Coffee heat rising

High Inefficiency: Washers and Rx Plans!

So this morning I take it into my pretty little head to do the laundry in my fancy new(ish) Samsung high-efficiency top-loading washer with the fun clear lid that lets you watch the clothes sloshing around, just in case you’re feeling unusually bored.

To do that I have to…

Sort clothes (colored, white…said not to be necessary, but watch this space…)
Sew up the mesh bag that split apart the last time I washed a few items
Put jeans into mesh bags, one bag per pair
Sneak one pair of cut-offs into a mesh bag holding a pair of jeans
Put socks, panties, and camis into several more mesh bags
Haul bagged laundry out to the garage, whereinat the fancy washer resides
Load washer
Measure portion of  radically expensive “high-efficiency” laundry detergent into stupid little cup from which the machine dispenses it
Clean the mess created by laundry detergent dribs of radically expensive “high-efficiency” laundry detergent that splashed from stupid little cup onto machine’s lid and tub rim
Set machine to “bedding,” the only cycle that dispenses enough water to get a load of jeans and T-shirts clean…in AN HOUR AND TEN MINUTES!
Go away for an hour and ten minutes but don’t leave the house because no one in her right mind would leave an appliance full of water sloshing around unguarded for a hour and ten minutes or for any length of time unless what she most loves to do is mop up gigantic messes

An hour and ten minutes. Figure there’s got to be a better way. Now I drag the whites into the bathroom, wash them in the vanity sink, rinse them in the bathtub half-filled with cold water, traipse them out to the garage, and hang them up.

By the time I finish this job, the washer has ALMOST filled with water and started to slosh its FIRST laundry cycle.

Got that? I washed an entire load of laundry by hand, in the bathroom goddamn sink, in less time than it took the wondrous high-efficiency washer to even START to wash the load I stuffed into it.

Okayyyy…. Now we understand why these amazing machines so “efficiently” save water and power: when you don’t use the thing, you don’t use water and power.

Wash four crocheted shirts by hand and lay them out on the tile floor to reblock and dry.

These items could also have been laundered in the wondrous high-efficiency washer. But I wanted to get them clean sometime during my foreseeable lifespan.

The khaki dye and the orange dye from two of these Nordstromsy made-in-Asia shirts leak into the sink water. Therein lies the reason we STILL separate the whites from the colored clothes, even though we are assured that it’s ever-so-much more highly efficient to launder all the clothes together. No doubt it is, if you enjoy wearing grunge-grey “whites.”

Moving on…

Now I decide I should go online and sign up for a new Medicare Part D (prescription drug) plan, since my outfit, Wellcare, is doubling its premiums. I decide to select Humana’s Walmart plan, whose premium is about what I’m paying now and whose copay is significantly (as in HUGELY) lower and which has four- and five-star ratings across the board as compared to my present plan’s three-star complaints ratings. You can sign up for these plans on Medicare.gov, in the same app that allows you to call up and compare plans. However, what you can’t do is figure out whether signing up for the new plan automatically unenrolls you from your present plan, or whether you have to jump through 15 to 30 minutes of phone-tree hoops to get disconnected from the folks who have been ripping you off for the past year.

Navigated to Arizona’s version of SHIP, a bureaucratic fragment that usually employs some uninformed volunteers to answer your questions. Checked the FAQs; this particular (very obvious, IMHO) question was not answered. Called the phone number. Got an obnoxious robotic answering machine, saying if I would leave a message maybe someday they would get around to calling me back (fat chance!) and maybe then I could ask the question whose answer I need now, not sometime in the remote future.

Found a phone number for Humana at the Medicare.gov site. Dialed it, expecting another obnoxious robot.

Mirabilis!!!!!!!! Got a human being!

Yes. You do get disenrolled from the old plan when you sign up electronically for a new one. But would I like for her to sign me up, as long as we were on phone?

Sure.

It took FORTY MINUTES to get through the tape-recorded boilerplate bullshit Humana’s doughty CSR had to play into my ear. At the end of of each of three long-winded segments of boilerplate bullshit, I had to answer, clearly and unmistakably, “YES.” This, she explained, is taken to be a telephonic “signature.”

God. All. Mighty.

The washer was almost done by the time this tedious experience ended.

So now I’m signed up for a new Part D plan, though it won’t kick in until January 1. This is good, because the plan I’ve got is the biggest rip-off ever to come down the pike.

I hope the new one won’t be a rip, too. There’s some reason to believe it will be slightly better:

User ratings show a lower tendency to deny coverage of drugs prescribed by your doctor and to try to substitute drugs your doctor specifically says you shouldn’t be taking.

Co-pays are much lower. In fact, if you can wait for them to send your pills by snail-mail, co-pays are sometimes zero dollah. What I’ve had is so ridiculous that I’ve given up even asking — I’ve just been paying out of pocket. The last Rx the Mayo prescribed was denied because, the pharmacist said, Wellcare didn’t like the doctor!

Got that? They don’t like a surgical resident in the service of one of the most prominent, high-powered, respected oncological surgeons in the country. The same surgical resident whose last three prescriptions were honored without quarrel.

Hauled the laundry out of the washer. Hung it up to dry. Cursed the double time-suck.

Another Day, Another Doctor…

So this morning came the appointment with the oncologist favored by my gynecologist.

You may recall that not one but two docs — my GP and my gynecologist — so worried about my insecurities over the ongoing (painful, disruptive, miserable!!!) treatment of NOT-a-breast-cancer that they felt impelled to refer me to the medical oncologists of their choice.

Young Dr. Kildare’s choice, visited last week, was perhaps not the God’s Greatest Gift to Diseased Womankind.

Today I visited Sainted Gynecologist’s guy, and he proved to be a great deal better.

First, he could figure out the difference between DCIS and invasive cancer. That was a good sign.

Second, this guy was fully, completely, UTTERLY up to date on the current research. Having made myself almost up-to-date on said current research, I was impressed. Oh, no. I was more than impressed. I was delighted and astonished. The man actually knew what he was talking about. A God’s miracle.

Third, despite being a high-powered medical doctor, the guy possessed an underlay of common sense. This is not a man given to flying off the handle in the various hysterical ways that some doctors  are wont (I’m sure you know who they are because you have visited some of them).

Fourth: being of an age comparable to mine, he knew my (now retired) internist at the Mayo, he knew the redoubtable Dr. Packaj and was similarly awed and worshipful of her, he knew the venerable gynecologist whose practice Present Gynecologist purchased (the guy was famed as the finest OB-GYN in the city, back the the day, and all the local doctors and — equally significantly — lawyers sent their wives and daughters to him), he knew Present Gynecologist well, and he did not know Young Dr. Kildare (YDK’s defining characteristic being “young,” after all) but nevertheless did not even flinch when I expressed a certain distrust of John C. Lincoln with the words “this is Arizona, after all.” All of these are signs of a medical doctor with a brain who is savvy in the ways of a large small town that has been fed too much Monsanto-style fertilizer.

(It’s another story…ask me some day and I will tell you, my children.)

Fifth, he did not treat me like a nine-year-old.

Sixth, he answered all my questions in ways that made sense. To do so, he spent well over 70 minutes with me.

Medicare may not pay for this antic, but if I have to pay for it out of pocket, I will do so cheerfully. The guy was ever so much worth it.

To make a long story short, this is what I now think:

On the repeated excision attempts vs. the proposal to cut to the chase and just get the damn mastectomy over with:

It’s worth letting Dr. P take another shot at getting the abnormal cells out of there. Although her chances aren’t good, they’re not hopeless, either. If she succeeds, bully for her — she’ll be proven right. And bully for me — I’ll still have part of a boob left. If she fails, the world will not end: a mastectomy will guarantee no return of the Evil Entity and will mean I won’t have to have radiation therapy.

On the side effects of radiation therapy:

Knock off worrying about that. It’s not great, but it’s not especially horrible either.

On tamoxifen:

Nix. Don’t take that.

On reconstruction:

Stand in front of the mirror and practice repeating this: NNNNN OOOOOO, NNNNN OOOOOO, NNNNN OOOOOO, NNNNN OOOOOO, NNNNN OOOOOO, NNNNN OOOOOO…..

Put the two sounds together and practice that a few times: NO…NO…NO…NO…

Utter this sound to Dr. P.

Refuse to sign any papers permitting anyone to do any reconstructive surgery.

Voilà. Problem solved.

On the advisability of declining reconstructive surgery:

His patients who have had implants removed or who have refused reconstruction report that they’re happy with their decision. But if I feel I am not a complete human being without a blob of flesh or fake flesh hanging from my chest, one can have this procedure done at any time in the future.

On recovery time from simple mastectomy:

Probably three or four weeks. Maybe a little longer to get over the fatigue. No point in working yourself into a state of hysteria over that.

On finding someone in town who makes custom prostheses:

Doesn’t know of anyone and believes no such company exists in Phoenix. Find a maker in some place where you’d like to take a medical vacation.

Okay, okay, he didn’t say that last thing. But that was the implication. No one in Arizona that we know of is making light-weight, comfortable custom prostheses. To get measured for one, patients have to travel to other states.

So it goes…

Annals of the Floored and Flabbergasted: Back Office Staff Edition

This morning I get on the phone to an assistant in the gynecologist’s office, to whom I’m trying to explain, for the THIRD time today (not to her, but to two other folks) that because it looks like I’m headed for a mastectomy, a medical oncologist advised me to consult with a plastic surgeon before that comes to pass,  and so I would like a referral to a plastic surgeon who knows what s/he’s doing.

She doesn’t quite follow. It’s a complex series of thoughts, after all. So I explain (again) that I need to talk to a plastic surgeon before I get scheduled for a probable mastectomy.

Says she:

“Is that in the pelvic area?”

{thought balloon: you ARE one of my students, aren’t you?}

“No, honey, mastectomy has to do with your breasts. They’re going to chop off one of my boobs.”

“Oh. How do you spell that?”

Ha haaaa! Is that hilarious or not?  And just think how hilarious it is that medical offices are populated with folks like this, ready to take care of your every health need…

Breast “Cancer” or Not: Another Amazing Adventure in Medical Never-Never Land

Okay, so after I had arranged an appointment with the medical oncologist my gynecologist wants me to see for a second opinion about the advisability of further surgical attempts at a successful lumpectomy, Young Dr. Kildare became concerned enough that he unilaterally scheduled an appointment for me with his choice of oncologists.

Interesting. I decided to take a chance that I will have to pay for one or both of these worthies out of pocket — surely there’s a limit to what Medicare will cover — just to see what TWO of them would say.

Yesterday I spoke with YDK’s guy.

He seemed like a very nice man — certainly has a thriving practice: there must have been 20 cancer victims sitting around the waiting room. He seemed very smart, very empathetic, and open to answering all my questions, which are manifold.

So as he’s talking, he says something that really drops my jaw. And he says it more than once.

He says that ALL incidences of DCIS turn into cancer. Therefore what remains in my boob must be removed, and if I were his wife, he would recommend going straight to a mastectomy.

Well. There are several good reasons to turn directly to a mastectomy without trying again for a successful lumpectomy. But “all incidences of DCIS turn into cancer” ain’t one of them.

It simply is not true.

It is not true that all DCIS turns into invasive cancer. By 2010, M.D. Anderson researchers were estimating that 40% to 50% do so — meaning that even then, they thought 50% to 60% do not do so. More recent estimates peg the conversion figures at closer to 15% to 20%.

So that was unnerving: a specialist in breast cancer treating God only knows how many people who directly contradicts the facts. And contradicting my surgeon, my gynecologist, the Mayo’s medical oncologist, and the Mayo’s radiation oncologist, all of whom seem to have managed to get their facts right.

He also interpreted the records from the Mayo as saying the surgeon had found two growths in the boob: the EPC*, which he says she has removed, and a DCIS, which she has not yet fully excised. That’s not what she (or anyone else) has told me: the EPC is the DCIS. So, either the Mayo team is obfuscating or this guy has no idea what he’s talking about.

Wow! This is one scary trip through the medical funhouse!

*EPC: “Encapsulated papillary carcinoma”: a rare type of DCIS, a condition thought to be preliminary to development of breast cancer.

Of Late…

Haven’t posted for a day or two. Busy couple of days and then last night the damn router went down again and this time stayed down all night. GOTTA get a new router. One of these days…

Meanwhile, a number of developments, all of them positive for a change!

The Mayo surgeon had to loosen her clutches long enough for me to get a grip on my wits, at least in a perfunctory way. As you’ll recall, on the weekend before the last planned surgery, scheduled for a Monday, a convenient case of bronchitis led the anaesthesiologist to intone,”It would be foolish to proceed,” frustrating the surgeon no end. The next fun procedure was scheduled for the 15th of this month.

Subsequently, the surgeon erred in forgetting to have the Mayo’s scheduling department reserve an OR for that date. So the soonest she can try again will not be until after she gets back from vacation, toward the end of this month. That gives me time to get to another doctor at another institution to try to get some fresh insight, and to gather enough strength to put up a fight. Somehow I’ve got to bring a stop to the present cascade of disasters; whether I can remains to be seen, but at least I’m beginning to make out a vague pathway toward that goal.

This is particularly good because a new challenge has developed: As I have begged the staff to just do the goddamn mastectomy and stop torturing me with (presumably very profitable) procedure after procedure after procedure, they have begun to pressure me to get reconstructive surgery. I do not want reconstruction, for two reasons.

1) I’m not in the market for a man, and at my age no one looks at my boobs and so no one is going to notice whether I’m a little lopsided or not. For that matter, at my age no one sees a woman at all. When strangers are staring in your direction, they’re actually looking right through you. What they see is the background behind you.

2) More to the point, especially for older women, breast reconstruction is more complications and more surgery waiting to happen. The autologous procedures now in vogue, where they gouge chunks of flesh out of your back, belly, butt, or thigh and slap them on your chest, are esthetically unsatisfactory IMHO, cause still more surgical wounds for you to have to recover from, weaken the muscles in those areas, and can leave you with chronic back pain, weakness, hernia, and the unpleasant. disabling manifestations of upper quadrant disorder. As for implants: silicone or saline, they have an expected lifetime of about ten years, at which time you get to enjoy still more surgery to have the damn thing removed or replaced.

When I told WonderSurgeon that I do not want reconstruction, she told me I need to “think about it.” In other words, I’m a child who doesn’t have good sense.

Guess which one is fake.

One of my friends chose to go flat after a double mastectomy; she said she never regretted it, and she looked just fine. Obviously, if one side is flat and the other is not, that’s a little more problematic. However, you can get custom-made prosthetics that are a great deal more convincing and comfortable than fake reconstructed boobs (if you’re feeling strong, go to The Scar Project, where you can see artist-quality images that show women with and without reconstruction — warning: this is graphic).

Such a large  contingent of women has decided to go breast-free that there’s even an organization representing them. Interestingly, many of these women describe similar pressure from their medical teams. Apparently people are so convinced that every woman’s self-image is so inextricably invested in her boobs that a woman must be crazy if she chooses not to go through the tortures of the damned for the sake of having a lump sticking out of her chest.

So: I need some reinforcements to put up a fight on this front.

I called to make an appointment with a medical oncologist at St. Joe’s that my gynecologist, who unwittingly plunged me into this mess, has been trying to get me to see. He also has been out of town, and so on the last attempt to get together with him, his staff couldn’t shoehorn me in before the the 15th. Called again, they managed to set up a meeting for the 20th. Hallelujah!  That means I’ll be able to talk with the guy before the Mayo doc can cut me up again and before the craziness makes another spin around the drain.  I don’t know whether he’ll provide enough moral support for me to hold my own, but everyone who knows the man says he’s eminently rational.

So that may be a dim light visible through the black fog.

Yesterday morning the damnedest thing happened. My single all-time deepest-pocketed client, Scott Flansburg — the man who made it possible for me to pay off the mortgage in one fell swoop — has hired a new business manager. He’s looking to kick his business plan up a notch, and he wants someone, namely me, to write new products for him and the like. Said bidness manager tracked me down, how I do not know — probably through LinkedIn — and asked if I would be interested in working with them. They want to expand into e-publications.

Lo! What should The Copyeditor’s Desk be into but e-pubs! I’ve got a slew of formatters, illustrators, and designers who can hire on to help him out, and of course I wrote the book that earned Scott $1.5 million in the first year after publication and $1 million the following year.

Heh. When we say “things are looking up,” we speak in cosmic terms.

Meanwhile, I have two clients who are just wrapping up their books. Both of these guys  have uttered the words “…and how do I market this thing?” Flansburg is a wily sort of a gent, and you can be pretty sure that he would not hire a marketing agent, which is what this guy is, unless the guy had a decent track record. So this is promising: we just may be able to do some bidness here!

If the guy can sell books (and authors), The Copyeditor’s Desk may soon have two happy customers. And that is always good. Very, very good.

And finally, in the God seems to have gotten over Her tiff at me department: I took it into my head to buy a large Talavera-style garden pot for my beloved shady deck. Purchased anywhere north of central Mexico, these things are absurdly expensive, and the place where I chose to buy, Whitfill’s Nursery, is famed for charging through the wazoo for everything. So I walk in there and find the desired vessel, and on my way out my eyeballs land on another design. The actual price of these monsters is $59.99, but someone has scribbled $29.99 on the one I happen to spot.

On close inspection, nothing seems to be wrong with it. Apparently some underling carelessly mispriced it. The kid at the cash register didn’t even blink…so I walked outta there with a BIG, beautiful, gaudy planter for half price!

Obviously, an omen.

TalaveraPlanter

 

Resuscitating My Life: A Pair of Überlists

Okay, enough is enough. After a week of lying in bed, I have got to try to drag myself back into the land of the living. The plan is to try to resuscitate my life by drafting two overarching überlists, one for managing the health situation and the other for managing the dog predicament, should I decide to keep Ruby.

Today, a plan for restoring my health to something at least vaguely tolerable. Tomorrow: how to deal with the dog problem.

Health Restoration To-Do’s

1. Draw a line at which the “it’s not a cancer” torture must stop.

Contact Dr. Laura Esserman at UCSF and ask for a consultation. Try to get answers to these questions:

• Given that there is no invasive cancer and there never has been a cancer, and given that an EPC is so indolent that it was never likely to have developed into a cancer and that only two cases of metastasis from an EPC have ever been recorded, is radiation really necessary?

• Is tamoxifen treatment really necessary?

• Instead of subjecting myself to a third re-excision — a fourth surgery in what is likely a futile quest — should I ask to have the breast amputated now instead of going after a successful excision + radiation + tamoxifen?

Make decisions as possible and reasonable in light of any answers obtained there

2. Try to return to some semblance of normalcy

Exercise:

• One walk in a.m. or p.m. without dog
• One walk in p.m. or a.m. with dog

Get back to healthy eating

• Make xergis so as to gag down yogurt to counteract antibiotic damage
• Restock veggies and fruits, and eat the damn things!
• Cut up the spoiling apples and refrigerate them so they can be cooked for breakfast
• Consume oatmeal for breakfast or lunch to get gut working again

Combat fatigue and depression

• Nap in afternoon to alleviate exhaustion
• Get back to the company of humans:
…..Go to choir!
…..Go to SBA!
• Have Shane style hair and come up with attractive up-do
• Get a top-quality body cream and massage hands, feet, and nails daily
• Oil skin all over once or twice a day

2. Fix the front bathroom so the shower in there can be used until this sh!t is over

Learn how to jimmy showerhead to remove flow restrictor; install
Remove bathroom decor for the duration

3. Clean out the lingerie drawer and organize so finding iron maidens and bras is no longer a headache

4. Buy a new heating pad; make another cover.

Treat boob with heat and ice three times a day

5. Decide what help to retain

Cleaning lady? Pool guy? Yard guy?
Figure out how on earth to pay them

6. Try to get back to work

Figure out how to deal with 235 class that starts five days after next surgical circus
Figure out what to do with Pete’s project or who to farm it out to, and for how much
Work on P&S website
If Jesse can’t or won’t help make sense of this, move it to BlueHost
In either event, move Writers P&S off WordPress.com at the earliest possible moment