she informs me, could lead to a liver biopsy!

Holy shit.

Look into it, and you discover this gem from the University of Michigan, among many others. Liver diagnosis is yet another example of over-testing and overtreatment, the very subject upon which I happen to be writing. A little more exploration reveals that there’s no hurry to dive into ever-more-expensive, ever-more-invasive testing. It’s best to wait six to eight weeks after a slightly elevated reading, during which the patient abstains from alcohol and any meds that might push readings up. Then do another blood test. Then and only then, if the second test again shows an elevated level, should you proceed to a sonogram.

But we have the question of what are elevated levels. At the moment, for example, the Mayo places the upper limit for normal serum levels of AST at 40 U/L. My test results come back just a few points higher than that. Interestingly, though, there’s a movement afoot to lower that threshold to 30 U/L — just as we have lowered the threshold for “normal” blood pressure a full ten points, rendering many tens of thousands of Americans targets for profitable blood pressure medications.

We are told, in a study published by the Cleveland Clinic, that one should “Suspect alcoholic liver disease when the aminotransferases are elevated and the aspartate aminotransferase [AST] level is two to three times higher than the alanine aminotransferase [ALT] level.” But that is not the case in the results returned by the Mayo’s tests. Not even remotely. In fact, each of these tests returns levels just slightly above the upper range of “normal.”

Returning from the macro- to the micro-level, we have the issue that not only have I been drinking freely for the past 50 years, the blood pressure med that caused so much havoc has as one its potential side effects — rare, yes, but there it is — elevation of liver enzyme levels!

So I’ll be damned if I’m going to be jumped through a series of misery-inducing hoops over this. I’m scheduled to go back in three months for another blood test. If those enzyme levels are still high then, after I’ve been off the sauce for 90 days, fine: they can do a sonogram. But until then: not so much.

Even though this sideshow consumed no actual hours yesterday —  canceling the proposed test rescued the entire morning for more constructive uses — it still has been a distraction. Psychologically, that is.

Like…I don’t have enough stress in my life, just trying to make ends meet and survive the homicidal traffic? 😀

And trying to make the goddamn computers work.

Part of the retrieved time was dedicated to posting another *FREE READS* chapter of the writing guide, over at Plain & Simple Press. For reasons I do NOT understand, every time I post a chapter from The Complete Writer, some endlessly annoying snafu occurs. Why is a mystery. It doesn’t seem any more complicated than the other two bookoids. But for some reason I end up diddling around and diddling around and diddling around trying to get that stuff online as a) a post and b) a chapter in the book-length archive.

Ella’s Story and If You’d Asked Me chapters go up with no problem. But try to post one for Writer, and you can expect to kill a good 45 minutes (or more!) screwing around with trying to get it right.

But I did manage to type up two chapters of Ella’s Story yesterday — one of them, admittedly, fairly short because of a truncated sex scene (sometimes, I reckon, silence speaks volumes).

Was entertained the other day when a dear friend remarked that she’s been enjoying If You’d Asked Me a great deal. 🙂 Now, if only we could get the rest of the world to enjoy it…