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The Time I Wrote About Electronic Health Records

April 14, 2013 1 comment

So, I don’t usually tackle serious topics on this blog, unless you consider severe anal trauma to be a subject of national importance. But I’m going to go ahead and break my informal rule.

Full disclaimer: I work in the field of electronic health records (EHR, also known as electronic medical records, or EMR). I’m not a vendor, and I’m not a provider, but rather I work at a nonprofit advocacy group for the modernization of American healthcare.

The USA is behind in so many ways. Most of our citizens’ health records are still on paper that must be schlepped from office to office, from hospital to hospital. Perhaps if you don’t have a chronic health issue, you don’t realize the inconvenience and incompetence this systems fosters. Imagine having cancer and having to carry a stack of files taller than 15 iPads stacked on top of each other to every specialist you see. Picture having to trust your medical records to a family member because you are too ill to take care of them. Wonder how a doctor will ever be able to read the horrible handwriting on a an old, yellowed piece of paper from 1992 that nonetheless may hold the key to diagnosing your condition.

Paper health records slow down a process that is already painful enough on its own. If you are admitted to an ER after a horrible car crash, how will the doctors and nurses on staff know about your allergies or past medical conditions? Yes, you could carry a flash drive or something on you at all times, but who’s to say it didn’t get crushed in the crash? What if the nurse on duty doesn’t have access to a computer that can view your files? In short, the system is FUCKED.

But this is not only a problem for John and Jane America. As Jon Stewart has recently brought up on The Daily Show it affects our veterans as well.

The Red Tape Diaries – Veteran Benefits

The Red Tape Diaries – A Modernized Department of Veterans Affairs

(I would embed these videos, but that feature apparently doesn’t work on WordPress. Lovely.)

Watch those two videos (er, assuming you have an American IP address, and try this app if you don’t), and tell me that those veterans don’t deserve better. That they should somehow be expected to wait over a year to hear a decision regarding their benefits. Benefits they never would have been eligible for had they not been wounded serving our country. To have recently returned soldiers grappling with their physical and psychological trauma with NO assistance from the government or anyone else is criminal.

The barriers to implementation are two-fold. One is the resistance of the old guard to change their ways. Though this sector is rapidly decreasing, it is still there, and it is full of providers who performed their jobs just fine on paper since the 1960s, and see no reason to change to a newfangled electronic system now. Why fix what ain’t broke? The second is the sheer cost of purchasing and using an electronic health record system. Imagine a room full to the brim with paper records. As Stewart pointed out, the weight of them can be enough to collapse through floors. Now think about the work and time required to transfer all of those to an electronic system. Is it impossible? No. But for many smaller practices, at least, the prospect of closing a practice for a week or more to perform the switch is simply unthinkable. The lost revenue alone makes it a nearly impossible scenario. Then of course there is the cost of the EHR system itself (not cheap), and the training needed for staff to actually use the new technology. There are government incentives available to qualified small practices to help subsidize this huge cost, but for doctors close to retirement, the benefits simply do not outweigh the investment.

However, for Veterans Affairs? What is their excuse? They are not a single doctor practice. They are not even an urban hospital. They are responsible for ALL US MILITARY SOLDIERS. The thought of them spending money on a new hand-crank filing system rather than investing in EHRs is laughable. They have the means, they simply seem to lack the will.

Though of course, even once you have an EHR system, there is still the difficulty of having each system talk to each other. That is what the first Daily Show clip addressed. Two systems, though electronic, cannot speak to each other unless the same vendor supplied both. This is one of the things my organization is currently working on – how to get all these disparate systems to talk to each other so that information simply FLOWS instead of becoming bogged down in red tape and misery.

Yes, there are many complexities associated with EHRs. What of privacy issues? What of security? What about the records of minors? But we have to face it – the future is coming, whether doctors, patients, or government bureaucrats want it or not. And to spend resources fighting against it rather than working to ensure its success dooms not only our generation, but the next to the medical inadequacies of our forefathers.

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The Time I Fainted Regularly

March 31, 2013 1 comment

So right around puberty, my body decided it could go fuck itself.

I mean, not literally. Well, maybe a little bit literally. But more like my body thought that betrayal of itself was the order of the day.

The first time it happened, I was in the kitchen getting some breakfast around 6:30 am before school. Suddenly, while in mid-sentence, I keeled over and thwaked my head against a counter before slumping to the floor unconscious. I had no memory of what had happened, but came to with my parents’ concerned faces floating above me, and a goose egg slowly forming on the back of my skull. After testing that I had my full wits about me, I was sent to go catch the school bus with little fanfare. My head ached the rest of the day, but I otherwise felt fine.

This scenario would replay itself several more times over the next few months, finally culminating in a fainting session where I stopped breathing and my mom had to call 911. By the time the paramedics arrived, I was conscious and talking, but couldn’t stand up without immediately passing out again. But I refused to go into the ambulance, and simply sat on the floor slowly eating cereal until I could get myself onto the couch.

We never really figured out what the problem was, but it seemed to be related to blood sugar. I started swallowing spoonfuls of sugar whenever I started feeling a bit out of it, which usually preceded a fainting spell. I began carrying hard candies around with me always, for a quick sugar boost on the go. To this day, I know I need some candy or soda if I start getting the “sweats and shakes,” as I call it.

It’s bizarre, but luckily the days of collapsing like a felled tree seem to be behind me.

The Time I Got Pins Pulled From My Foot

October 19, 2012 1 comment

Sorry I’ve been neglecting this blog so much. Work has been insane, and has only recently finally calmed down.

Anyway, this morning was pretty traumatic.

Remember when I had pins in my feet? Well today, they were finally yanked from my right foot. And since I was awake for the whole procedure, I can give you the blow-by-blow.

I was called into a small room where my blood pressure was taken, and I talked with the anesthesiologist. However, my plan was to do this all under local anesthesia only since I don’t much like being put under. This would prove to not be the best idea.

I was then led into a freezing cold room where a curtain went up between me and my foot, and a nurse bathed my foot liberally in betadine. Hence the yellow color in the photo above. I tried to sneak a peek at what was going on, but was told doing so would “compromise the sterile site.” Really? Because the air conditioner was blasting air all over the room, and the door to the hallway was open for the entire procedure. Plus the curtain was only maybe two feet across, so it wasn’t much of a barrier.

Anyway, the doctor came in and poured some freezing cold liquid on the injection site, which was incredibly uncomfortable. It wasn’t liquid nitrogen (I can’t remember what it was called for the life of me), but it felt like the entire top of my foot had been dunked in ice water. Then it was time for the numbing injection, which hurt like a BITCH. Three CCs of something were pushed into my foot, and I was told to “relax.” Yeah, not happening. Only the site where he would be cutting was numbed, with the rest of my foot left alone.

After waiting 10 minutes or so, it was time for the cutting to begin. Though I could only feel pressure or minor pinching, it was still psychologically scarring to realize what was going on down towards my toes. The doctor made a 3/4″ cut directly on top of my original surgery scar, then went to TOWN with a chisel. Well, maybe the tool looked different, but I couldn’t see it, so I’ll just describe the sounds and sensations.

He chipped away at my bone with large amounts of pressure. The bone had grown over top both of the pins, so freeing each one was not an easy task. He would position himself, then just start scraping away for several seconds, my bones grinding the entire time. He would then pause, reposition, and repeat. I’m honestly not sure how long this lasted, and though it felt like 15 minutes of pure torture, I imagine it was actually shorter than that. Though there wasn’t really any pain, it was still incredibly upsetting to imagine what was going on down there, and I felt close to fainting for almost the entire procedure. Hence, if you ever get this done yourself, you might want to opt for the IV sedation. Most people who get this done get the sedation, and according to the doctor, it takes a “tough sort” to opt for local. I certainly didn’t feel tough. I was almost in tears by the end.

Finally, he pronounced that both pins had been removed, and he stitched up my skin, which felt like I was being bitten by fire ants. Two bandages were applied, my foot was wrapped up, I was x-rayed, had my blood pressure taken again, and was sent on my way. I wore my usual sneakers out, and was told to take a cab home so that I didn’t put too much pressure on my recently battered bone.

Now I’m home, and though the pin site is still numb, I can tell that it’s swelling, and I feel a vague burning sensation. However, I can walk decently, so at least there’s that. I have to keep the stitches dry for 10 days (which means no bathing my foot AGAIN), and will get them out the day before Halloween. And then I’ll get the pin taken out of my left foot. Maybe I’ll opt for some happy-time drugs in the future? Or I’ll at least bring headphones, since the bone scraping sounds were the worst part of all.

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The Time I Had Pins in my Feet

September 26, 2012 4 comments

So when I feel the tops of my feet, I have…well…horns, essentially.

These are the pins sticking out of my healing bones. After my bones were broken during bunion surgery, they were realigned and stabilized with scary-looking metal hooks. And so they’ve stayed since June, just waiting to poke up their sharp little curvy heads.

As the swelling in my feet go down, the pins are becoming more and more prominent, and are now sticking up and bruising my skin. My scar can’t fully heal while the pins are pushing on it from the inside, so they’ve got to go. I had an appointment with my surgeon yesterday to discuss the procedure, which turns out to be a bit more involved than I had anticipated.

Basically, the doctor will make a small incision over the pin, perhaps a centimeter wide, then yank on the exposed metal with pliers for all he’s worth. If he’s lucky, the pin will come out smoothly and relatively painlessly. If he’s not so lucky, the bone will have grown up over the head of the pin, and he’ll have to chip away at it until he can pull the pin free. If he’s really unlucky, the pin will have bent at some point while it was embedded in my bone, and it will be nearly impossible to remove without doing some painful damage. Then the incision will be stitched up, and I’ll have to keep my foot dry (AGAIN) for another ten days. Torture.

The doctor said this could (hopefully) all be performed under local anesthesia, though my mom, who has had pins removed from bones before, warned that it would still be plenty painful. Though injected anesthetic can numb skin and muscle, it apparently has no effect on bone, which is just bristling with nerve endings. When my mom had pins pulled from a broken finger, she said the pain was some of the worst she had ever experienced, and this is a woman who has had natural childbirth at home more than once. So…that’s daunting.

And so the nurses told me to be prepared to be put under IV sedation. Though the pin removal will be first attempted under local anesthetic, if I start freaking out, I’ll apparently be put down like an unruly circus animal. I’m really, really trying to avoid that outcome since it involves being escorted home on a Friday morning, which is a tough sell since all my friends/family work for a living.

So here’s hoping I won’t pussy out, and the whole thing will take five minutes TOPS. Or else I’ll scream and be injected with powerful drugs. Oh yeah, no pressure at all.

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The Time I Had (Kind of) Normal Feet

August 31, 2012 2 comments

So the bunion journey has been long and shitty. In short, lots of pain, broken bones, canes, and dirty feet. But I realized that the last photo I had posted of my foot was a few weeks ago, and it was disgusting and wrinkly. Like a jaundiced raisin.

So I wanted to post to prove that yes, skin and bone do heal.

BEFORE:

AFTER:

Would I do it all again? At this point, I think it’s too early to tell. I can walk better than a few weeks ago, but can’t run or jump, and am in more pain than I was before the surgeries. But hopefully, once everything is healed, I’ll be glad I went through it all.

Also, I’m attending physical therapy twice a week, and it SUCKS ASS. Painful to the point of tears, it’s a miserable experience that takes 90 minutes or so each time. There’s heat, ice on bare skin, massages that are the opposite relaxing, and lots of balancing exercises that involve me picking up towels with my toes. Fun stuff. But I think it’s helping, despite the pain.

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The Time My Fish Lost His Tail

August 29, 2012 2 comments
Ichigo’s (semi) new digs. Note the HALF A TAIL (he’s hanging out by the new filter sponge).

 
So I came back to work after the weekend, and Ichigo had only half of his tail.

I flipped out and figured he had fin rot, and started reading up on the condition. I had some Bettafix medicine, but that was it, and apparently most people who keep Bettas don’t even LIKE Bettafix. Sigh.

But the more I look at Ichigo, the more I think it was a mechanical, rather than bacterial, laceration of his tail. Maybe he got it caught in the filter uptake and it got shredded? Maybe his ceramic barrels cut him up badly? Maybe he just freaked out and chewed off his own tail? Or maybe he blew out his fins by flaring so much at his own reflection?

Whatever the reason, I immediately took everything out of the tank except for his little leaf hammock and the gravel. The live plants were looking a bit worse for wear considering they were only a week old (brown leaves, brown spots, etc.), so I chucked them and got silk plants. His barrel toy turned out to be a razor-infested death trap, and though I’ve filed down the rough patches, I’m too scared to put it back in.

After a few days floating in aquarium salt and Bettafix, Ichigo looks much the same, though at least he hasn’t lost more tail. He’s eating well and swimming around as much as ever, so hopefully he’ll pull through.

But I bought him all kinds of new goodies, including a new log toy (much smoother than the barrels) and a pre-filter sponge to protect Ichigo’s little fins. I also did a full water change, though the picture makes it look cloudy. Sigh.

I think I need to make a baffle for the filter, though. It seems to be pushing him around now when it didn’t before. Or maybe I just didn’t notice?

I have spent more on this fish than I am comfortable admitting.

The Time My Foot Decided to Go Rogue

August 10, 2012 3 comments

The healing on my left foot is much different than it was for my right one.

For the first foot, it was always an upward trajectory with each day being a little better than the day before. Now, with the second foot, it’s a total crap shoot. Some days I feel okay, other days the pain is unbelievable. Some days the pain is quite manageable, and others my foot throbs and burns with every heartbeat. I never know what it’s going to be like until I wake up in the morning and put weight on it. It’s a brutal reminder that, yes, my bone is indeed broken, and I should quit trying to hop around town on it. But I’ve been almost entirely housebound for the past three weekends, and I’m getting very antsy.

The doctors don’t really know why I’m having such a hard time with the left foot, but suppose that it might just be because my right foot is still not at 100%. There’s a lot of pressure involved in walking, and there’s no super stable bone for it to travel through. Sigh.

So yeah, on again off again pain, and I was told to stop taking Percocet and switch to Aleve instead (which does nothing). I’m supposed to get the boot off on Tuesday, though I’m worried about walking in a regular shoe, given the shooting nerve zaps I get even in the surgical shoe.

Below are pictures from my bandage change earlier this week (2 weeks post-op), and my before and after x-rays. Only one pin instead of two in the left foot, for some reason. I wonder if that could be causing any extra twisting, which would result in more pain? No idea.

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