Support Hose

     Do you have sore or tired legs? Recently had a surgical procedure on your legs?
     Then compression hose are for you!
     They come in full or knee-length, different sizes according to your height, and either dress, athletic, or casual styles.
     There's only one problem: getting them on!
     I recently had a minor surgical procedure done above one knee. Since companies don't make support hose for single legs, Laurie, the doctor's assistant, asked what my height was. After I told her, she returned with a pair of skin-toned compression stockings and some thin rubber gloves.
     "These should fit," she said, "They're casual, and not too thick. Please wear them for two days, but take them off at night." She had a smirk on her face.
     The stockings looked like Pantyhose, with the standard construction of a strong elastic band at the waist and nylon covering the hips and buttocks thicker than the leg portion. If these were the thinnest variety, I pictured the thicker ones resembling an alligator's skin. "What are the gloves for?" I asked.
     "You'll see. First, sit down on the examining table so I can help." She handed me the gloves to put on, put another pair on herself, and sat on a low stool at my feet.
     "Many patients think this is just like putting on Pantyhose. It's not. The first thing you do is scrunch up the hose in your hands all the way down to the ankle. That way you can put your foot in without getting it caught."
     She handed me one scrunched-up leg. The flesh-colored nylon that filled my entire hand was at least three times the thickness of a Pantyhose. I slipped it over my foot.  So far, so good!
     "OK, now pull the hose up about six inches. It's much thicker than Pantyhose, so don't expect it to go farther than that. You'll have to straighten it every few inches. The gloves will let you get a firm grip." From the floor she helped the hose go north of my ankle. "You try the rest of the leg."
     The opening for my upper thigh was about the size of my fist. "Are you serious? I have to put that over my thigh? I feel like an elephant trying to get into a pail."
     "Keep working every few inches."
     At first I pulled so hard I thought the stuff was going to rip. Then I jumped down from the table and twisted. I squirmed. I thrashed. I got the damned nylon up to the middle of my thigh but by then sweat was dripping into my eyes so I couldn't see. Laurie was trying to stifle her laughter. She handed me some paper towels.
     "It is pretty funny," I said, sitting back down on the examining table. "I felt a twinge in my abdomen. Maybe I pulled a muscle there I didn't know I had!" The stocking was binding my thigh like a lasso pulled tight. "Maybe I've got some blog material here." I began to laugh with her.
     "Now the other leg," Laurie said. She left me on my own for that one.
     "Can I try it without the glove?" I asked, thinking I'd get a better grip with my very sweaty hands. It felt as if my first leg had a tourniquet around it. I began to feel pins and needles creeping along the seam and looked down to make sure the leg wasn't turning purple.
     "Sure, go ahead," she said.
     I removed the gloves and held them upside down. They dripped moisture as though I'd used them in a tennis match. I scrunched up the other leg all the way down and tried to put the wad over my foot. My hands slipped and my foot got caught half-way up the wad. So much for bare hands! I put the gloves back on, got my second foot in, and jumped down from the table.
     At mid-thigh level on the second leg, I felt as if I'd played three sets of hard tennis. "There's no way the rest of me is going into this opening," I said to Laurie, holding open the elastic that was supposed to go around my waist.
     She just kept grinning from the floor. "Just a few inches at a time," she said.
     My hips weren't the problem. It was my butt. I've never had a small butt, even when I was twelve years old. It's a wonder I was able to get off the ground during all the years I was a cheerleader! You would think the exercises I've done for years at the fitness center and all the tennis I play would have made it smaller.
     I began to do the twist, pulling the nylon over my butt first on the right side, then on the left. Laurie clapped from the floor. Next I pulled up the waistband and jumped up and down. Too bad I couldn't get a few jumping jacks in, but I'd had enough exercise for one day. "Just a few more inches," she said. "Maybe your husband can help you tomorrow."
     That sent me flopping back on the table in hysterics as I pictured Charley stuffing me into a sausage casing from the floor. "Are you sure I can't leave them on tonight?" I asked.
     "Trust me. You won't want to!"
   
   

   
   

A Doctor's Office in Florida

     One November a doctor (not my primary-care) ordered an ultrasound - a simple outpatient procedure at the hospital which lasts approximately twenty to thirty minutes.  I wasn't scheduled to have the test until the following April, and in-between I lost the prescription I needed to take with me.

     I called the doctor's office two days before the scheduled date to request another written prescription. "Please leave your name, number, and a brief message and the nurse will return your call," the answering machine told me.  I did as I was told.  No return call that day.

     I called back the next day to make the same request. Again I heard, "Please leave your name, number, and a brief message and the nurse will return your call."  I explained what I needed and described the urgency for the ultrasound test the next day.  If the doctor couldn't fax me the paper, I was prepared to go pick it up.  No return call that day.

     Since my hospital appointment wasn't scheduled until the afternoon, I jumped in the car the day of the test and headed to the doctor's office in the morning. I signed in and knocked on the closed window. A sign on the glass read, "Please do no knock on the glass."

     "Yes?" the receptionist said.

     "I don't have an appointment but have left messages for two days that I have an ultrasound scheduled this afternoon and have lost my script.  I haven't heard a word."

     "Your name?  (I answered.)  Take a seat, please."  The glass window slid closed and I found an empty chair.

     "I don't know why anyone comes here, but their reputation is so good," the patient sitting next to me said, her long braid following her as she shook her head back and forth.  "There are too many doctors in here.  I had a reaction to a medication and I called this morning, but the doctor's gone on vacation. So now I'm supposed to see another one, but I've got to get back to work in an hour.  They told me on the phone there would be no problem.  I've already waited thirty minutes."  Her mouth turned down as she got up to approach the glass fortification at the window.

     Just then we heard pounding from the outside hall against the waiting room door.  "Let us in!" someone shouted.

     "We're stuck out here and can't get in," another voice yelled.  The pounding continued.

     The patient closest to the door rose to help.  His helpful willingness camouflaged his sallow complexion and sagging Bermuda shorts.  He fiddled with the door knob but couldn't disengage the lock.  The next patient in the row jumped up. "Let me see what I can do, old-timer," he said. When the lock disengaged, a torrent of patients poured in and lined up behind the closed glass doors.

     The woman with the time issue stood at the front of the line.  "Excuse me," she said, knocking on the glass till it shivered in its tracks.  "I'm sorry to cut in," she said to the person signing in, "but I have to get back to work."

     The glass slid open.  "Mrs. Carey?" I heard.

     "Yes," I said, out of my seat like a kid's jack-in-the-box.

     "Here's another copy of your script," the receptionist said, handing me the paper and swiveling an evil eye toward the woman who'd knocked.

     "Thanks," I said, spinning in place for a quick retreat.

     "You're next," the receptionist said to the irritated patient who'd spoiled her day. "Please enter the door to the left. The rest of you, please sign in," she said, slamming the glass shut.

     When I got home, I found the original script buried in my calendar.

     On my follow-up visit, I bit the bullet.  "I've been coming here a long time," I said to the doctor. "May I have a private conversation with you?"  I proceeded to explain the situations that had arisen in one day's visit.

     "If you don't tell us the issues, we'll never know," the doctor said.  "Would you be willing to explain all this to our office manager?"  He led me down the hall.

     The day before I visited that doctor the following year, I got a personalized message on my answering machine confirming my appointment.  When I arrived, the glass doors above the sign-in sheet stood open. Inside the office, one staff member was answering the phone, another writing receipts and scripts for patients exiting. "Good afternoon, Mrs. Carey," the receptionist said with a smile.  "The doctor will be seeing you in about ten minutes. Meanwhile, please sign in and let me know if there's anything I can do for you."

   

   

   

The Physician's "Squeeze"

As a person outside the medical community, I want to mention a couple of scenarios I've read about that are emerging in this country affecting physicians.  Much of this information is based on a report by Dr. Sandeep Jauhar (author of Intern: A Doctor's Initiation, 2009) in SaturdayEveningPost.com (Jan.-Feb.'15, pgs. 34-38, 78).

Let's start with where the U.S. ranks in life expectancy among developed nations - #45 - according to a report by The Commonwealth Fund, a healthcare research group.

If you live in Miami, Medicare will spend $8414/person/year versus $3341/person/year in Minneapolis. Why?  A large supply of doctors in Miami means more per capita utilization of services and testing, hospitalizations, and intensive care stays.

Doctors in this country are reimbursed for whatever they bill.  They're paid separately by insurers for patient visits.  As long as their patients are in the hospital, doctors can bill and be paid for each visit. In our healthcare system, "if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur."
(SaturdayEveningPost.com, Jan.-Feb., '15, p. 36).

Volume counts.  Fear of lawsuits creates volume in terms of services (some unnecessary) and referrals.  Better-informed patients might be the most potent restraint for over-utilization.

Here's the other side of the coin.  According to Dr. Jauhar, he was under pressure
at Long Island Jewish Medical Center to reduce the length of stay of patients
hospitalized with heart failure.  The shorter the patient's stay, the more the hospital's costs were reduced (associated with less use of hospital resources during a shorter stay).

It's a physician's squeeze.

The result?

Doctors are trying to sell their practices; uncompensated care is growing; admissions and elective procedures (money makers) are declining; and hospitals are cutting costs, staff, and services.

Dr. Jauhar suggests several options:
          - Hire doctors as employees and put them on salary, removing incentives to
            overtest
          - Use bundled payments for packages (an entire hospitalization, for example),
            rather than discrete services
          - Move to an "accountable care organization" in which teams of doctors would
             be responsible (and paid) for patients' clinical outcomes.  Most doctors have
             performed poorly in such situations. (pg. 38)

A recent Time magazine article by Steven Brill  (Jan. 19, 2015) suggests another option:
          - The University of Pittsburgh Medical Center's model (Brill also cites the
            Cleveland Clinic's model, a 75-facility enterprise)
             in which hospitals, doctors, clinics, AND INSURANCE COMPANY would be
             under one roof.  Tight regulations for these conglomerates, mostly through
             use of
             federal anti-trust laws and state regulatory authority, would ensure their
             accountability.  The in-house insurance company
             would have the incentive to control the doctors' and hospitals' costs
             AS WELL AS the means to do so. There would be less incentive to
             inflate costs or overtreat, because the in-house "boss" would get the bill
             through the insurance company.





 
       

How Not to Get Sick(er) in the Hospital

This is a recap of a Consumer Reports article of the same title, February, 2015, pages 32-37.  The information reinforces the experiences I relate in my book, ELDERLY PARENTS WITH ALL THEIR MARBLES: A SURVIVAL GUIDE FOR THE KIDS. In a future blog I'll discuss the physician's "squeeze."

TO INCREASE THE ODDS OF A GOOD HOSPITAL EXPERIENCE:

- Check infection rates at local hospitals before surgery.
   Go to www.LeapFrogGroup.org to check
   hospital performances on
   patient safety, high risk procedures, and intensive care.

- Pick a medical team that will involve you in decisions
   about your care and respect your capacity to make
   those decisions.

-  Make clear to the staff you want to be treated with patient respect and dignity.
   Among 1,200 recently hospitalized people surveyed by Consumer Reports,
   29% said they rarely received respect from the medical staff.  Those patients were
   2 1/2 times more likely to experience a hospital-acquired infection, a wrong
   diagnosis, an adverse drug reaction, or a prescribing mistake.

   Respectful treatment includes:
   Doctors minimizing use of medical jargon or explaining it
   Staffers introducing themselves before doing anything else
   Doctors and staff listening to your concerns, answering questions, honoring your
       wishes
   Medical teams acknowledging mistakes and treating you like a person

   If a patient doesn't think the staff is listening or his wishes aren't
   being met, he'll hesitate to ask questions, point out mistakes, or communicate
   in ways that could improve his situation.

   "The safest hospitals," according to a group of Harvard Medical School doctors and
   researchers as reported in Academic Medicine (journal), "share core values of
   transparency, accountability, and mutual respect."

   "Every day almost 2,000 people on average pick up an infection in the hospital and
   about 1,100 preventable drug errors occur.  Hospital medical errors are linked to
   440,000 deaths annually."

   The greatest danger for a patient in the hospital is NOT 
   infection or drug error.  
   It's REMAINING SILENT!
   Patient (or advocate) engagement
   has been nicknamed
   "the blockbuster drug of the century."

IF YOU'RE A PATIENT IN A HOSPITAL:

- Let a nurse know the extent of your pain.

- Find out what tests and procedures are for.

- Ask about drug side effects and interactions.

- Be a person to the staff, not a diagnosis.  Talk about your family or personal details

  about your life.

- Invite doctors to have a seat and look at them in the eye to initiate direct
  eye contact away from an electronic device or clipboard.

- Bring an advocate with you (family member, friend, health care proxy, 

   health care manager) to make sure you're comfortable, to get information 

   from the doctor written down, to help you make decisions, to speak for you 

   if you aren't able.  The advocate should meet the head nurse, attending physician, 

   therapist, and aide.

- Have an advocate with you when the most hospital errors occur (shift changes 

  and care transitions).

- Keep a journal and pen or e-device for questions and notes.

- Make a list of questions for the doctor when he makes his rounds.

- Ask your questions but try not to alienate the doctor or staff.

- Ask a doctor to repeat himself if you don't understand. 

- If you don't see your doctor or nurse wash his/her hands, make a respectful request

   that he does so.  Gloves don't necessarily stop the spread of infection.

Many thanks to my friend Al West for passing this article along to me!

   

                                         
 

Sixty Is a New Sixty

In anticipation of the 2014 publication of my book, ELDERLY PARENTS WHO HAVE ALL THEIR MARBLES: A SURVIVAL GUIDE FOR THE KIDS, I've invited fellow writer and practicing pharmacist Don (D.G.) Weiss to be a guest blogger.  D.G. is the author of three detective/mystery novels, including the first in the series, Picture Perfect.  He'll be sharing some lighthearted commentary on the aging process.


At my yearly physical when I turned fifty my doctor asked, "Do you know what being fifty means?"

Image courtesy of Photostock at FreeDigitalPhotos..net

I stared at him.

"It means you just bought yourself a colonoscopy."

"I'd rather buy a vowel," I said.

Then at fifty-five, my blood pressure and cholesterol went through the stratosphere.  For years, I'd had the blood pressure of a seven-year-old girl.  Now I was being introduced to all the medications I'd been dishing out over the years:  ACE's, ARB's, Calcium Channel Blockers, Beta Blockers, and the ever popular Statins.

After months of trying different combinations, my blood pressure and cholesterol returned to near normal levels.  Of course, now I have leg cramps, acid reflux, and heartburn - all in the fine print.  I've cut back on salt and sugar and I'm trying to exercise.  Sometimes, though, I can actually taste chocolate butter cream frosting melting on my tongue.

I look back on my life before sixty, before fifty, before pills, and sigh.