Posts
Have I mentioned Ed has a stand-up desk?
Well, he does.
That's gotta be next on my list.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Sunday, March 7, 2010
Wednesday, March 3, 2010
"The Joy of X"
here
Speaking of joy, I finally got back to my ALEKS geometry course,* which I abandoned last August after my mother fell.
My mother is continuing to improve, by the way. Which means the four death talks -- four -- that various doctors initiated with me and my siblings were premature.
Actually, the four death talks appear to have been not only premature but wrong in every respect. Take, for instance, the observation, made by my mom's intensivist in ICU, that: "Your mother has tiny little lungs and an enormously enlarged heart. Her only hope of survival would be a heart-lung transplant."
That appears to be codswallop, according to my mom's new cardiologist. "Heart function is good." "Heart muscle is strong." "Ejection fraction is normal." "Pulmonary hypertension has resolved." And so on.
Also, the diagnosis of congestive heart failure: wrong, it seems. My mom tells me she was given a brochure on congestive heart failure sometime after her heart attack 5 years ago, which informed her that a person in her situation had 5 years to live, max. Also wrong. Unless, of course, she doesn't have congestive heart failure (confusion reigns amongst us family members), in which case the brochure is possibly right but irrelevant.
Meanwhile, the physicians associated with the nursing home where my mom is recuperating have been operating under the assumption that my mother's diagnosis is congestive heart failure so they are now trying to nail that down. Congestive heart failure: yes or no? That is the question. The nephrologist (my mother does have kidney failure; of that we are sure) says she is going to read the entire history.
oh, man
My life goal: vegan my way to a healthy old age and die in my sleep. By then I will have spent a good 30 years dealing with the public schools; I don't want to spend the last 20 wrangling with hospital intensivists and hospice-touting PCPs. Noooooooooo.
That said, I will also point out that modern medicine is a miracle. Wow. My mom is alive and recovering because emergency rooms do what they do and dialysis machines & nephrologists do what they do and a good nursing home does what it does - because they all do what they do. Modern medicine keeps desperately sick and dying people alive and then some.
true story: in February I flew back to Chicago and went with my mom to an appointment with her new cardiologist. We're sitting together in his tiny office, my mother is back from the grave and getting around by wheelchair and medi-van...... and the doctor tells her to "lose weight and exercise." In 6 months we have gone from "tiny little lungs and an enormously enlarged heart" to "lose weight and exercise."
Alright, then!
Seriously, though, I don't know what to make of our experience thus far, and I have made a conscious decision not to delve into the literature on US medicine. (Also banned: the literature on US food industry.) I've read just enough to see that some of the institutional problems besetting health care are similar to institutional problems besetting public education, and that is helpful and intellectually stimulating to know. But that's enough. If I start finding out what goes on in your basic American hospital, my head will explode. Ditto for factory farming and the USDA.
The one tentative conclusion I hold at the moment: doctors aren't particularly expert at making predictions about an individual patient's immediate future. That's fine with me. I want doctors to save my mother's life, not ship her off to hospice because things look bad. And save her life is what they did.
My advice, which I realize is not original but bears repeating: when you're dealing with major medical, keep your wits about you and take things with a grain of salt.
And: if different doctors are telling you different things, pay attention to that fact. In our case, we were getting so much bad news about our mother, doctors were so insistent the jig was up, that we discounted the observations of doctors who weren't telling us that death was imminent. Not long after the intensivist told us my mom's only hope was a heart-lung transplant, another doctor told us, "She's doing well. This is what we do in ICU. We support a patient's organs and bodily systems while the patient recovers to the point that they can function on their own."
Hearing this, my sister and I thought, in so many words: this guy is nuts.
Then, during my mom's third hospitalization, when I received two hospice-promoting telephone calls from two of her PCPs, the hospital cardiologist told my sister that my mom's heart was strong and we weren't anywhere near hospice decisions. The nurse said the same thing. Another glaring contradiction.
That go-round we reached the reductio ad absurdum of having the hospital social worker apparently develop a suspicion that we children were trying to usher our mother out the door, seeing as how we kept bringing up hospice. The social worker actually interviewed my mother on the subject. What is your relationship with your children, she asked.
Hah!
Next time, Ms. Hospital Social Worker, try asking: What is your relationship with your PCP and why does he keep calling your kids up long-distance to bend their ear about how their mother can have a "peaceful, quiet death" if they talk her into going to hospice sooner rather than later?
My other provisional conclusion: more specialists. Fewer PCPs. (Just kidding.)
In any event, my siblings and I needed to attend to the fact that we were getting wildly different opinions from different physicians, and we needed to find out why that was happening and insist that everyone get on the same page if possible. Instead, we assumed the worst and we grieved. Grieving before the fact clouds your reasoning. I don't think there's any way not to grieve before the fact, but from now on I am going to know that's what I'm doing and try to reason my way around it.
But back to ALEKS. I've got 3 more topics to master, then I return to Algebra 1, which I was working on before I decided to sign up for geometry last June because I was forcing C. to sign up for geometry. During the 9 months I've been away, ALEKS Algebra 1 seems to have grown from 288 topics to 333. Oy. When I switched to Geometry last June, ALEKS erased my Algebra 1 records, but my screen grab says I had mastered 270 topics.
Will I ever get to calculus?
* Now I just have to get back to Fluenz Spanish and life will be good.
Speaking of joy, I finally got back to my ALEKS geometry course,* which I abandoned last August after my mother fell.
My mother is continuing to improve, by the way. Which means the four death talks -- four -- that various doctors initiated with me and my siblings were premature.
Actually, the four death talks appear to have been not only premature but wrong in every respect. Take, for instance, the observation, made by my mom's intensivist in ICU, that: "Your mother has tiny little lungs and an enormously enlarged heart. Her only hope of survival would be a heart-lung transplant."
That appears to be codswallop, according to my mom's new cardiologist. "Heart function is good." "Heart muscle is strong." "Ejection fraction is normal." "Pulmonary hypertension has resolved." And so on.
Also, the diagnosis of congestive heart failure: wrong, it seems. My mom tells me she was given a brochure on congestive heart failure sometime after her heart attack 5 years ago, which informed her that a person in her situation had 5 years to live, max. Also wrong. Unless, of course, she doesn't have congestive heart failure (confusion reigns amongst us family members), in which case the brochure is possibly right but irrelevant.
Meanwhile, the physicians associated with the nursing home where my mom is recuperating have been operating under the assumption that my mother's diagnosis is congestive heart failure so they are now trying to nail that down. Congestive heart failure: yes or no? That is the question. The nephrologist (my mother does have kidney failure; of that we are sure) says she is going to read the entire history.
oh, man
My life goal: vegan my way to a healthy old age and die in my sleep. By then I will have spent a good 30 years dealing with the public schools; I don't want to spend the last 20 wrangling with hospital intensivists and hospice-touting PCPs. Noooooooooo.
That said, I will also point out that modern medicine is a miracle. Wow. My mom is alive and recovering because emergency rooms do what they do and dialysis machines & nephrologists do what they do and a good nursing home does what it does - because they all do what they do. Modern medicine keeps desperately sick and dying people alive and then some.
true story: in February I flew back to Chicago and went with my mom to an appointment with her new cardiologist. We're sitting together in his tiny office, my mother is back from the grave and getting around by wheelchair and medi-van...... and the doctor tells her to "lose weight and exercise." In 6 months we have gone from "tiny little lungs and an enormously enlarged heart" to "lose weight and exercise."
Alright, then!
Seriously, though, I don't know what to make of our experience thus far, and I have made a conscious decision not to delve into the literature on US medicine. (Also banned: the literature on US food industry.) I've read just enough to see that some of the institutional problems besetting health care are similar to institutional problems besetting public education, and that is helpful and intellectually stimulating to know. But that's enough. If I start finding out what goes on in your basic American hospital, my head will explode. Ditto for factory farming and the USDA.
The one tentative conclusion I hold at the moment: doctors aren't particularly expert at making predictions about an individual patient's immediate future. That's fine with me. I want doctors to save my mother's life, not ship her off to hospice because things look bad. And save her life is what they did.
My advice, which I realize is not original but bears repeating: when you're dealing with major medical, keep your wits about you and take things with a grain of salt.
And: if different doctors are telling you different things, pay attention to that fact. In our case, we were getting so much bad news about our mother, doctors were so insistent the jig was up, that we discounted the observations of doctors who weren't telling us that death was imminent. Not long after the intensivist told us my mom's only hope was a heart-lung transplant, another doctor told us, "She's doing well. This is what we do in ICU. We support a patient's organs and bodily systems while the patient recovers to the point that they can function on their own."
Hearing this, my sister and I thought, in so many words: this guy is nuts.
Then, during my mom's third hospitalization, when I received two hospice-promoting telephone calls from two of her PCPs, the hospital cardiologist told my sister that my mom's heart was strong and we weren't anywhere near hospice decisions. The nurse said the same thing. Another glaring contradiction.
That go-round we reached the reductio ad absurdum of having the hospital social worker apparently develop a suspicion that we children were trying to usher our mother out the door, seeing as how we kept bringing up hospice. The social worker actually interviewed my mother on the subject. What is your relationship with your children, she asked.
Hah!
Next time, Ms. Hospital Social Worker, try asking: What is your relationship with your PCP and why does he keep calling your kids up long-distance to bend their ear about how their mother can have a "peaceful, quiet death" if they talk her into going to hospice sooner rather than later?
My other provisional conclusion: more specialists. Fewer PCPs. (Just kidding.)
In any event, my siblings and I needed to attend to the fact that we were getting wildly different opinions from different physicians, and we needed to find out why that was happening and insist that everyone get on the same page if possible. Instead, we assumed the worst and we grieved. Grieving before the fact clouds your reasoning. I don't think there's any way not to grieve before the fact, but from now on I am going to know that's what I'm doing and try to reason my way around it.
But back to ALEKS. I've got 3 more topics to master, then I return to Algebra 1, which I was working on before I decided to sign up for geometry last June because I was forcing C. to sign up for geometry. During the 9 months I've been away, ALEKS Algebra 1 seems to have grown from 288 topics to 333. Oy. When I switched to Geometry last June, ALEKS erased my Algebra 1 records, but my screen grab says I had mastered 270 topics.
Will I ever get to calculus?
* Now I just have to get back to Fluenz Spanish and life will be good.
Sunday, February 21, 2010
thinner
Speaking of Randi Weingarten and the Campaign to Combat Childhood Obesity, I weighed myself the other morning and the scale said 125.5. Since September 25, I have lost 11 pounds.
11
That's a lot.
That's more than I've lost on any diet, ever, and I lost it during the fall & winter, which is to say I lost 11 pounds at the same time of year (the Halloween-Thanksgiving-Christmas-New Year's-Valentine's Day time of year) when normally I'm regaining the 5 or 6 pounds I managed to lose by dint of determined calorie counting & food logging in the spring and summer.
So, doing my bit for the Campaign, here's my story:
I deviated from the true path in two respects: I eased into the diet instead of going cold turkey, and I calorie-counted. Thanks to Magic iTouch, I plan to carry on calorie counting. Fuhrman, Barnard, and Esselstyn all say there's no need to count - or restrict - calories if you're following the diet closely, but given that I'm not following it as closely as I ought, I count calories. Also, I'm guessing that calorie restriction in and of itself is probably going to be as good for me as it is for yeast cells and mice (haven't read that article, fyi).
The hitch: I ended up having problems with the no-added-fat part. First I got cranky, then I started waking up in the middle of the night feeling despairing and grim. So now. . . now, I'm not sure. My plan at the moment is to a) add some walnuts & avocados to my salads and b) cheat more.
We'll see how that goes. Maybe Gerald Reavan is right that what some of us need is a relatively high-fat diet? Dunno.
other:
Last month I had total cholesterol of 131, LDL (bad cholesterol) 62, HDL (good cholesterol) 60. (I know those figures don't add up.) Triglycerides: 43 (normal is below 150).
So that's it.
For me, adopting a don't-get-diabetes diet means placing a bet -- or, at this point, placing a bet on plant-based/whole foods/no added fat, sugar, or salt and hedging it with plant-based/whole foods/somewhat more fat & somewhat less carb. I don't know and can't guess which expert is right.
But there's no question this works brilliantly for weight loss.
books & blogs
blog: Happy Healthy Long Life
Eat to Live by Joel Fuhrman (for diabetes: "beans and greens")
blog: diseaseproof
Emily's Postmodern Transformation
The China Study by Thomas M. Campbell
20-year study of Chinese diet & health – “this project eventually produced more than 8000 statistically significant associations between various dietary factors and disease...”
Introduction (pdf file)
Prevent and Reverse Heart Disease by Caldwell B. Esselsstyn - all plant food all the time, "not one drop of added fat"
Chapter One
The Engine 2 Diet: The Texas Firefighter's 28-Day Save-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds by Rip Esselsstyn (haven't read - Rip Esselstyn is Caldwell Esselstyn's son - 28-day before & after photos!)
Dr. Neal Barnard’s Program for Reversing Diabetes by Neal D. Barnard
Neal D. Barnard
The Calorie Restriction Experiment by Jon Gertner New York Times October 7, 2009 - people undereating for two years straight
Calerie study: Comprehensive Assessment of Long-Term Effects of Reducing Energy Intake
The "i" Diet by Susan Roberts (haven't read but it sounds great - Roberts is part of the Calerie study)
Just to confuse everyone: Syndrome X: The Silent Killer by Gerald Reaven, Terry Kirsten Strom, and Barry Fox
Anticancer: A New Way of Life by David Servan-Schreiber "All of us have cancer cells in our body. But not all of us will develop cancer."
David Servan-Schreiber
Volumetrics Eating Plan by Barbara Rolls - "Eat big food."
Barbara Rolls
And: Younger Next Year
scared straight
the Ed diet
Barney adopts a healthy new eating style
11
That's a lot.
That's more than I've lost on any diet, ever, and I lost it during the fall & winter, which is to say I lost 11 pounds at the same time of year (the Halloween-Thanksgiving-Christmas-New Year's-Valentine's Day time of year) when normally I'm regaining the 5 or 6 pounds I managed to lose by dint of determined calorie counting & food logging in the spring and summer.
So, doing my bit for the Campaign, here's my story:
- the diet: plant-based, whole-food, no added fat, sugar, or salt
- and: calorie counting via LoseIt (see: "Dose This Pencil Skirt Have an App?")
- not essential but terrifically helpful: Get Running - I have kept up a running program through the depths of winter, thanks entirely to this app along with iAchieve
- still working on incorporating the glycemic index
- you lose your taste for meat &, to a much lesser degree, fat, over time (but see below)
- minimal hunger
- more energy
- so far, going back on the wagon has been as easy as going off the wagon, knock on wood
- sounds dreadful going in but your tastes change
I deviated from the true path in two respects: I eased into the diet instead of going cold turkey, and I calorie-counted. Thanks to Magic iTouch, I plan to carry on calorie counting. Fuhrman, Barnard, and Esselstyn all say there's no need to count - or restrict - calories if you're following the diet closely, but given that I'm not following it as closely as I ought, I count calories. Also, I'm guessing that calorie restriction in and of itself is probably going to be as good for me as it is for yeast cells and mice (haven't read that article, fyi).
The hitch: I ended up having problems with the no-added-fat part. First I got cranky, then I started waking up in the middle of the night feeling despairing and grim. So now. . . now, I'm not sure. My plan at the moment is to a) add some walnuts & avocados to my salads and b) cheat more.
We'll see how that goes. Maybe Gerald Reavan is right that what some of us need is a relatively high-fat diet? Dunno.
other:
- apples & soup
- apparently, vegetables actually do consume more calories than they contain
- plant foods plants seem to increase metabolism (that may not be the right way to put it: Campbell found that rural Chinese peasants, who are essentially vegetarian, consume more calories than we do but weigh less - see here)
- Campbell also found that animal protein promotes cancer growth (terrific summary)
Last month I had total cholesterol of 131, LDL (bad cholesterol) 62, HDL (good cholesterol) 60. (I know those figures don't add up.) Triglycerides: 43 (normal is below 150).
So that's it.
For me, adopting a don't-get-diabetes diet means placing a bet -- or, at this point, placing a bet on plant-based/whole foods/no added fat, sugar, or salt and hedging it with plant-based/whole foods/somewhat more fat & somewhat less carb. I don't know and can't guess which expert is right.
But there's no question this works brilliantly for weight loss.
books & blogs
blog: Happy Healthy Long Life
Eat to Live by Joel Fuhrman (for diabetes: "beans and greens")
blog: diseaseproof
Emily's Postmodern Transformation
The China Study by Thomas M. Campbell
20-year study of Chinese diet & health – “this project eventually produced more than 8000 statistically significant associations between various dietary factors and disease...”
Introduction (pdf file)
Prevent and Reverse Heart Disease by Caldwell B. Esselsstyn - all plant food all the time, "not one drop of added fat"
Chapter One
The Engine 2 Diet: The Texas Firefighter's 28-Day Save-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds by Rip Esselsstyn (haven't read - Rip Esselstyn is Caldwell Esselstyn's son - 28-day before & after photos!)
Dr. Neal Barnard’s Program for Reversing Diabetes by Neal D. Barnard
Neal D. Barnard
The Calorie Restriction Experiment by Jon Gertner New York Times October 7, 2009 - people undereating for two years straight
Calerie study: Comprehensive Assessment of Long-Term Effects of Reducing Energy Intake
The "i" Diet by Susan Roberts (haven't read but it sounds great - Roberts is part of the Calerie study)
Just to confuse everyone: Syndrome X: The Silent Killer by Gerald Reaven, Terry Kirsten Strom, and Barry Fox
Anticancer: A New Way of Life by David Servan-Schreiber "All of us have cancer cells in our body. But not all of us will develop cancer."
David Servan-Schreiber
Volumetrics Eating Plan by Barbara Rolls - "Eat big food."
Barbara Rolls
And: Younger Next Year
scared straight
the Ed diet
Barney adopts a healthy new eating style
Monday, October 26, 2009
up, down, up
Every time I try to describe what life has been like since my mom's fall on August 12, the words 'roller coaster' pop into my head.
"It's been a roller coaster."
I haven't put up a post saying it's been a roller coaster, however, because It's been a roller coaster is fantastically clichéd - and seems oddly discordant under the circumstances.
Turns out it's not:
Trajectory of End-Stage Heart Failure
Nathan E. Goldstein and Joanne Lynn
Perspectives in Biology and Medicine
winter 2006 | volume 49 | number 1
p. 12
* I don't know what stage my mother is in.
"It's been a roller coaster."
I haven't put up a post saying it's been a roller coaster, however, because It's been a roller coaster is fantastically clichéd - and seems oddly discordant under the circumstances.
Turns out it's not:
Patients with end-stage heart failure* have a trajectory of illness characterized by an overall gradual decline in function punctuated by periods of symptom exacerbation followed by a return nearly to their baseline. These exacerbations are not predictable.You can say that again.
Trajectory of End-Stage Heart Failure | Nathan E. Goldstein and Joanne Lynn
Trajectory of End-Stage Heart Failure
Nathan E. Goldstein and Joanne Lynn
Perspectives in Biology and Medicine
winter 2006 | volume 49 | number 1
p. 12
* I don't know what stage my mother is in.
Tuesday, October 6, 2009
in case you'd like to share my pain...
Eat to Live by Joel Fuhrman
The China Study by Thomas M. Campbell
20-year study of Chinese diet & health – “this project eventually produced more than 8000 statistically significant associations between various dietary factors and disease...”
Introduction (pdf file)
Prevent and Reverse Heart Disease by Caldwell B. Esselsstyn
The Engine 2 Diet: The Texas Firefighter's 28-Day Save-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds by Rip Esselsstyn (son of Caldwell: 28-day before & after photos!)
Dr. Neal Barnard’s Program for Reversing Diabetes by Neal D. Barnard
And don't forget: Younger Next Year
The China Study by Thomas M. Campbell
20-year study of Chinese diet & health – “this project eventually produced more than 8000 statistically significant associations between various dietary factors and disease...”
Introduction (pdf file)
Prevent and Reverse Heart Disease by Caldwell B. Esselsstyn
The Engine 2 Diet: The Texas Firefighter's 28-Day Save-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds by Rip Esselsstyn (son of Caldwell: 28-day before & after photos!)
Dr. Neal Barnard’s Program for Reversing Diabetes by Neal D. Barnard
And don't forget: Younger Next Year
I miss you guys!
Well....I'm in Irvington, clearing my head.
I've been so fogged in by fear, grief, and suspense over my mom's health that I can't come up with a proper metaphor and/or clinical term to convey the situation and have been on radio silence. Although I did, during my mom's first ICU stay, acquire the term mentating. As in: Your mother is mentating so well!
I have not been mentating well.
quick update: Since August 12, when my mother fell and fractured her pelvis, she has been:
Has it been 56 days?
I'm grateful I have 3 siblings to help me deal with all this. I just wish C. had 3 (typical) siblings, too.
scared straight
My mom has heart failure.*
She didn't start out with heart failure; she started out with a weight problem, which apparently led to high blood pressure. In middle age she developed Type 2 diabetes, and then, three years ago, she had a heart attack. After that, heart failure.
In short, she seems to be a classic case of what is now called metabolic syndrome.
Of course we kids are horrified not just by the prospect of losing our mother but by the possibility of going through what she is going through ourselves -- and of putting our kids through this, too.
Hence: scared straight.
Which seems to mean becoming a vegan.
When I told a friend that the vegans appear to be right, she said Anthony Bourdain called them a "Hezbollah-like splinter faction" of vegetarians.
* update 7.3.2011: My mom didn't have heart failure. Her PCP thought she did, but she didn't. A year before she died, I went with her to see her cardiologist, who gave us a blank look when we brought up her heart failure and told us she didn't have it. The only reason this exchange took place was that I'd read an article about left ventricular assist devices, and I wanted to know whether my mom could have one. Turned out she wasn't a candidate for a left ventricular assist device because she didn't have heart failure.
I'll probably never know why we all lived with a fatal diagnosis hanging over our heads for -- how many years? I don't remember. Also, I'm pretty sure the fact that everyone thought my mother had heart failure led to everyone mistaking symptoms of kidney failure for symptoms of heart failure. The extreme pain she was experiencing from kidney failure severely constricted her life and caused the fall that ultimately killed her.
I know this will sound obvious, but it bears saying: when you're dealing with a parent's health issues, make sure you understand the diagnosis. As I understand it now (and please correct me if I'm wrong), there are two forms of congestive heart failure: chronic and acute. It's entirely possible that both my mother and we kids were told that she had the acute form and no one explained the difference.
It's also possible she was misdiagnosed -- or that she was correctly diagnosed by her original cardiologist, who left town, but there was some kind of miscommunication with the PCP.
I've been so fogged in by fear, grief, and suspense over my mom's health that I can't come up with a proper metaphor and/or clinical term to convey the situation and have been on radio silence. Although I did, during my mom's first ICU stay, acquire the term mentating. As in: Your mother is mentating so well!
I have not been mentating well.
quick update: Since August 12, when my mother fell and fractured her pelvis, she has been:
- in Evanston Hospital ER
- in Evanston Hospital CCC (cardiac care)
- in Evanston nursing home for rehab
- back to Evanston Hospital ER
- Evanston ICU
- back to Evanston CCC
- in Highland Park skilled nursing care facility
- in Highland Park Hospital ER
- in Highland Park Hospital
- back to Highland Park skilled nursing facility
Has it been 56 days?
I'm grateful I have 3 siblings to help me deal with all this. I just wish C. had 3 (typical) siblings, too.
scared straight
My mom has heart failure.*
She didn't start out with heart failure; she started out with a weight problem, which apparently led to high blood pressure. In middle age she developed Type 2 diabetes, and then, three years ago, she had a heart attack. After that, heart failure.
In short, she seems to be a classic case of what is now called metabolic syndrome.
Of course we kids are horrified not just by the prospect of losing our mother but by the possibility of going through what she is going through ourselves -- and of putting our kids through this, too.
Hence: scared straight.
Which seems to mean becoming a vegan.
When I told a friend that the vegans appear to be right, she said Anthony Bourdain called them a "Hezbollah-like splinter faction" of vegetarians.
* update 7.3.2011: My mom didn't have heart failure. Her PCP thought she did, but she didn't. A year before she died, I went with her to see her cardiologist, who gave us a blank look when we brought up her heart failure and told us she didn't have it. The only reason this exchange took place was that I'd read an article about left ventricular assist devices, and I wanted to know whether my mom could have one. Turned out she wasn't a candidate for a left ventricular assist device because she didn't have heart failure.
I'll probably never know why we all lived with a fatal diagnosis hanging over our heads for -- how many years? I don't remember. Also, I'm pretty sure the fact that everyone thought my mother had heart failure led to everyone mistaking symptoms of kidney failure for symptoms of heart failure. The extreme pain she was experiencing from kidney failure severely constricted her life and caused the fall that ultimately killed her.
I know this will sound obvious, but it bears saying: when you're dealing with a parent's health issues, make sure you understand the diagnosis. As I understand it now (and please correct me if I'm wrong), there are two forms of congestive heart failure: chronic and acute. It's entirely possible that both my mother and we kids were told that she had the acute form and no one explained the difference.
It's also possible she was misdiagnosed -- or that she was correctly diagnosed by her original cardiologist, who left town, but there was some kind of miscommunication with the PCP.
Saturday, September 5, 2009
compare and contrast, part 3
In countries where there is a single health care system -- and thus a single pool of money to pay for it -- it is somewhat easier to control costs. Britain's NHS often decides, for example, that it won't pay for kidney dialysis for a 90-year-old. That means somebody's grandmother will die, but at least Grandma and her relatives know that the money saved is going to be used to help some sick baby or some accident victim.
Q&A with Correspondent T.R. Reid
I came across this passage quite by accident; I was looking for info on the Swiss health care system, and suddenly there it was. The NHS "often" refuses to pay for dialysis for 90-year olds.
yikes
Seeing as how my own 80-year old mom needed an emergency dialysis last year, I took that amiss, and I don't see myself feeling any more friendly to such a policy 10 years from now, when she's 90. Assuming she lives to see 90, which, given her determination and the medical care she's had, she may. Unfortunately, by the time she's 90 she probably will need dialysis, so thank heavens we live here, not there.
At some point, mulling this over, I realized: the wording of this passage is odd.
The NHS often decides not to pay for dialysis for 90-year olds?
Because Britain has a lot of 90-year olds needing dialysis?
Because Britain has a lot of 90-year olds needing dialysis?
And does often mean not always? Do some 90-year olds who need dialysis get dialysis? (And how does a person get in that queue?)
The glaring anomaly, however, and it took me a little while to notice this, is the choice of the word "grandmother." Somebody's grandmother, no less. Not your grandmother or my grandmother. Somebody's.
Of course, when somebody's grandmother dies because the NHS won't pay for dialysis, the people who are most distraught aren't the grandchildren, usually.
The people who are most distraught are the children.
So let's try it that way:
In countries where there is a single health care system -- and thus a single pool of money to pay for it -- it is somewhat easier to control costs. Britain's NHS often decides, for example, that it won't pay for kidney dialysis for a 90-year-old. That means somebody's mother will die, but at least Mom and her children know that the money saved is going to be used to help some sick baby or some accident victim.
It would be fun to put together a collection of political euphemisms* from all realms of the political spectrum** to use teaching writing.
I wonder if anyone's done that.
* I realize that this passage is not, on the whole, what you would call euphemistic, seeing as how it states directly that the NHS withholds critical care from the elderly in order to reduce costs. Nevertheless, the use of the words "somebody's grandmother" and, later, "Grandma" avoid calling a spade a spade.
Friday, September 4, 2009
the sorting machine
I'm sick as a dog* -- who knew stress had anything to do with the immune system?
And, on a directly related subject: Who Killed Health Care? by Regina Herzlinger is great. Wonderful! Especially the chapter on 'dysfunctional culture.'
I've been planning for months now to write a post called "It's the culture, stupid," a concept that came to me after re-reading Richard DuFour's "Restructuring Isn't Enough." Turns out Herzlinger has a section titled exactly that: It's the culture, stupid.
Before I retire to my bedroom, here's an excerpt from her book:
"You won't believe what happened to me this week. I checked an elderly diabetic into my hospital. The guy had a lot of troubles. A great guy, but he just can't manage his diabetes. I had operated on his foot a few weeks ago. And what do you know? As soon as he heals, he goes on a bender. His sugar goes out of control. He was in terrible shape. I checked him into the hospital because I suspected he had an aneurysm ... If he tested positive, I knew I had to operate immediately, the next day. That baby could blow any minute and he would bleed to death."Well, the PCP (primary care physician) who is my patient's gatekeeper just called me. Because he represents the HMO, the gatekeeper has to approve the bill. He thinks I should not have admitted my patient into the hospital for the tests. He questioned my judgment. He told me I was practicing bad, wasteful medicine. He threatened to throw me out of the insurer's network of doctors if I kept this up. I lost my temper. I told him in no uncertain terms that he just does not understand my kind of medicine. He's out of his league-out of his depth."[snip]I have heard Paul's plaint many times in the course of the research I've conducted for my Harvard Business School case studies and after the lectures I've delivered to hundreds of health care groups. I know from decades of interactions with business organizations that when colleagues cannot communicate with each other without rancor and misunderstandings, when competence and motives are questioned without cause, the organizational culture has gone terribly wrong. In successful organizations, confrontations of this sort lead to intervention and analysis by upper managers, and ultimately to a plan to correct the problem ... but in most managed care organizations, this kind of culture does not exist.[snip]Here's how a successful health care organization handled a similar problem.Joan is the Oklahoma-based technical specialist for a firm that manufactures life-support equipment. She is notified that the device in a Louisiana hospital is not working properly. The hospital has no backup and has tried all the usual remedies to no avail. This too is a life-or-death situation that calls for immediate action. But, unlike Paul, who had to "consult" the PCP before he could act, Joan can proceed to do what she knows to do: she e-mails a request to her manager for permission to ship an expensive replacement device ASAP. Permission is expeditiously granted. She also knows that if she does not receive a response within 15 minutes, she is authorized to proceed on her own. Here, everyone cooperates: all efforts are properly focused on the right and expeditious thing to do for the patient's well-being.Why are these two situations so glaringly different? It is not the existence of clear procedures in one case and not the other. They could have made a difference, of course. But the core difference is that Joan's organization has a culture that lends itself to the development of such protocols and Paul's does not.People in an organization whose culture relies on a shared vision are positive and action oriented rather than negative and blame oriented. They want to work things out, find solutions, and serve their customers. ... The culture helps them realize that a confrontation is not a clash of personalities, but rather a sign that something deeper is going wrong and a signal that it must be fixed to preserve the organization's ability to perform its mission.In health care, a productive organizational culture means finding ways to help patients. But such cultures have become rarer and rarer in managed care organizations and hospitals for reason that we will explore....Who Killed Health Care?pp. 29-32
That's what we're missing in so many public schools: a culture focused on making sure all students succeed.
Here's DuFour, writing in 1995:
Ten years ago both the structure and the culture of Adlai Stevenson High School in Lincolnshire, Illinois, reflected it commitment to the traditional task of sorting and selecting students.[snip]In this structure, teachers saw themselves as quality control inspectors. Their job was to present information as clearly as possible, assess the aptitude of each student, and promote student success by placing students at the appropriate ability level. Assigning grades according to a bell-shaped curve was a common practice that, by definition, limited the number of students who could achieve at a high level and ensured that a certain percentage were destined to fail. The “teacher as quality control inspector” had little need to collaborate with others. There was no compelling reason to coordinate curriculum, instruction, or assessment with colleagues teaching the same course.Teachers were not only isolated from one another but from parents as well. No active parent organization existed other than booster groups for specific student activities. Teachers were required to communicate with parents only when a student was in danger of failing. Further, the primary means available to communicate student failure was an individual letter to each parent. Thus, parents received a progress report only if failure was imminent. The majority of parents had no idea how their child was doing until they received a repot card in the 10th week of the semester.
“Restructuring Isn’t Enough by Richard DuFourEducational Leadership April 1995 p. 33-24
* How sick is that, anyway? I've never seen my dogs take to their beds with fever & sore throat.
All Things PLC (Richard DuFour)
If Health Care Were Run Like Retail by Regina Herzlinger
Monday, August 31, 2009
how I spent my summer vacation
Yesterday my mom transferred to the nursing home for rehab. Amazing.
Turns out she did break her pelvis after all; she broke it twice, in fact. Two fractures finally showed up on a bone scan.*
The fractures were the least of her problems, though. We've had two harrowing weeks dealing with spikes in potassium, drops in kidney function, tachycardia, bradycardia, "afib," elevated white blood cells (2 episodes), an unexplained bout of extreme abdominal pain, and a memorable episode of apparent heart failure.
All this along with extreme pain, which my mom rated '9' on a scale of 1 to 10 when someone finally asked. The pain prevented my mom from sitting up, standing, or walking, all of which she critically needed to do.
And now she's in rehab.
* When my mom's primary care physician called to report the results, he said, "Sometimes the primary care physician is right."
Turns out she did break her pelvis after all; she broke it twice, in fact. Two fractures finally showed up on a bone scan.*
The fractures were the least of her problems, though. We've had two harrowing weeks dealing with spikes in potassium, drops in kidney function, tachycardia, bradycardia, "afib," elevated white blood cells (2 episodes), an unexplained bout of extreme abdominal pain, and a memorable episode of apparent heart failure.
All this along with extreme pain, which my mom rated '9' on a scale of 1 to 10 when someone finally asked. The pain prevented my mom from sitting up, standing, or walking, all of which she critically needed to do.
And now she's in rehab.
* When my mom's primary care physician called to report the results, he said, "Sometimes the primary care physician is right."
Sunday, August 23, 2009
"the persistence of bad industry practices"
in the September Atlantic:
Sitting here in Evanston Hospital, keeping watch over my mom and reading the National Reading Panel Reports of the Subgroups in the lulls between crises,** I had a blinding flash of recognition when I read the passage above.
ALMOST TWO YEARS ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.
About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.
It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.
by David GoldhillAtlantic Monthly September 2009
The subject of formative assessment came up in the Comments thread for Allison's post about middle school math pre-tests.*
Sitting here in Evanston Hospital, keeping watch over my mom and reading the National Reading Panel Reports of the Subgroups in the lulls between crises,** I had a blinding flash of recognition when I read the passage above.
My blinding flash was not about hospital sterilization procedures and physician hand-washing, however. No. My blinding flash of recognition was all about formative assessment, (aka collect & correct).***
Ed and I have now been lobbying our school district to use formative assessment (pdf file) ("assessment for learning") for four years. Four years!
Moreover, the district has been paying formative assessment consultants to teach teachers how to use formative assessment for at least two years.
But do we have formative assessment?
No, we do not.
Not only do we not have formative assessment, we do have administrators sending FOILable emails to parents in which they openly refuse to provide formative assessment when directly asked to do so.
Formative assessment at its simplest means: find out what the kids learned, then reteach the stuff they didn't learn.
Can't get it; district won't do it. Or doesn't do it. Either one. I don't know any district that does.
And that is "deeply unsettling," as Goldhill says. How is it possible that parents have to beg schools to provide an essentially cost-free idea that stands a chance of getting kids to college ready to do college work?
update 1:49 Chicago:
* [news flash: at the moment, I can't log on to the old ktm site, which had a number of good posts about formative assessment. Usually when this happens the site eventually becomes available again, but we'll see. I really need to get it backed up, finally. Here's the URL for the search page: http://www.kitchentablemath.net/twiki/bin/view/Kitchen/CommentsSearch]
** Do you know the meaning of the words meaning troponin leakage? I do.
*** It's possible I have been writing an education blog for too long.
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