Category Archives: Health

The Power of…

Me with my favorite Scotch! St. Pat's 2009

As you all know I have migraines.

I also love scotch and wine, artisan cheeses and newly baked bread, Chinese food and pickles.  

I’ve wiped out cheeses, bread and MSG from my diet (and probably a lot of things that I can’t remember because they were easy and I didn’t miss them). Pickles are new for me as a possible trigger so they will need to go.

My diet is so bland at times and the only thing I use as a reward system is scotch and wine. I don’t eat sweets much and I don’t like chocolate.

I need to give up wine.

The problem is that wine does not equal migraine every time which makes it like playing roulette. Actually the same things that happen in the brain of a gambler happens in mine. Inconsistent stimulus is actually more powerful than consistent. Ask anyone who likes to play the slots.

Unfortunately this is keeping me thinking that the wine is not hurting me – but as a friend pointed out this morning it is, and I need to give it up. I also know that he isn’t going to let me off the hook so I need to really let it go.

The scotch is fine in moderation but I’m starting to have problems with moderation. I don’t tend to an addictive personality so this is new to me and I’ve been trying to sort out the “why” behind the behavior.

Last night, at a party, a friend of mine may have stumbled upon a clue as to why I love scotch so much. And it may also help me go back to moderation. Information, after all, is the beginning of change.

My friend at the party connected my love of the smell of scotch with the fact that I don’t tolerate most scents well. Almost everything that I can smell makes me ill from headaches and sneezing, or my ears will itch and my throat will close. But not scotch. I’ve been known to pour a little bit of scotch into a glass and just have it next to me while I read or write because the smell makes me so happy. I don’t even drink it.

When I had a job, scotch was the thing I did to move from the work day into the evening. The ritual of pouring a glass and sipping it while I wandered the house getting ready for whatever I was planning for the evening kept me sane.

In the Fall of 2007 I hired a personal trainer.

Not only did he put me on an amazing physical regiment but he also provided me with some dietary guidelines that my body responded well to. I was allowed one glass – 1.5 ounces – of scotch per day. I became obsessed with the exercise and the eating pattern and allowed myself my one scotch per night.

I don’t think there was a time when I was happier.

There is nothing I want more than to get back to that. It was after that, that the migraines started, as everything fell apart. Migraines make me crave carbs, bad carbs, things like goldfish crackers and bread that also qualify in my book as comfort food. I felt crummy, I ate carbs, the carbs added to my body fat, migraines would sideline me for days or weeks, and I would start the cycle all over again.

But like I said – moderation is a problem for me right now.

I’ve always said that the best thing about living alone is the control you have over your environment. The next best thing is not having someone around to criticize your choices – but that is another story. The answer for now is to not have it in the house just like I don’t have soups with MSG, cheese, or bread.

I also noticed a positive shift in my behavior now that I’ve started focusing on exercise and diet again. I make better choices. One of the interesting things that occurred when I was working with my trainer was my unwillingness to work as hard as I was and blow the benefits by poor food choices.

Last night was an example – when I was training I would have left before I poured myself the second drink or ate anything that I didn’t bring. But it was late and I was having fun so I cheated a little. The farther I get into my training the more I know I will be unwilling to cheat.

This morning started the daily weighting portion of the exercise.

From here on out I weigh every day. Cardio is 4+ times a week either 45 minutes on the elliptical or my ~ 4 mile walk. Weights and Yoga start out as twice a week. I eat every three hours and my diet is high in protein and complex carbohydrates like fruits and vegetables. I will stay away from bread, white rice, and cheese… and alcohol. If you want to make it hard to lose weight… keep drinking.

I have a theory that as my fitness level rises my migraines will become fewer.

I’ll let you know.

~ Tess

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I’m Tired

Allergy Degranulation Process - Wiki Commons

Actually I’m starting to get some place beyond tired these days.

A week ago I would have blamed my insomnia, favorite vice (scotch), or my lifestyle. But this time it isn’t anything I’ve done to myself, its Spring.

My allergies are killing me.

My eyes hurt, which doesn’t help. I think this part is psychological. Our eyes hurt when we are tired, my eyes hurt because of the pollen in the air, so therefore I must be tired.

It isn’t just the tired eyes.

All of me is tired. My nose is raw and my voice scratchy. If I didn’t know better I’d think I had some unusual strain of the common cold. But all I have is allergies. Severe allergies that have decided to get worse each year for the last three years.

Each time I go to the doctor and request help for this they look at me oddly. My main complaint isn’t the sneezing, runny eyes or nose, my main problem is how tired I feel. I can handle the rest, hell that is what my life is always like. Granted usually I only sneeze 10 times rather than 30 but that is merely an issue of degree.  

“Your allergies make you tired?” they invariably ask with just the faintest sound of disbelief in their voice.

Yes they do, and not because I’m a drug whore looking for some medically proscribed speed but because my immune system is having a field day.

Once I was so cranky I almost asked my physician if they remember their immunology. I sure do. But I kept my mouth shut and waited for her to think it through. I’m not sure she ever really got there – it appeared to be a new idea for her.

What I don’t understand is why?

What we call allergies is the equivalent of our immune system crying Wolf! The immune system thinks it is fighting off nasty invaders that must be destroyed before they compromise the system. Or kill all the sheep.

Don’t you get tired when you have a cold? How about how exhausted you feel when you have the flu? The nice thing about those experiences is you are actually sick and your body is doing its job. Unlike my body (and oh, so many of us out there this time of year) who are faced an over-active hyper-imaginative immune system.

Wolf!

My economics are such that I can’t afford to take the next step and find an allergist. The last time I was at an allergist I received the lovely diagnosis of having a low level allergic reaction, i.e. 30% – 40% if you think of 100% as anaphylaxis, to everything. Beyond the peaks – Mint, Bee Stings, Rabbit Fur, Male Mouse Urine etc.

Really not helpful!

So, I’m just going to whine to you all. Take lots of showers, make sure my Hepa filters are in good shape, eat my OTC allergy meds every morning, and think about getting a neti pot.

Oh yes, and wait for Spring to end.

~ Tess

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My Last Vice

Riedel Sommeliers Single Malt Scotch Glass

Sometime last week I realized I was my own worst enemy.

I’ve been suffering from insomnia and migraines but I haven’t stopped drinking. Any idiot knows that those three don’t play well together.

The problem was that until recently I couldn’t see the affect the alcohol was having on the migraines because it was so slight. It bumps an existing migraine about 0.5 on the pain scale. You know that scale. The one the doctor always asks you. “On a scale of 0 to 10 how much pain are you in?” When you are having daily migraines in the 7-9 category the increase in magnitude of a 0.5 just isn’t enough to register.  

My daily migraines are closer to a 1 so now I’m noticing.

It is the insomnia that is the real kicker. Some days a single drink will cause me to wake up every hour or so. But wine and scotch are part of my lifestyle. They are part of how I view myself.

Funny – I’m sure that is similar to how smokers feel.

We have so many hang-ups around drinking in our culture I have a feeling many of you are out there labeling me. Label away. I’ve been referring to myself as the “family alcoholic” for some time now. I’m one of the only ones who drinks.

At least I’ve discovered that I’m not addicted, but I don’t have an addictive personality so that wasn’t a surprise. I can stop and I can limit. I just like to drink. I love the adventure of tasting new wines and visiting old scotches. Only now I need to make the decision about when and when.

It’s all about health.

Health is one of those things that I like to manage myself. Now I know that for me to sleep well and limit that minor bump on the migraine, I have to limit my consumption. Sometimes one drink is too much but often I don’t know until the next day if I’ve caused a negative impact.

Logic says that I should be saying good bye…

The thing is I’ve changed my diet, my exercise program, where I go and who I go out with, all to limit my need for drugs to manage my health. Alcohol is my last food related vice. I never had many but they are all gone. The fried egg sandwiches, nachos, soft drinks, aged cheese, fresh baked bread, and goldfish crackers are all things of the past. There is nothing left to comfort myself with or use as a reward system.

That was what the scotch was for.

Scotch is the ritual that allows me to relax. It was what helped me handle the stress when everything in my life was falling apart. Just the smell of a good island scotch makes me smile. There is enormous power in the wafting scent of peat and seaweed, a strange sort of something that my brain responds to with pleasure.

My scotch brought me happiness when few things in my life did. Often it was less than a glass. Sometimes when I had a migraine I would simply pour enough in so that I could smell it.

I need sleep, but I love my scotch. I wonder if there is any way I can keep my vice and still provide my brain with its much needed downtime?

Moderation in all things I suppose.

We shall see.

~ Tess

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Tired of taking care of myself!

Last year, about this time, I simply got tired of taking care of myself.

I was seeing a Naturopath, an Acupuncturist, a Massage Therapist, a Chiropractor, and a Neurologist in an attempt to get my migraines under control. I wanted to have some level of quality of life. I also wanted to feel like I was “doing” something and not just giving into the migraines.

Those who know me well know that I fight.

So I fought.

Not only was I spending a small fortune on my healthcare providers I was also on drugs, supplements, and vitamins.

I started to wonder what was working and what was window dressing? But I had been in such bad shape and I wanted, so badly, to feel better. At the time I was keeping a migraine journal – the migraines, what I ate, the drugs/supplements/vitamins I took and when, and any exercise I was able to do.

I keep my appointments but I stopped writing in my journal. That was the first sign. I was exhausted. Taking care of myself had become a full time job.  

Then I was laid off – and anyone who has been surviving on unemployment insurance knows that there was no way I was going to continue my healthcare lifestyle on what I was receiving weekly.    

So I had to prioritize.

What was the most bang-for-the-buck and what was really required and what could go away. I don’t want to think about the money I’d been spending. Several of the things I was taking cost upwards of $90 a month. Trust me, I could do the math but it would make me cry.

Now don’t think that anyone was taking advantage of me – they weren’t. I made all the decisions with my eyes open. Granted the decision was to throw everything at the migraines, but that was my decision, and it did help.

It also helped knowing that they cared and wanted to help. I have great doctors!

But now I was facing financial disaster at the same time as I was becoming tired of working so hard just to make it through another day.

My decision was very unscientific. I kept taking everything until the supply ran out. Then if I got worse I put it back in and if I didn’t notice it was gone I left it. As the months went by the migraines ebbed and flowed with no real rhyme or reason. Except, as the months passed, the daily ones became less severe and the sever ones less frequent.

For years one of my doctor’s was of the opinion that my job was killing me.

I think she was right.

The farther I got away from the job, the more I went back to my old habits of scrimping and saving. The more control I had over my life, my time. Going back to working hard only for myself rather than being a tiny cog in the huge mechanism that is business in the US the better I felt.

I still have migraines. But I’m getting better at controlling them through diet and exercise.

I still take drugs and supplements – but I’ve pared them down to the essentials and got lucky. Two of the drugs I’ve been on in the last 12 months have gone generic.

And I wonder…

One of the things that has always bothered me is when I take a drug and it has an unacceptable side effect, so I take another drug for the side effect.

What if the root of my problem was the job, the migraine was the side effect, and the drugs I was taking to control the side effect?

We so rarely look at our lifestyle.

All of our lifestyle.

Just before the migraines hit my exercise program started to fall apart. It was a gradual thing but as my exercise decreased my migraines increased. As long as I had the migraines on a daily basis I couldn’t exercise.

I’m not sure where I’m going with this ramble.

Today I woke up without a migraine. It’s happening more and more often.

I’m grateful for everything my doctors did for me – they kept me sane and productive when my world was falling apart.

I think my doctor who said my job was killing me was right. I’m not really built to work in corporate America.

I’m even more grateful to the recession since it caused my company to have to shrink by 10% – and so glad I was one of the causalities. As brave as I usually am I was terrified to lose the paycheck.

I’m exercising more, my migraines are less, I am productive and I’m content.   

~ Tess

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A Bump in the Road

See, I told you I’d talk about my migraines at some point.

Yesterday was a bump in the road.

I hate bumps but sometimes the road is all bumps for months on end so I shouldn’t complain too loudly about this last one. It was a little bump.

The thing is – I had work to do and it took me three to four times as long to do it plus I had to rely on a friend and the client for a level of feedback I don’t normally need. Stringing words together yesterday was like trying to move a mountain.  

And I didn’t fight through just one day. The day before yesterday was rough and today I’m whipped. You see, a migraine isn’t just a headache.

The headache is simply my version of Stage 3 of a migraine. And Migraine is a very complicated and poorly understood process.

Stage 1, Prodrome, causes me to have trouble concentrating. I feel sluggish and stupid.

Stage 2, Aura, leaves me with language and spatial problems. I have difficulty finding the right word or completing a sentence.

The worst was the day I needed the word ‘faucet’. I could not come up with it to save my life. I was frustrated and angry but it didn’t do any good the word wouldn’t come.

There was also a period of time when things were so bad that I would get lost. I’ve traveled all over the country and have a great sense of direction but I was getting lost in my own city. A city I know so well that I don’t even use a map.

Stage 4, the hangover or postdrom, is my favorite part because I’m exhausted and a little stupid but I know the worst is over.

I once spent ages stuck in Stage 3. Constant headaches and nausea for months on end with no surcease. So the fact that they now end leaves me lighthearted – even if the fun isn’t over because Stage 4 usually lasts a day or so and is directly proportional to the migraine often even if I caught the worst of it with drugs I only escape the pain but not the aftermath.

Like I said – we are not talking about a headache.  

Stages 1 and 2 can happen in a few moments or over a couple of days. Sometimes they hang on like a storm cloud on the horizon. Always threatening thunder but never actually arriving. You want the storm because it clears the air – but you dread it all the same. Those stages drain you and make you feel less than human.

I’ve had migraines all my life, but a year and a half ago something changed. My migraines used to be bolts out of the darkness, more frequent than a Blue Moon but not as frequent as a new one. Then all that changed and they became chronic – nearly untreatable and completely unmanageable.

Because so little is known about them, what they are, what they actually do, and what causes them, people have a difficult time relating.

When my migraines became chronic I told my doctors that I’d rather be diagnosed with cancer. It’s something people understand and we have developed cultural norms about how we deal with it. Migraine is something else – we can’t see it or test for it and worse it’s all in our head – so suffers are often treated as having a psychosomatic problem and not a disease.

Yet migraine is a neurological disease. A disease that causes American businesses over $18 million in lost productivity every year.

Today is better and even though none of the drugs helped yesterday I got through it. Tomorrow is a tossup but I’m getting used to that. I’ve learned to forgive myself the bad days, work through the middling ones, and live to the fullest when I have a good one.

~ Tess

Oh, and I tried to find a picture for this but I couldn’t find anything that approximated my level of pain. Everyone looked too pretty. Where were the dark circles, the bad hair, and the hooded eyes?

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Leave me alone – I want to stay in bed!

The alarm went off with plenty of time for a snooze yet I didn’t want to get up. It is so nice to not hurt! My back, which has been cranky for the last five years, is feeling great. My neck is still having issues – but that is a pillow problem not a mattress problem. I feel great when I get up… I just don’t like getting up.

This is all because after 10 years I finally purchased a new bed. I’ve decided that is my excuse for sleeping in this morning not a lack of discipline. I’ve always loved bed. Not necessarily sleep – I just like lying in bed. When I lay there my mind wanders I come up with ideas and work through problems and issues. For me my bed is a second office.     

Yet – how many of us feel inferior to those souls who need only a few hours a night? The average adult needs between 7 and 9 hours. I’m more of a 9 hour girl myself, yet every once in a while I dream of only needing 4 hours so that I can be more productive during the day.   

But sleep is important!

But I digress – what amazes me most is that after multiple doctor visits about my back I don’t remember anyone telling me I needed to get a new bed. Now they may have – and I may have ignored them. But the bed is magic! And I’m wondering if pressure from the medical profession might have tipped me over into getting one sooner.  

We seem to be in a transition between “here’s a pill” to “let’s look at your lifestyle”.

One of my doctors recommend, and threatened to prescribe, having someone clean my house. I’m allergic to dust mites and mold. I am also allergic to cleaning products. My reliance on drugs and the number of days I felt sub-par because of allergies has decreased. I truly believe that when we are having health issues we need to look at all the factors – and not reach for the medicine cabinet.

Changing behaviors takes effort, taking a pill only means remembering to take the pill.

It’s funny because it is a matter of degree. I once dated a guy who dealt with his allergies and asthma though drugs. His house was filled with dust and mold but no matter what was causing it he found it easier to mask it with drugs then deal with the root cause. Being with him was causing me to go back to using medications to keep me healthy – that didn’t last long. I left preferring my health over his company.

This leads me to wonder about the medical profession.

How many of us are willing to change our behavior if a doctor tells us to? Most of us still feel a reverence for the profession and put a lot of weight in what they tell us. But so much of what I’ve read about healthcare talks about doctor’s unwillingness to look at behavior – often because they don’t believe it will work.

Maybe it is just the people that I hang out with – but I was surprised to learn how many of them responded to their doctor’s request to alter their life style. A couple I know are the most religious of gym goers – three times a week without fail. No whining, no complaints. All because a doctor told them to.

Another friend has altered her diet multiple times as she tries to sort out what might be affecting her migraines. A co-worker, who had multiple serious injuries in the last year, is recovering faster than average because she does the physical therapy prescribed by her therapist at home. Oh, and then there was the couple who one of them was having insomnia and the other discovered he had sleep apnea – the hope is once the sleep apnea is resolved his wife will be getting better sleep.    

Now there are also folks I know who aren’t doing quite so well… but they are at least beginning to understand that they are their own worst enemy. Having chronic insomnia and heading up to play computer games at 11 at night with a two liter bottle of regular Coke is a recipe for another sleepless night. But most of us are taking our health more seriously and understanding that our environment and habits could be responsible.

Now there are plenty of times when I reach for medication – my allergies are only under control with daily drugs but I’ve cut down on the need for Benadryl. I have severe migraines but have successfully moved off of daily meds to Imitrex as needed. My back was fixed by my bed and regular exercise, however my insomnia would be much better if I didn’t drink – but we all need a vice.  

I hope that I always start with the root of them problem and then work out – leaving medications as my last course of action. And think more of us would if we were given the information to make that choice.  

So where do you sit on this spectrum? The pill or the behavior or someplace in-between?

 ~ Tess

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HPV Vaccinations – By the Numbers

I was out a few nights ago and a friend asked me my thoughts on vaccinating her daughters for HPV – Human Papillomavirus. We’ve all seen the ads but what is it? Why is it taking center stage now? And in the grand scheme of sexually transmitted infections (STI) how dangerous is it?  

I didn’t have an opinion – although my gut was telling something so I thought I’d take a look. I’m writing this as I’m doing my research… so I’m taking you on my “thought” journey to look at the data and see what I think. This is how I’m thinking about the numbers – but if you find a different way let me know.

HPV is actually better known as the virus that causes warts – yep those icky things on your hand and feet. There are around 100 HPV strains that have been categorized.

There are about 40 known strains of HPV that infect the genital region. Of these 9 of these are considered high-risk – causing anything from low-grade cervical changes to cancers in women. Low-risk strains (the American Cancer Society lists 2) may cause genital warts, respiratory pappillomas (very rare – and involves the transmission from a mother to a new born) or low-grade changes in the cervix.

So… what about the other 29 strains?

The Centers for Disease Control state that 50% of sexually active adults (men and women) will get HPV at some point in their life.

According to the American Cancer Society “70% of HPV infections appear to go away within a year and 90% within 2 years.” The CDC adds that “in 90% of the cases, the body’s immune system clears the HPV infection naturally.” Most people don’t even know that they’ve had it.

So for a huge number of the infected there is no cause for alarm – our body takes care of itself and off we go.

Forgive me while I do a little math… let’s start with 200 people, 100 men and 100 women. Okay out of each group 50 will get some strain of HPV – whether it is a high-risk or a low-risk strain 90% of them will clear it up in two years. That leaves 1 woman and 1 man left to worry about right (I know – it could be 2 women or 2 men – but this is a thought experiment)?

So what about that 10% – which is a huge number if you’re looking at the total population of the US – what happens to them? Remember they can have either high-risk or low-risk HPV infections.

Now I’m going to limit this to cancer – the other types of problems HPV creates can be dealt with fairly easily – but cancer kills.

To figure out the risk to our 10% I plugged in the American Cancer Society’s estimates of the number of HPV related cancers in 2008 and the US population curtsey of the US Census Bureau and got the table below.

So… this gets a little funky – I made the US Population numbers to equal 10% of the population. So the risk to the 10% is the percent below. Not the risk to the general population.

HPV Related Cancer  Est. Number of cases US Population Est. (2008) the 10% problematic HPV Percent of the problemenat HPV population at risk for Cancer
Cevical                11,070                30,382,464.00 0.03643549%
Vulvar                  3,460                30,382,464.00 0.01138815%
Vaginal etc                  2,210                30,382,464.00 0.00727393%
Penile etc                  1,250                30,382,464.00 0.00411422%
Anal Men                  3,050                30,382,464.00 0.01003869%
Anal Women                  2,020                30,382,464.00 0.00664857%
       
RRP                  2,000                      450,514.29* 0.44393709%
       
Total                25,060                30,382,464.00 0.08248179%

  *estimation of US births in 2008

Our two people – have less than a .08% chance of getting a HPV related cancer to their problematic HPV strain – less if you are male and a little more if you are female. And there isn’t a vaccine for men – so if you are looking at the 30 million remember that the vaccine could only help 15 million of them.

Which means that the Jill on the street has a .008% chance of getting a HPV related cancer and yes genital warts can be an embarrassment but they aren’t cancer. I think most lottery odds are better. On the site Dr. Math it is reported that a person has a 1:80,089,128 chance in matching all 5 numbers plus the power ball if playing Powerball Lotto. I didn’t look at his formula but thought we’d roll with it – it makes my point.

Now let’s play another game because even 15 million problematic HPV infections in women seems a like a lot. But remember there are 40 strains of HPV that infect the genital region – of which 9 are high-risk.  

Gardasil, one of the two vaccinations for HPV on the market, was designed to prevent the following:

  • 2 types of high-risk HPV known to cause cervical cancer that are responsible for 70% of all HPV related cervical cancers.
  • 2 types of low-risk HPV known to cause genital warts that are responsible for 90% of all genital warts.

Cevarix will protect against the same high-risk HPV but not the low-risk.

So, if our young woman gets cancer from HPV – she has a 41% chance of having a cancer that isn’t cervical. She also has a 30% chance, if she has cervical cancer, that it isn’t one of the two strains included in the vaccinations.

These odds become more astronomical by the minute….     

The American Cancer Society in their guidelines state:  

  • girls ages 11 to 12
    The vaccine should be given to girls ages 11 to 12 and as early as age 9.
  • girls ages 13 to 18
    Girls ages 13 to 18 who have not yet started the vaccine series or who have started but have not completed the series should be vaccinated.
  • young women ages 19 to 26
    Some authorities recommend vaccination of women ages 19 to 26, but the American Cancer Society experts believed that there was not enough evidence of benefit to recommend vaccinating all women in this age group. We do recommend that women ages 19 to 26 talk to their doctors or nurses about whether to get the vaccine based on their risk of previous HPV exposure and potential benefit from the vaccine.

I’m not against vaccinations – I think they are great! In fact just got a booster shot at the doctor the other day for tetanus. No Small Pox almost no Polio – these were great things that saved lives and dealt with viruses that were killing us. But we are being asked to “protect our girls” from an almost nonexistent cancer. A cancer that appears in a sliver of the population and the biggest risk is from cervical cancer which currently has a survival rate of 92% with early detection and 71% for detection at all stages.

Yes – HPV is very infectious but statistically it’s not killer.

So why? Why the huge ad campaign? Why make us feel that something is terribly wrong when the number don’t really support it?

Viruses evolve with their hosts – that said HPV has been around for a very long time – infecting us for millions of years.

The odds are that it will continue to be an occasional problem and general nuisance. A lot of viruses are in a push-me-pull-you state with their hosts. They come. They go. And Leave immunity in their wake.

Which makes me wonder if there is any indication of reinfection with HPV? You know like the common cold – you get it and then get it again and we never seem to get much better at fighting it. But the raw data – just the numbers that we’ve looked at suggest that infection happens – is cleared – and then you have your own immunity. 

Is it the right thing to do? Why are so many women talking about this and wondering what they should do? Well… remember the ads?

Let’s look at the issue another way.  

If we become convinced, as a society, that the guidelines should be adhered to there are an estimated 4.5 million children born every year in the US. Imagine half of them are girls…2.25 million. That means that if we go by the America Cancer Society guidelines and vaccinate every young woman, right now, between the ages of 11 and 18 that is an estimated18 million young women.

Gardasil goes for $120 a dose and three doses are required for immunity so that is $360 per woman.

18 million young women multiplied by $360 per treatment is $6.5 billion…with an additional $900 million possible every year thereafter.

If they succeed in making us believe… what? That we are doing a disservice to our young women not to vaccinate them – this may be a “nice to have” but I just can’t classify it as a “need to have”.  

Oh, and on the American Cancer Society website they have a section that interests me in their FAQs. “Did the American Cancer Society play a role in the development of the HPV vaccines?”

The answer… Yes. One of the four teams received funding from the ACS in the mid 1990s – the grant could be anything from a little to a lot…  

And you wonder why you’ve seen all the ads. I don’t. This is economics driving healthcare – and I have to admit I’m rather sad about it.

But there is a flip side… I was talking to another friend who has decided to immunize her daughter. She did it because she and another mother she knows had been one of the 10% – the ones with some sort of problem with their vaginal wall cells caused by HPV. The treatment was painful and my friend felt that since her insurance was paying for it she would rather not take the risk of there being a genetic predisposition.

Another woman said that she would have done it – her daughters are older now – just because it was one less thing to worry about.

Yet another said that since there are very few “wins” when preventing cancers of any kind that it was just nice to know you were doing something.

So where are we?

A drug company is going to make billions off our sense of responsibility? This will be a choice each of us will have to make. The risks are low yet it seems this is a bizarrely difficult decision to make.

What about you?  

 ~ Tess

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Simplification Gone Wrong!

I just got back from my yearly physical – mostly blood work – and had the same conversation with the gal at the front desk that I had a few weeks ago at my Neurologists.

I have a new insurance card – it doesn’t show the co-pays.

Some bright boy at my insurance company decided that they would save money by printing up cards that didn’t have the co-pays – because co-pays change – and by doing this they are saving me money. I even got a nice letter with my new card telling what a benifit this would be to me. Now I have Providence insurance, I go to a Providence clinic where everyone is directly employed by… you guessed it Providence. So… how is this saving money?

Think about this for a moment.

  1. The front desk staff must spend time looking up co-pays if they are unknown or the patient doesn’t know.
  2. If staff or patient gets it wrong – think of all the lovely mail that will be generated not billing you until you finally get a bill.

So is this better?

I don’t think so. I think that one department had a Six Sigma moment – they had a directive to simplify and cut costs. I’m sure those cards are expensive when you take all of them into account – but in simplifying one part of the business they’ve increased costs in another.

How often do we get new cards anyway?  

I was getting them once a year – for each reenrollment – and surprise surprise in the three years I’ve been on Providence the co-pay has never changed. New cards are being generated all the time as people change jobs, employers switch providers, individuals change healthcare options, have children, get married, are divorced… there is a constant flux of reasons why this happens – so why not just update the cards when it’s needed? There’s a thought… I would have the same card I had three years ago.  

A decision in a vacuum is never a good decision.

Too often we take a microcosm and think that it is a macrocosm. The card printing department made a decision that affected so many more people. None of us operate in a closed system – what we do, how we run our businesses and our lives impacts the world around us.

I’ve watched – twice now – as millions of dollars and thousands of man hours have been poured into software development that it turned out no one wanted. No one talked to the end user. In this case – the end user is not me. The end user is the person behind the counter who is charging me my co-pay. Did anyone ask them if they felt this was a good idea? That it would save them time and money? I doubt it.

I’ll get off my soapbox now – but let me know if you’ve seen the same thing. The “bright” idea that cost more than it saved or the project in a black box that failed to deliver.

~ Tess

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Washing hands – the myth of a clean world

So I tend to go against the grain anyway, but our current obsession with hand washing and the wonders of antibacterial soap – sorry… it is now antimicrobial soap is driving me just a little up the wall.

The climb became faster after suffering from an antibiotic resistant sore throat.

See – the problem here is that we are self selecting for better, stronger, and more infectious bugs. The faster something can reproduce the faster it can respond to environmental factors and boy are we giving them a lot to respond to. 

Back when I took Microbiology my lab consisted of taking a petri dish and rubbing my hand on it – taking all of the microorganisms from my hand and giving them a lovely nutritious place to live. After several days I came back to something that looked like this:

Petri Dish

From there we then picked one or two colonies – the round spots on the dish – and grew them. Then we had the enviable task of figuring out what they were. We did this by growing them in different petri dishes with different types of food and with antibiotics.

That was really the thing – and the point. Some of the microbes that grew on my hand were susceptible to antibiotics and some were not. And some were in the process of developing immunity – they often had smaller colonies on the antibiotic dish than on the one with just good food.

If I want to get really technical I could tell you all about how antibiotic immunity can be transmitted between bacteria – kind of like sex but not quite – it’s called conjugation.  That should worry you because only one bacteria has to develop the immunity and then it can not only create copies of itself (bacteria reproduce by binary fission – one cell divides into two cells). But it can pass the immunity to their friends and family.

Oh, and a bacterial colony can double in size every 10 minutes. They also have a genome with a high base line mutation rate – they can afford to and need to. Individuals are expendable and their environment enormously changeable.     

The thing is that all of these things were on my hand so… what happened in the petri dish happens on my hands.

First off – there is a huge difference between washing your hands and washing your hands. We are going to assume, for the sake of this mental experiment, that this hand washing involves one of those antibacterial gels – because they are one of the problems. When you wash your hands with soap and water – you kill everything and then you wash it all off. When you use an antibacterial product it doesn’t get washed off – instead it hangs on providing regions in which resistant colonies can develop.

If I was obsessive about using antibacterial gel hand sanitizer that means that I could be selecting for resistant bacteria and after a single work day (say 10 hours – to make the math easy) I could be washing my hands every 20 minutes – 3x an hour so 30 times in the day.  But the stuff I was trying to get rid of was multiplying by 6x an hour so 60 times a day. Each time I used my antibacterial gel I would kill some but not all of the bacteria on my hands. Each time I would be selecting for those bacteria that could live in the new conditions.

Just like I did with my petri dishes.

Now I’m not saying that we are going to develop a ‘superbug’ this way – but it just seems to me to be a bad trend. We know that decades of giving antibiotics to anyone and everyone created some hellish strains of resistant bacteria. Right now infections in hospitals are up – not ones you come in with but the ones you get once you are there. It seems to me such a simple thing to avoid.    

Oh, and by the way… the Centers for Disease Control has written about this as has Scientific American and WebMd.

No one is saying that you shouldn’t wash your hands – but triclosan hand sanitizers antimicrobial soaps are over kill with some unpleasant side effects. There is indication that triclosan finds its way into human breast milk and has other effects – I haven’t yet tracked down the original articles (the ones published in scientific journals) so if you want to read more see the article below. 

Triclosan Article

So why take the risk… besides you aren’t only using this stuff on your body, it is getting onto other surfaces, into our bodies, and being washed into the water system (that is a post for another time).

But now your thinking H1N1 – well sorry to burst your bubble but H1N1 is a RNA virus that ‘buds’ from the cell taking the components of the cell wall with it. Cell walls are almost entirely made up of a lipid bi-layer – which is not the strongest thing in the world and can destroyed by drying out. H1N1 is being passed by fluid contact – the virus is suspended in droplets – like those you produce when you cough or sneeze and the microscopic ones you create when you talk.

So the odds against being infected by hand to hand contact is astronomical. Besides the best way to destroy a lipid bi-layer is plain old fashioned soap and water.

So the next time you see that hand sanitizer sitting there – give a thought to my petri dishes and all the things we didn’t know about the overuse of antibiotics fifty years ago. Maybe you’ll make a different decision. 

~ Tess

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Healthcare?

I was thinking about the migraine that’s been sitting behind my left eye all day. It made me remember last year when I had a migraine that lasted 31 days (yes DAYS not hours).

That made me think about Healthcare.

You see, I’d never really thought about healthcare until I needed to get help for my migraines. Real help! The kind where you know that you can’t keep going if you don’t get some assistance. Nothing I was trying was working and I needed a specialist. Plus I was concerned that if I didn’t get better I would lose my job.

I did get better – then I got laid off. It could have been worse.

But while I was suffering through the maze of healthcare and HR I realized that it was the most inefficient system I had ever seen in my life. My friends and former co-workers know that I don’t do well with convoluted systems – and from what I can tell my experiences were mild compared to most – but the system is broken. But fixing it… that is all about change and as much as we may rail about the system, it is our system, we are used to it, and on some level it works.

I don’t think the Healthcare debate is really about Healthcare. I think it is about change – and it is rare for people to embrace change. We may also have used up our ability to handle change after voting in President Obama. That was change on a grand scale – and it took unprecedented visionary leadership – and guts. Guts for all of us to believe that change was possible.

We are the only industrialized nation without universal healthcare. You can read all the stats on who’s covered, who isn’t, all the horror stories of healthcare gone wrong, all the stories of waste and malfeasance. But none of those are going to make you change your mind… because for a lot of us, what we have works for us and we are afraid that by moving to a different system we will have less.

Fear is what keeps us here. Fear of change.

Isn’t the first thing you do when your company changes healthcare providers is check to see if your doctors are on the list? Or when you change jobs? Who wants to change? To walk into the unknown? Even though change is usually… what?

When something changes… how often is the change bad, good, or just more of the same? And the corollary – where do we have to be before we actively pursue change?

I like that… where do we have to be before we actively pursue change?

If it is our health – is it the X year class reunion, when your doctor says you are going to die of a heart attack in 2 years if you don’t, a major milestone of a birthday, or something else. What tips you into changing your behaviors?

If it is the Presidency – did we really have to go into freefall before the country woke up and said “No More!”

If it is your Healthcare – how bad would it have to get or how good would the option have to be to get you to change? And are you looking at this from a personal standpoint or from what is right for the Nation as a whole?

I could quote you more statistics here but as Benjamin Disraeli said, “There are lies, damn lies, and statistics.” Although 1+1=2 in stats numbers are a lot like words, and words can say whatever you want them too.  

The question is what do you want? If we could find the top three things that defined a vision of Healthcare that spoke to everyone – could we then change? Right now we are bandaging the scrape on the knee when the leg is broken. This is a fix. What we need is a reimagining of the whole system. Something that I’m not sure we are capable of.

Our Founding Fathers did a great job making sure that any changes of a momentous nature to our country were slow. The system, with all its checks and balances and division of powers, is meant to make sure that all aspects of a problem are weighed. I don’t think they ever imagined how huge and convoluted our government would become. All systems do this – they build complexity until they drown in it.

No one can wave a magic wand and make this work and without a clear vision we don’t know where we are going – and that scares us.

It took me two months of daily migraines to get a referral to the Neurologist that finally helped me. Would I have gotten in to see him sooner if the system changed or would I have been left waiting for months? Migraines are rarely life threatening so I’m not so sure where I would be on the importance scale.

The thing is – I’m ready to face the change, even if it causes inconvenience for me in the short term because I believe it is where we have to go. We need everyone to have access to Healthcare – everyone to have access to preventive care – well baby checkup – screenings for breast cancer/colon cancer/diabetes/heart disease – whatever you are at risk for. Then we can catch things early – save money on late stage care – and start providing preventive rather than reactionary care. Wouldn’t it be nice if the Healthcare system was about keeping you healthy rather than just fixing you when you’re broken?    

So yes, I want change. It won’t be easy, it won’t be pain free. Hell, we may go backwards before we go forwards – but where we are will just collapse in on itself costing us more and providing us less.  

 ~ Tess

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