Health care

…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…