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THURSDAY NIGHT IS HEALTH CARE CHANGE NIGHT, a weekly Health Care Series (cross-posted at ePluribus Media and Docudharma)

In the interests of full disclosure, as I write this I'm under the influence of approximately a tablet and a half of Oxycodone (Percoset 5/325), which I've been taking about every four hours for the past 48 hours. Likely way too much.

Hmm, where do I start and what elements of my story are cardinal to this post? And why the heck am I on pain medication?

In December this past year, I began to have some mild to increasingly painful chest aches, shoulder pain, and shortness of breath. I've been hypothyroid for around 15 years, and in 2006, while uninsured, I was profoundly idiotic and went off my thyroid medication. I wound up in the local ER one night after my kids determined that I might be dying (I was too stubborn to go due to the cost and frustrated that the appointment schedule at all of the local Basic Health clinics offered through the county for uninsured patients had an eight week waiting list). During that ER visit, my TSH level was tested. Thyroid Stimulating Hormone, or TSH, is one of the things commonly checked for to see how the thyroid is functioning. The so-called normal range (debated within the endocrinologist community) is between 0.4 to 5.0. Mine was 223. Suffice it to say, they prescribed me thyroid medication and I have not gone off of it since.

I've also never returned to what I'd call a fully healthy state since that time. My energy level has not returned, my weight has not dropped, though I'm not an overeater in general, and my joints have always had some mild pain on occasion – like when the barometric pressure drops. Old sports injuries – basketball, threw javelin and shotput one year in college, overextended golf swing during years of junior competition, etc. You might say these things are natural for a woman who's passed through menopause, is now 50 years old, and has led a fairly frenetic existence as a single parent with three kids, now grown, multiple animals, and who is now employed at a company known for its rigorous working environment and continuous software release schedules. Other than the age and the menopause thing, all of those other factors are things that have not really changed in my life over the last eighteen years – with the exception of that one full year of unemployment (when I was between contracts).

And, hell, I've always had a high threshold of pain tolerance. Criminy sakes, I had three children over four years, all around nine pounds at birth, with no or few pain meds, no epidural, nothing. I walked around once on a broken ankle for four days before I realized the pain wasn't going away. I've smashed countless fingernails and thumbnails with a hammer and endured complete nail losses without so much as a whimper (I obviously need to improve my hammer handling skills, though...).

By the time December 2008 came around, my frustration with increasing fatigue and continuously low iron levels, as well as an overall feeling of continuing malaise, drove me to seek an alternative, additional treatment after a couple of years of requesting through my family physician to see an endocrinologist and being told, "let's just try another adjustment of Synthroid".

On December 23, I went to see a naturopath to investigate additional alternatives for treating my hypothyroidism. Over the last three years since my unemployment ended and I became re-insured , my Synthroid, one of the many forms of the thyroid replacement medication given to folks whose thyroid doesn't function, has been raised and lowered multiple times in response to my rather erratic and shifting TSH and T-3 blood test results. I wanted to explore adding Cytomel to the mix, another thyroid replacement hormone that regulates T-4 production. She started me on a low amount of Cytomel twice a day. While I was in the naturopath's office, I mentioned that I had been having palpitations at night and had been experiencing some shortness of breath and pain in my chest and left arm. As a precaution, she called over to the cardiology department of the hospital complex to see if I could get in for a checkup with a cardiologist. December 23 here in the Seattle area was a day of snow on the ground, and most Puget Sounders avoid driving in snowy conditions  - so cardiology had several cancelled appointments and I was able to walk across the street to be seen right away.

They hooked me up for an ECG. Normal. Blood oxygen. Normal. Blood pressure. 117/60 - Normal. Are you sure you are a smoker? Yes – about a half pack a day now. "Quit smoking and lose weight and come back to see me in a month for a stress test. Everything looks fine."

Five days later, more pain, more shortness of breath. Extreme fatigue. Saturday night, January 3, my youngest comes home from work and discovers that I've been pretty much in bed all day, propped up on about five pillows, gasping for breath. Crushing sensation in my chest and sharp pains in my back. She takes me off to the ER around 10 pm that night.  Four hours later I'm sent home with, effectively Pepto Bismol for GERD, percoset for chest pain, and a course of Zithromax (five day antibiotic) for viral bronchial pneumonia, though nothing was evident from a chest X-ray and I had no cough, nor a fever.

Seven days later, no relief. Pain still there, fatigue increasing, breathing labored. No cough. I give in and call my family practitioner. In fifteen minutes, he diagnosed pericarditis. Ordered a CBC and SED rate, another chest X-ray and told me to schedule an ultrasound of my heart.

SED rate 51, cardiac aminos elevated, white blood cells elevated. Something's going on! Echocardiogram shows pericardial effusion and a slightly enlarged left aorta, no other damage. So I'm on Colchicine, Indomethacin for two months.

I'll stop there with the detail. Suffice it to say that I've seen, in the interim months, a rheumatologist, another cardiologist, an endocrinologist, and I'm on my way as soon as can be scheduled, to see a pulmonary specialist for the recent occurrence (in the last seven days) of right side chest pain, stabbing when I breathe in, and for blood specks and small clots in my sputum when I cough. The pulmonary specialist I called this morning can't book me in until July 7th, so I'm waiting for another referral for an appointment in the next week. The ER (that my cardiologist recommended I go to a couple of nights ago when I couldn't breathe again and they couldn't get me in during the day) ran an ultrasound on my legs to check for DVT – deep vein thrombosis, or clots – in the event that I am experiencing a pulmonary embolism. No clots, but the hospital's CT scan machines were down so they couldn't run a scan of my chest that night. This, at a Level III trauma center.

I've had a CT scan three months ago, two ultrasounds now, and multiple X-rays, along with several bloodwork panels. Inconclusive.

I've been on Colchicine, Indomethacin, four weeks of decreasing levels of Prednisone which I'm convinced only mask the inflammation, Methotrexate to stop deterioration of my joint linings, and a new off-label course of Hydroychloroquine, used as a slow-acting anti-inflammatory and prescribed by the rheumatologist since the Prednisone did nasty things to my insides and to my skin. And the ever-present Oxycodone when needed. I need it now just to be able to recline a bit when I sleep.

So, what's my point? I'm insured and all is good? Well, yes and no. Those uninsured days were horrid. I was scared for my kids, all still dependents of mine in that unemployed year, and of course, terrified for myself as well. I ran up thousands of dollars of debt for that uninsured ER visit (which I'm convinced saved my life by getting me back on the straight and narrow with the Synthroid and the ER doc who wrote me out four months worth of prescriptions and handed me forty dollars to cover the next round of medication when I ran out of the hospital supply). I claimed bankruptcy last year to avoid garnishment of my now regular wages. That is a diary for another day.

But even insured, with the best insurance in the country (no co-pay, Preferred Provider, large scale employer), what I find parallels the parable of the blind men and the elephant:

Six blind men were asked to determine what an elephant looked like by feeling different parts of the elephant's body.
The blind man who feels a leg says the elephant is like a pillar; the one who feels the tail says the elephant is like a rope; the one who feels the trunk says the elephant is like a tree branch; the one who feels the ear says the elephant is like a hand fan; the one who feels the belly says the elephant is like a wall; and the one who feels the tusk says the elephant is like a solid pipe.

I'm not so sure that my story is indicative of the breakdown of what might fondly be called collaborative medicine in this country. I can tell you as one who has worked in program management for a software company, the ideals of good management, whether it's a software application, or a patient, might essentially be similar. In my job, I'm evaluated by the effectiveness of my ability to engage in cross-group collaboration, my practice of transparency with others in my group, and my willingness to share documentation and arrange collaborative "triage" on bugs in the system I'm working on. These elements are considered crucial to achieving a successful outcome (or product shipment, or patient care, or...well, perhaps you get my meaning).

In the current medical system, it feels as if everyone operates within the boundaries and confines of their own practice – highlighted by overwork, lack of time to truly evaluate and document the histories of patients, reliance on initial assessments of test results without access to results patterns over time or to the overall picture of treatment by numerous specialists and doctors. Is this simplistic?

Per autoimmune diseases in general, what I do know is this: 75% of those affected in this country with autoimmune disease are women. Over 80% of those affected with thyroid disease alone, are women. The American Autoimmune Related Diseases Association highlights the complexity of diagnosis and treatment, especially for women, in the following paragraphs

Autoimmunity and Women
Even though there is some universally accepted knowledge about autoimmunity, its victims -- mainly women -- have suffered from a lack of focus and a scattered research approach. For example, autoimmunity is known to have a genetic component and tends to cluster in families as different autoimmune diseases. In some families, a mother may have lupus; her son, juvenile diabetes; her sister, antiphospholipid syndrome; and her grandmother, rheumatoid arthritis.
Getting a proper diagnosis is sometimes as difficult as living with the disease itself. Victims face problems not only because physicians often don't think of autoimmunity, but also because of who they are, namely, women in the childbearing years. As a rule, this is a time in a woman's life when she looks healthy, though looks can be deceiving. Often, women who suffer from autoimmune diseases are not taken seriously when they first begin consulting their doctors. A woman's symptoms are likely to be vague in the beginning, with a tendency to come and go, and hard to describe accurately to her physician. In a typical scenario, she is often shunted from specialist to specialist and forced to undergo a battery of tests and procedures before a correct diagnosis is made, which can sometimes take years.
According to a 2001 survey by the Autoimmune Diseases Association, over 45 percent of patients with autoimmune diseases have been labeled chronic complainers in the earliest stages of their illness. This can be devastating to a young woman who may then begin to question her sanity as she tries desperately to find out what is wrong.Tragically, many of these patients suffer significant damage to their organs in the meantime and end up carrying this health burden with them for the rest of their lives because of the delay in diagnosis.

I'm at risk of potentially overstating this, but those paragraphs underline my own anecdotal experience.

One of my questions has recently been, when I speak of my experience to others - how do patients succeed in getting proper treatment, patients who are not as educated as I am, not as calm as I normally am with doctors, not as articulate, not as organized about carrying their reports and results with them to each new physician (a learned lesson after multiple record losses between fax machines over time), and not as healthy or clear thinking as I can force myself to be even with "brain fog" - how do these patients fare in the mouse maze of healthcare? Especially if uninsured or underinsured?  

What to do? What to do right now? One thing to consider – contact your Congressman and request that they support Patrick Kennedy's recent bill.

Additionally, you can contact and request the support of members of the House Committee on Energy and Commerce, where the bill is now in review.

H.R. 2084: Prevention, Awareness, and Research of Autoimmune Diseases Act of 2009

The bill's purpose?

To increase awareness of and research on autoimmune diseases, which are a major women's health problem, affect as many as 23.5 million Americans, and encompass more than 100 interrelated diseases, such as lupus, multiple sclerosis, rheumatoid arthritis, Sjogren's syndrome, polymyositis, pemphigus, myasthenia gravis, Wegener's granulomatosis, psoriasis, celiac disease, autoimmune platelet disorders, scleroderma, alopecia areata, vitiligo, autoimmune thyroid disease, and sarcoidosis, and for other purposes.

Much like the fragmented and often fractured approach to medical care in this country, submitting bills like this in Congress is often a fruitless venture due to the "market basket" nature of inclusion of multiple interests, concerns and diseases that the bill attempts to cover. However, history shows that the submission of bills that have a more singular focus and nature are often defeated or rejected out of committee due to their very exclusivity – they are too narrowly written to drum up much support except from specific interest groups without much political power.

However, submitting this bill does further the purpose of illuminating the issue of autoimmune diseases, the increasing complexities of said diseases and the lack of research.

A bill like this also targets the very real evidence that women's health care in general still suffers in this country due to the still nurtured archaic mindsets that a woman's health is too often characterized as "all in your head".

The oxycodone is wearing off now...talk amongst yourselves and thanks for reading. I'll join in comments when I can.

Originally posted to exmearden on Thu May 28, 2009 at 06:39 PM PDT.

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Comment Preferences

  •  tipjar.... (50+ / 0-)

    The Thursday Night Weekly Health Care Series is published every Thursday. It is meant to provide a forum and encouragement for people organizing for positive health care change. If you would like to contribute to the series, please contact TheFatLadySings at tflsster/at/gmail/dot/com.

    Apologies for the delay tonight...overheated computer fan. Sigh.

    -exme

    "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
    Teilhard de Chardin

    by exmearden on Thu May 28, 2009 at 06:41:41 PM PDT

  •  Time warp going on here (20+ / 0-)

    How could there be no comments yet.  But I guess I speed read?

    Anyhow, whatever the story, you do have a way with the language.  Too bad you have to be telling this story (which I've only heard bits and pieces of before now.)

    Could our health system be more fucked up?  Laura Clawson had an interesting link to a New Yorker article about how the Mayo Clinic gives top notch service at one of the lowest per patient costs.  Amongst other things.  Great article, and much of it deals with some of the management issues you touch on.

    The river always wins. -- Mark Twain

    by Land of Enchantment on Thu May 28, 2009 at 06:51:07 PM PDT

  •  Whenever I hear a healthcare reform opponent (19+ / 0-)

    whine that any changes to our current system might mean having to wait for care, I wonder if they realize that things like what you cited

    The pulmonary specialist I called this morning can't book me in until July 7th, so I'm waiting for another referral for an appointment in the next week.

    happen every day in the US ...and that's to someone with good health care. Don't tell me nobody waits for care now.

    Best of luck to you as you get your problems under control.

    •  Waits for specialist care is common in U.S. (2+ / 0-)
      Recommended by:
      exmearden, Loonesta

       In 1999, I was out of state when I started having cardiac arrest and spent 5 days in SW MI hospital.  They would not release me without putting in a pacemaker and told me to see a cardiologist when I got home.  I had to wait 2 months to see a cardioligist when I got home to Missouri after having a pacemaker put in.   To make matters worse, my insurance company said my initial treatment in MI. was 'out of network' and wouldn't cover everything.  I had multiple health problems in 1999/2000, along with a divorce and a job loss.  It ruined me financially and I have never recovered.  I used to make pretty good money, had a college degree, a decent job and great credit.  Bad credit is still haunting me after my last 10 years of healthcare nightmares.

      Now I am uninsured since my COBRA insurance expired last month.  I've been out of work for over 1 1/2 yrs and have multiple chronic health conditions, including pacemaker/heart irregularities, autoimmune problems, chronic back pain, joint pains, depression, anxiety and sleep disorder.  There is no help for a single woman in rural Missouri.  Some days I can hardly get out of bed.  Yea...the U.S. has a wonderful healthcare system, NOT!

  •  (((Ex))) (17+ / 0-)

    how do these patients fare in the mouse maze of healthcare?

    I'll let you know when I get midway in the maze I just entered

    I was uninsured for 15 years, and thank the PTB I finally got really good coverage last fall with a new employer (not just really good coverage but actually affordable with reasonable copays).

    My internist ran this huge battery of tests to set a base line, had me get all the scans & screenings I hadn't had since my son was born, but doh, it never occurred to check the thyroid, even though I had all these really contradictory results on the blood work.

    I presume she was so trying to catch me up on all the big things that this was low on the lists.

    I am now waiting on the results, I do have a majority of the hypothyroid symptoms...but it took me going back with a damn list of things that weren't "right" , and I mean a literal list.

    I also thank God her first answer wasn't to slap me on anti-depressants, since the crying jags & brain fog were what finally sent me in..I am post-menopausal so it wasn't that.

    I have just a major ordeal with dental work, and the answer became the same...sorry to be sexist but find a woman doctor, a woman who won't dismiss you as a "crazy" woman

    Barn's burnt down -- now I can see the moon. Masahide

    by bws on Thu May 28, 2009 at 07:00:34 PM PDT

  •  getting care before they get a diagnosis (15+ / 0-)

    is REALLY hard with this system. I don't know any others, but it sure seems like there is better co-ordination in fields other than medicine.

    I have Graves disease, which is a hyper-thyroid disorder. The time I went untreated (while trying alternative methods) may very well have contributed to my ovarian cancer.

    I"m sorry to learn about the pleural effusion--I've heard they're very painful.

  •  Excellent diary, em, "under the influence" or not (17+ / 0-)

    Thank you.

    I am so sorry about your pain and travails dealing with a system
    not set up to coordinate information for patients. As a sufferer of
    two of the autoimmune diseases listed in that block quote, you bet
    I'll be contacting members of the House committee.

    Ironically, I was lucky, since my sarcoidosis and sjogrens presented so
    dramatically (after a year of symptoms I ignored, I admit) that the
    doctors rushed a lung biopsy (ouch) and  expensive blood tests that
    successfully diagnosed what the heck was up.

    My MD daughter had been a member of a national group of doctors,
    public health advocates, et al for a few years whose goal is better
    collaborative medicine. Let's hope it stays funded and contributes
    to what is so obviously necessary.

    {{{HUGS}}}

    (And now I have to leave for a meeting, darn it.)

    Don't take anyone seriously that says one thing and does another--that's the worst sin of all...Claire McCaskill

    by begone on Thu May 28, 2009 at 07:07:40 PM PDT

  •  Thanks for posting exme! (15+ / 0-)

    I'm really sorry to hear you are having such problems. Thank you for a beautiful diary. I hope you are able to find someone who can and will help you.

    You have all our prayers and best wishes. I sent out your diary to the listserve.

  •  wow, sorry you're going through all that (14+ / 0-)

    Your diary is a shot in the arm. Hypothyroid runs deep in my family and I've got a big chunk of the symptoms, just can't seem to get off my fatigued butt to get to the doctor. I know I'd feel better if I did, but the doctor paranoia thing gets to me.

    •  get off your butt (12+ / 0-)

      untreated hypothyroidism leads to dementia, heart disease (the number one killer of women in the US), it's suspected in bone loss, more rapid aging of both brain cells and general cells, weight gain, and, of course - pericarditis and pleural effusion - both of which are inflammatory situations that may be related to under-treated hypothyroidism, though it's less recognized in this country as being related than it is in European medical studies.

      It's a serious, serious disease. When I went in to the ER in 2006, I looked and felt like I was dying - and according to the endocrinologist I just saw two weeks ago, I was. I was off my meds for only three months and my health and mental state divebombed rapidly.

      Taking meds every day is a pain in the butt, too, but well worth. The alternative sucks.

      Just sayin'...

      ;)

      "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
      Teilhard de Chardin

      by exmearden on Thu May 28, 2009 at 07:28:44 PM PDT

      [ Parent ]

  •  Beautifully written, and so right on target. (14+ / 0-)

    Often, women who suffer from autoimmune diseases are not taken seriously when they first begin consulting their doctors. A woman's symptoms are likely to be vague in the beginning, with a tendency to come and go, and hard to describe accurately to her physician. In a typical scenario, she is often shunted from specialist to specialist and forced to undergo a battery of tests and procedures before a correct diagnosis is made, which can sometimes take years.

    The above is my story....just got sicker and sicker.
    Sometime I will diary it.

  •  was just thinking of quitting (12+ / 0-)

    my thyroid medication...and what is it with endocrinologists in general?  They are so precious with their information and so few up to date of possessing any courage or intuition.  Oh the very expensive a**holes I've had to pay for.
    end of my little rant.
    Peace.

    •  Don't give it up.... (12+ / 0-)

      not just from my story, but as a cautionary note - my mother was on thyroid medication for twenty years until she was 80. She got a new doc who took her off of it - said her labs were great and she didn't need it anymore and he refused to do follow-up tests over the next year (after she was off Synthroid for a year) to see what her TSH and T-3 was at.  Within a year, we saw the onset of dementia; within two years, her heart started to fail; within 6 years she was dead.  Now, she was over 86 when she died. But there was little sign of memory loss or dementia when she was still on Synthroid.

      I had no idea until she died that she had been taken off of thyroid (long family story buried within that tale) and I still believe, unconfirmed, that she experienced faster dementia and the more rapid onset of heart disease due to the full stop of the thyroid medication.  I've always heard and still hear that once you start thyroid for an underactive thyroid, it's very rare to be taken off of it - and even worse to be completely pulled off of it without further testing to check levels.

      Don't stop taking your meds. The worst part is the brain fog and it can cloud your judgement about what is going on with your health - trust me.

      "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
      Teilhard de Chardin

      by exmearden on Thu May 28, 2009 at 07:34:43 PM PDT

      [ Parent ]

      •  Gee, you've had it rough. I'm (8+ / 0-)

        really sorry to hear about your mother. My mother had a psychiatrist that prescribed lithium for everything. She was schizophrenic and he placed her on lithium for eight years. Every time we complained to him, he told us her symptoms were her "fault" because she wouldn't take her medication properly.

        We couldn't get her to change doctors.She loved this doctor because, after years of mistreatment, she thought of schizophrenia as a criminal charge. She liked this doc because he called her "manic depressive" instead.  She had a small inheritance from her mother, as well as insurance. After a number of years we learned he had allowed her to pay his bills without billing her insurance, thus eating up her meager inheritance.

        He was such a jerk!

        •  omigod. (6+ / 0-)

          Seems like that's a case of elder abuse.

          My mother died seven years ago and the halting of the thyroid medication is still an open question in my mind. That unanswered question has damaged the one direct family relationship, besides those with my own kids, that I have left and that I truly treasured.

          On his side, the relationship is damaged because I'm such a flaky chick - can't stay married, can't pay my rent,  and I'm always out of money. I recognize the fact that he's never been a single parent with three kids of which he was the total support, never done something so criminal as claim bankruptcy due to medical bills and unemployment (!), and never had a chronic illness (to my knowledge, unless one considers borderline alcoholism a chronic illness).

          In my mom's case, she switched to the naturopath my brother recommended. I'll leave it there for now.

          Sigh.

          ;)

          "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
          Teilhard de Chardin

          by exmearden on Thu May 28, 2009 at 08:14:24 PM PDT

          [ Parent ]

    •  Don't quit! (12+ / 0-)

      Your body becomes dependent on the thyroid medication- my MD warned me when I began Synthroid that this was for life.

      Something else I've found over the years- generics vary wildly in quality.  Went brand-only for this reason and have been fine since then.

      My little sister was just diagnosed, as was my mother.
      Suddenly, they are A LOT more awake on the phone since starting medications.  

      Can you be managed with a regular MD instead of an endocrinologist?  It was a gyn who suspected me to be hypothyroid and who managed my meds.

      Reason, observation, and experience; the holy trinity of science. Robert Green Ingersoll

      by offred on Thu May 28, 2009 at 07:52:38 PM PDT

      [ Parent ]

      •  ditto on the generics here... (8+ / 0-)

        The generics never worked for me - I finally determined that after a round of up and down in the latter half of 2007.  I stick to Levothroid now and have been okay on that.

        My middle daughter was diagnosed when she was 8 years old - initially the school (and I) thought it was hyperactivity and attention deficit - though she's still treated for ADD, it was predominantly hypothyroidism.  The real key was the bouts of anger - over the top reactions to siblings and friends - weight gain too rapid for her age or the amount she was eating, and her face, which rounded out in a "moon-face" shape in the course of six months.

        She balks still at the medicine (even at 21), but she knows that if she doesn't take it, all the symptoms I describe hit her like a ton of bricks.

        After being on Synthroid between 8 years of age and 9 years of age, she went from being in a special ed reading program to reading at the high school level. From being a "C" student to an "A" student.

        This particular disease touches so many aspects of life that it's hard to encompass the many reasons it's important to get treated.

        I say this holding my breath...one of my next specialist steps is that I'm going in to have an echo done on my thyroid to see if a nodule measuring over an inch in diameter is benign or malignant.

        Who knows? That may the root cause of all of this, or it may have nothing to do with any of it.

        I understand why my dad used to say "it's all a crapshoot".

        ;)

        "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
        Teilhard de Chardin

        by exmearden on Thu May 28, 2009 at 08:00:52 PM PDT

        [ Parent ]

        •  I was tested for hypothryoidism (9+ / 0-)

          but all they told me was that I was in the proper range.  I have a lot of the symptoms, the tiredness, the difficulty losing weight, and what I call a squishy mind.  I just forget what I'm doing.  I think they think I'm looking for a miracle drug to lose weight (I'm not), and they don't believe I eat as little as I say because my husband is overweight too, but he eats tons more than me.  I know, I know, I know there's something wrong with something, but damned if I know what.  I have psoriasis and psoriatric arthritis, but that's the only autoimmune diagnoses I have.  The meds I'm on have stopped working and insurance won't let me have any more.

          I'm at the absolute end of my rope.  My skin is a disaster, my joints are a disaster.

        •  most of them are benign-good luck (7+ / 0-)

          as I'm sure you've been told, exmearden, but I know it's worrisome.  I have one too which was benign but they have to continue to watch it and I'm way overdue to have it checked again.
          I originally had autoimmune thyroiditis and an inverted goiter which was crushing my throat - painful and a very bad memory.  I'd been (wrongly) prescribed lithium for many years and suspect that is what trashed my thyroid but who knows...it could have been tobacco with all the additives way back then.
          Thanks for this thread.

    •  Only reason I didn't rec this was cause I (6+ / 0-)

      don't want you to neglect your health. Even if specialists are arses, don't take a step that might harm your health.

  •  One maze Buster (10+ / 0-)

    is computerized records...the medical group I am using has gone to the tablet/notebook system so every test, visit & procedure is all in one data base that all the doctors access

    The group also, thankfully, is big enough that they have every specialty covered.  Referrals are quick & efficient within the system.

    they are also a partner with my insurance plan and are considered preferred providers which actually has kept the bills down, billing is efficient and I get an email from UHC on every claim so I can keep tabs on everything.

    Hmmm...in many ways it's a private single payer system

    Barn's burnt down -- now I can see the moon. Masahide

    by bws on Thu May 28, 2009 at 07:25:48 PM PDT

  •  Slightly OT but nonetheless... (13+ / 0-)

    My situation was far less severe but it does speak to another "fracture" in diagnosis, treatment and collaborative medicine:

    Over the last two years it seemed I had developed allergies to things for which I'd never been allergic before, pollens in particular. My lungs were constantly flooded with gunk.  My doctor suggested I first try claritin and/or zyrtec, which seemed to control it well.  We figured I was just unlucky to develop allergies as an adult, which is not uncommon at all, apparently.

    During those same two years, my dentist and I were "watching" an old crown.  She thought I might have some infection (decay) there but the x-ray couldn't penetrate the metal crown so it was a guess, hence the "watching" mode.

    About two weeks ago, when flossing, the crown just broke off.  I know this sounds ghastly, but the remaining tooth underneath had rotted at the gumline.  Yuck..

    Within two days, in the middle of the worst part of spring allergy season, my lungs COMPLETELY cleared.  I mean COMPLETELY.  Any evidence of allergies is GONE. (A persistent case of dermatitis also seems to have vanished, but that may be a stretch...)

    Apparently I had a low grade infection which had perhaps gone from my tooth into my lungs - not my heart, which dentists had warned me about, but my lungs.  Or maybe my lungs filled as a result of an over response to the infection from my immune system. I never had a fever and despite the impairment to my lungs, I continued to work... as an opera singer, no less!

    The doctor never asked me about my teeth and my dentist never asked me about my allergies.   I guess I don't really blame them but...

    I just do not understand why the dentist and doctor are not part of the same system.  Why doesn't health insurance cover dental health issues?  Dentists are doctors, yes? I have no idea how serious things might have gotten had this gone on longer, but...

    That said, what I went through can not compare with the issues you have faced and are facing, ex-mearden, and I'll be pulling for you to regain your health and spirits.  Thanks for the important diary and all best wishes to you and your loving family.

    (btw - I've a brother-in-law in the final stages of ALS, a sister-in-law with lupus, and my partner died of AIDS in 1996, so I've had my experiences over the decades with the human immune system and its many stages of function and dysfunction: complex and fascinating)

    "History is a tragedy, not a melodrama." - I.F.Stone

    by bigchin on Thu May 28, 2009 at 07:43:23 PM PDT

  •  Answer to your question: (13+ / 0-)

    Many of them don't.  They simply fall through the cracks.
     
    My Mother had a very serious illness a few years ago, and if I hadn't been there as a relentless advocate every step of the way I can say with near certainty that she wouldn't be with us today.  I'm so grateful that I was able to navigate the system, and since I'm in the medical field I had a bit of an advantage, but there are so many people who are too ill, too old, too intimidated, too uneducated, or too alone to demand the care they deserve.  Many don't have any idea what to ask or even tell their doctors, and for any number of reasons are unable to be a partner in their own health care.  My Mom is one of the lucky ones, but why should anyone have to depend on luck?
     
    As I like to say, we don't need health care insurance in this country, we need health care assurance.

    Good diary.  Thank you.      

    •  a few years back (12+ / 0-)

      a good friend of mine developed an infection from the iv chemo pump she wore every day. we went in right away and the doc says'well, we're going to have to take you off the medication" so i say ive heard they have that drug now in pill form.... don't u know he goes in and researches it and finds out that yes they do and she didn't have to be on that damn machine anyway@!!!!! AND THIS IS ONE OF THE MOST RENOWNED ONCOLOGISTS IN THE AREA.  My friend died about 6 months later but for that year and a half of her treatment, we fought with every doctor she saw, for every new treatment we researched. won most of our battles, but sadly lost the war.

      They tortured people to get false confessions to fraudulently justify our invading Iraq.

      by boatsie on Thu May 28, 2009 at 08:21:06 PM PDT

      [ Parent ]

      •  First. please accept my condolences (12+ / 0-)

        about the death of your friend.  Friends can never be replaced with new ones, because everyone is unique.

        I guess my main point is to say that physicians are not omniscient, and they do not read the medical literature as often as they should because they are too darned busy.  That is why continuing education is now mandatory in almost every state.  But that does not make them demigods.

        That is why it is important for friends and relatives to keep up with folks with chronic medical conditions, and acute ones, too.  Two pairs of eyes are better than one, and the benefit increases exponentially.  I would not allow a loved one to stay in a hospital room overnight alone, because mistakes happen and a cogent person, even a layperson, can reduce those mistakes just by asking a simple question.

        Warmest regards,

        Doc  

        "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

        by Translator on Thu May 28, 2009 at 08:28:26 PM PDT

        [ Parent ]

        •  thank you and a question.... (4+ / 0-)

          i just today visited a dear friend who recently lost her lifetime companion who was also a very good friend of mine. We had an incredible visit. She had been trying to locate me for 2 weeks, and had just a minute before put the computer I had lent to her companion into the truck .... it was truly one of those times of sharing one never forgets ... sitting in her bedroom with all her beautiful paintings around (she was an artist) and her bed and knick knacks and slippers still there and i remembered so well the time we had met in russell square in london in the middle of a very very hot June and she had told me about the fauvism exhibit i couldnt miss and we rode the bus together....
          anyway, here's my conundrum. my suriviving friend still smokes. I quit smoking 4 1/2 months ago. It was the hardest thing I have gone through in my life. It totally messed up my precarious brain chemistry and caused a major breakdown. My friend smoked a cigarette in the room while we talked. It wasnt the time to mention I had stopped smoking. She is coming over next week for dinner and as she lives over the mtn. (and is older and doesnt see well) I invited her to spend the night. As soon as I left i became frightened about the fact that she smokes and we used to smoke all the time together. How do I handle this to ensure I don't slip?

          They tortured people to get false confessions to fraudulently justify our invading Iraq.

          by boatsie on Thu May 28, 2009 at 09:32:21 PM PDT

          [ Parent ]

          •  No easy anwser. (2+ / 0-)
            Recommended by:
            exmearden, Loonesta

            Ask her to smoke outside, away from you, is my best guess.

            Contratulations that you are done with it.  I have not bought cigarettes since March, but roll them.  I have 40 cents a pack ones, and starting with the new week will restrict my use of them.  My goal is to use this last 14 ounce tub of Prince Albert into my last one.

            Do not drink coffee with your friend if tobacco is involved, or a cocktail either.  Get rid of the rituals.  I never smoke with a cup of coffee these days, and have restricted the rooms in which I smoke to two.  Since I live alone, I am not contaminating anyone.

            Warmest regards, and good luck,

            Doc

            "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

            by Translator on Thu May 28, 2009 at 09:52:39 PM PDT

            [ Parent ]

          •  call one of the stop smoking hotlines (2+ / 0-)
            Recommended by:
            exmearden, Loonesta

            and see what they recommend.

            My sister quit 78 days ago thru a local program and got a lot of good support, stress management tips.

      •  That's incredible. (7+ / 0-)

        At least the doc wasn't arrogant about it and actually followed up on your suggestion. Some doctors would have blown you off, even at the expense of their patient.  You are a good friend - I'm sorry for your loss.  I lost a dear friend almost a year ago to ovarian cancer.  She also won many battles, some that I helped her fight, but she too lost the war.  I miss her every day.

        •  To the credit of the physician, (7+ / 0-)

          there was some research after the suggestion.  That is a good thing, and I THINK, although this is only anecdotal, that there may be a very slow transition from completely authoritarian to more participative.  I hope that is the case.  But many of the old school ones still use the "my way or the highway" approach.  This is one reason why I very strongly advocate a liberal education experience for all premedical students.  I have taught many, and in my experience the best physicians arise from the most open minds.

          I respect you very, very much for standing by your friend.  Ovarian cancer, along with pancreatic cancer, are the horrible challenges in medicine, because they are almost never caught until symptomatic, and then they are very difficult to treat.  Please think good thoughts for your lost friend for me, even I did not know her.

          Warmest regards,

          Doc

          "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

          by Translator on Thu May 28, 2009 at 08:47:24 PM PDT

          [ Parent ]

        •  I am sorry for your loss too (3+ / 0-)
          Recommended by:
          exmearden, begone, Loonesta

          I'm an ovarian cancer survivor and I know your friend did not have an easy time--no one does with ovarian cancer.
          there are two good advocacy organizations
          OCNA and NOCC

          we work to encourage public funding of research and ovarian cancer education. If you ever feel like working a health fair booth or passing out literature, look for your local chapter.

  •  Best wishes, exme, and to all here (11+ / 0-)

    What a saga!  I am thankful you are getting help, and I will hope for the best treatment to be provided and that you make progress and are able to have less pain and to be able to sleep.

    {{{{{{HUGS}}}}}}

    Join us at Bookflurries: Bookchat on Wednesday nights 8:00 PM EST

    by cfk on Thu May 28, 2009 at 07:49:48 PM PDT

  •  I am very sorry about your condition. (9+ / 0-)

    I am also very concerned with such high doses of Percocet.  It is not the oxycodone that concerns me as much as the load of acetaminophen that you are getting with it.  Acetaminophen is a very dangerous liver toxin that, in my opinion, should be by prescription only.  Talk with your physician and see if he or she will prescribe an oxycodone product without any acetaminophen in it.  You can get Percodan, which has aspirin in it instead, or just plain oxycodone, or, I suspect, one with ibuprofen in it.

    Please do not take much acetaminophen.  If you drink more than very casually, do not take any at all.  This is an extremely dangerous drug,a and is hyped beyond belief.

    Please do well.

    On another note, The Fat Lady Sings contacted me to write a contribution for this series in the near future (we are working out the date now, but in a week or two or three).  We agreed that I would examine the facts and the hype about High Fructose Corn Sweeteners (HFCS) that are so common these days in practically all consumer products.

    Warmest regards,

    Doc

    "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

    by Translator on Thu May 28, 2009 at 08:07:16 PM PDT

    •  the fortunate thing (6+ / 0-)

      is that I rarely take any acetaminophen, or ibuprofen. Aspirin has no affect on me.

      Not sure if it's a good thing or bad thing that I don't usually take acetamiophen. My weight is (gasp) at 228 lbs, so it's a gamble. Okay, I'm still a size 14 - go figure. Water weight (Prednisone effects) and still have muscle mass. That profile in the mirror, though, is just sad...;)

      My blood work should be back from the endo tomorrow (though that will be pre-Percoset). I'll ask my FP tomorrow for something milder if there's no resolution in sight for this round of chest pain. Thanks, Doc.

      -exme

      "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
      Teilhard de Chardin

      by exmearden on Thu May 28, 2009 at 08:27:09 PM PDT

      [ Parent ]

      •  It is not really much your body mass, (9+ / 0-)

        it has to do with metabolic processes, and some folks have more of one than the other, and chronic alcohol drinkers (even very light ones) induce a liver enzyme that favors a very destructive path, although some folks naturally favor it anyway.

        Without getting too wankish, the "bad" pathway for metabolizing acetaminophen involves the formation of a highly reactive, electron deficient nitrogen centered species called a "nitrene".  These, once formed, immediately attack the lipids in the cell membrane, killing the cell.  Since the liver concentrates products to be eventually eliminated, the concentration of those destructive species are particularly large there.  Alcohol and many other drugs induce a high concentration of the enzymes that potentate the "bad" pathway.

        I really think that the OTC status of acetaminophen should be pulled.  It is fine under controlled conditions, but much too dangerous for widespread, unregulated use.

        Make sure that they explain your liver enzyme profile to you in detail, and ask them if there is a anomaly.  Aspirin has a very subtle effect and is very safe unless you either have an asthmatic reaction, a bleeding problem, or an outright allergy to it.  Ibuprofen is well tolerated by most.  But, hey, if you are taking oxycodone, the .50 calibre bullet against pain, the little .22 of the other analgesics are really not that important.  Unless they poison you.

        Warmest regards,

        Doc

        "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

        by Translator on Thu May 28, 2009 at 08:39:18 PM PDT

        [ Parent ]

        •  oh, and I'm not a drinker (7+ / 0-)

          except for a pint of IPA about every six months when I get over the 520 into Seattle to my favorite neighborhood pub - Montlake Brew Pub (locals know it as the place where the Drinking Liberally gang hang out on Tuesdays).  They have a very fine IPA.

          But, seriously, I don't drink, even a glass of wine, at home. Perhaps it's my slice of Native American blood, or just a general disregard of spirits on a daily basis, but it isn't a concern.

          My liver enzymes were out of whack a bit back in February during the peak inflammation, but the last panel indicated all were in the normal range. The ones from the ER on Tuesday morning appeared good, too. I'll keep watch.

          Thanks again, Doc. I always look forward to your diaries, btw.

          "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
          Teilhard de Chardin

          by exmearden on Thu May 28, 2009 at 08:49:03 PM PDT

          [ Parent ]

          •  Thank you for the kind words! I write (7+ / 0-)

            not only to impart information, but to receive it, and receiving it is actually more important to me.

            I intentionally did not pimp my series in these comments, but will freely do so when it is my turn to post here.  For those whose interest has been piqued, you can always hit my profile for the full series.

            I am glad that your enzymes came back in good order.  I am not surprised that they were not quite right during the worst, because it was working overtime.  That they came back to normal recently is certainly a good sign.  But do sit down with your provider and get an explanation of what each means, and pattern recognition for more subtle trends.

            No matter how much you trust your provider, it is always possible that retirement, getting run over by a bus, or any number of things would separate the two of you.  Get the insight now and carry it in your brain.

            Warmest regards,

            Doc

            "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

            by Translator on Thu May 28, 2009 at 08:55:44 PM PDT

            [ Parent ]

            •  Pimp away! (5+ / 0-)

              I consider it a benefit to provide participants with access to good information.

              I follow it. Isn't it on Saturday mornings? Pique the Geek? I'm so tired I can't remember. I have to go to bed!!!

              •  Well, only because you asked! LOL! (5+ / 0-)

                It is Pique the Geek, and it is every Sunday evening (even if I am not feeling well) at 9:00 PM, right here on this same bat channel.  Thanks for allowing me to advertise it.  This Sunday we will continue the series on drugs of abuse about true narcotics, and will finish this series with a flourish with a three or four part about psychedelic drugs.

                Thanks!

                Warmest regards,

                Doc

                "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

                by Translator on Thu May 28, 2009 at 09:12:51 PM PDT

                [ Parent ]

            •  Doc (5+ / 0-)

              I have a leg up on most patients, I confess. I worked in a blood lab in Portland during the early years of AIDs testing, when we were the only lab that accepted AIDs draws and returned HIV results.

              I learned a lot from that experience, and the owner (and microbiologist) of that now-defunct lab is the father of my best friend and family friend.

              I also make certain to always obtain the print results (or CDs as in the case of the CT scans) of my tests so that I can maintain them as my own personal baseline over the years.

              This is a practice I started with two of my siblings, my mom, and several other relatives who all had cancer and whose patient care I acted as advocate for.

              When you mentioned in a previous comment that patients need to be their own advocates, I fully agree. But in so many cases, family members aren't prepared to act as advocates for their own too-sick relatives, and the patients themselves don't have the resources, personality, or stamina to keep on insisting they receive better care, more open and transparent directive care, and additional important information on their illnesses.

              As  you mention above, doctors are not omniscient; but too many patients - especially women patients - tend to view those in the medical profession as intimidating and more informed than said professionals actually are.

              Many in the medical profession promote this attitude - it creates an environment that is less conducive to questioning the diagnosis and less conducive to assigning wrong direction, wrong care, or malpractice to the doctor or the facility.

              I understand the "why", but as a patient who speaks out, this tendency to "subordinate" the patient turns those patients who are assertive in their own care into patients who are perceived as potential "mental cases". Especially, I'll say again, women.

              How do we change the environment that encourages this "subordination" of the patient behavior? And how do we encourage the patient to ask more and better questions? My hope is that with the advent of the internet, more questions are being asked. But the internet itself can be a dangerous place to seek information if you are not already an informed and skilled researcher.

              In my case, I am not a demanding person, nor I'll propose, am I obnoxious in the least when I discuss symptoms and treatments with a doc. Those who met me in Austin last year may disagree! Or perhaps my kids might disagree. Hmmm.

              Nor do I ever suggest that I know more than a doc does - because I don't.

              However, I will admit that my daughters do suggest that I'm too articulate when I speak to docs and that it might be intimidating. Not sure how to overcome this one.

              It's kinda like Obama being called elitist. Can't win.

              ;)

              "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
              Teilhard de Chardin

              by exmearden on Thu May 28, 2009 at 09:33:27 PM PDT

              [ Parent ]

              •  You posted a very complex essay, (2+ / 0-)
                Recommended by:
                exmearden, Loonesta

                and I will only approach a bit of it.

                First, I have seen several hospital mistakes that could have been prevented by an alert loved one being there.  This is not rocket science, but it important.  Just being there keeps folks on their toes.

                Second, no physician should be treated as a demigod.  Ask them where they derive their opinions, and for the documentation for it.  If they will not, they are not practicing proper medicine.  Even a hunch, and sometimes hunches are proper medical diagnostic devices, should be recorded.

                Third, you DO know more than the Doc does, because you have the advantage of thousands of hours with your children and spouse, whilst the physician has, perhaps, 30 minutes.  You tell me who knows the symptoms better.

                Warmest regards,

                Doc

                "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

                by Translator on Thu May 28, 2009 at 10:04:36 PM PDT

                [ Parent ]

                •  wish I'd come across (2+ / 0-)
                  Recommended by:
                  Loonesta, Translator

                  more docs like you in the hundreds of docs I've interacted and worked with over the years...;)

                  Thanks much, doc. No need to answer all the things in my comments.

                  As you may notice, I'm a fairly extemporaneous and reasonably hypothetical commenter. I rarely expect responses, so you are quite kind to provide me with some focused answers.

                  thank you again.

                  -exme

                  "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
                  Teilhard de Chardin

                  by exmearden on Thu May 28, 2009 at 10:08:01 PM PDT

                  [ Parent ]

                  •  You make very interesting comments and (2+ / 0-)
                    Recommended by:
                    exmearden, Loonesta

                    anwsers, an I want to take your diary to over 100 commnents, becasue it deserves it.

                    Warmest regards,

                    Doc

                    "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

                    by Translator on Thu May 28, 2009 at 10:19:42 PM PDT

                    [ Parent ]

                    •  In my years of posting here (2+ / 0-)
                      Recommended by:
                      Loonesta, Translator

                      I've rarely been over a hundred comments, or even much over 50, so no worries on that account, please.

                      The two diaries I maxed on comments (and recs, for that matter) back in the day, were, of course, on rather controversial subjects:

                      But if I did, well really, what's it to you?

                      and

                      Not the diary I should write.

                      'Fraid I just don't have the stamina or imagination currently, for such things.

                      < smile >

                      "We are one, after all, you and I, together we suffer, together exist, and forever will recreate each other."
                      Teilhard de Chardin

                      by exmearden on Thu May 28, 2009 at 10:27:27 PM PDT

                      [ Parent ]

                      •  Well, you are over 100 tonight. (2+ / 0-)
                        Recommended by:
                        exmearden, Loonesta

                        You deserve it.  Please return the favor Sunday on my post.

                        Warmest regards,

                        Doc

                        "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

                        by Translator on Fri May 29, 2009 at 12:45:56 AM PDT

                        [ Parent ]

                      •  I just read your very (2+ / 0-)
                        Recommended by:
                        exmearden, Loonesta

                        intense post.  As a man, I can not begin to imagine the wonders and harsh adversity of a woman.  I have learnt some from Mrs. Translator, but no one knows everything.  I very much respect your position, and you may take comfort knowing that I hold nothing against you.  You did what you had, or needed to do.

                        I hope that you consider me to be one of your friends.

                        Warmest regards,

                        Doc

                        "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

                        by Translator on Fri May 29, 2009 at 01:02:26 AM PDT

                        [ Parent ]

                •  Thanks Doc (1+ / 0-)
                  Recommended by:
                  exmearden

                  I would recommend this 100 times if I could. Would that there were more doctors like you. When one of our family members is in the hospital, we have someone there with them 24/7 and keep a notebook with everything the Dr says and the patient. People (and some doctors) seem to forget that the doctor works for the patient.

    •  Hi doc! I am really looking forward to your (7+ / 0-)

      diary. A few years back I looked at ten years worth of OD death records in my county. One startling death record that popped out was a young man who died of a tylenol overdose because he had a toothace and couldn't easily get to a dentist. He died while his parents were transporting him to the nearest dentist who was over four hours away.

      Another reason Bernie Saunders "strange obsession with rural dentistry" is not strange if you actually live in a rural community.

      Yes. Acetominophen is dangerous.

      A side note: I am TheFatLadySings. There is another diarist here who goes by The Fat Lady Sings, but she is not me!

      •  Hello! You are indeed right. (4+ / 0-)

        I will tell you a personal story.

        When I was just little, maybe three, I got into my grandmum's purse and ate her whole supply of Ex-Lax.  I got sick.  They took me to hospital, did a gastric lavage, and I was fine the next day after observation.

        If I had eaten her pillbox of acetaminophen, even with the lavage, I would have died.  They did not have liver transplants in 1960, and they do not have enough donors in 2009.  Fortunately, there was not any OTC acetaminophen in 1960.

        Folks, if you are not organ or tissue donors, resolve to become ones.  In some states, all you have to do is sign the back of your driver's license.  In others, there are web sites to sign up for the program.  If that fail, you can still write a living will, but unfortunately your organs might be dead by the time they get to it.  In any event, tell your loved ones, in particular the one who will make the decisions, that you want every part of you that might help people to live a full, or even a partial, life that you want anything that can be salvaged from your body to go to that end.

        I have already told my family that I do not want a memorial service, but would rather have anything useful taken and given to those who need whatever I can provide.  Perhaps that is selfish, in a perverse way.  But who needs to see a dead body of a reprobate?

        Warmest regards,

        Doc

        "We can not figure out everything, but we can figure out some things." Wow, I just made that up today.

        by Translator on Thu May 28, 2009 at 09:09:33 PM PDT

        [ Parent ]

  •  what a great diary (8+ / 0-)

    and what a valuable subject and i loved that $40 doc! I try so hard to break through with my psy the blind commitment to the psychopharmaceutial model of treatment. She is sold hook, line and sinker. Even when I got down to 37.5 mg of Effexor and .5 of Ativan to deal with MDD, substituting strenuous agility, balance and cardio training along with yoga and feldnerais and meditation, even when I lost the weiht the effexor had put on me and began writing poetry again Still she would not entertain the belief that I could change my brain, could create new neural pathways that would replace the literal holes in my brain caused by years and years of untreated depression and anxiety.

    And the problem? Not enough time. No access to a peer group expeimenting with new models....

    Thank you for sharing this story. I wish you the best in your recovery process. I loved your using your experience and skillsets in your professional life to explain exactly what is missing in our health care system.
    Somebody has to take this bull by the horns and make it right! SOmebody's gotta do it soon! If I have learned anything from these thursday nights it is how many, many of us are out here, so many of us with more knowledge than those we pay to take care of our health.

    They tortured people to get false confessions to fraudulently justify our invading Iraq.

    by boatsie on Thu May 28, 2009 at 08:12:14 PM PDT

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