Gratitudes

I have been extra grumpy possibly because of:

1. delayed reaction to cancer experience
2. sudden-death menopause
3. exotic post-op infection
4. hurricane-force antibiotic
5. decision to go off pain pills because dang! they're getting to be a little too nice

so I decided to count my blessings, which always helps:

1. cancer contained and removed and now miles away in some pathology lab
2. NO MORE BLEEDING! I haven't celebrated this enough yet. I am grateful, grateful, grateful for no more tampons, no more pads, no more accidents, no more "I've got to stay next to a restroom," no more soaking underwear in cold water, no more flooding when I stand up, no more black trousers only, no more jumping out of bed for the bathroom in the middle of the night (well, the hurricane-force antibiotic keeps that going, but only for 9 more days)
3. John, my support , friend, and lover
4. my beautiful garden which I spend hours in every day, thanks to Amy, Jamison, and John
5. water retention over with (I weighed 18 lbs more when I came home from the hospital than I did when I went in four days earlier--now it's gone)
6. light at the end of the tunnel--swimming at the BYU pool! walking around the block or up to the cemetery! hiking! camping--even backpacking!
7. Chris, who is just--it's like living with a young Jim Morrison, an aesthetic experience in and of itself.
8. my psychotherapy practice and patients I'm starting to miss.

I have a great life. Maybe that's the main point--I have a life. Three times now I've made it into more years via surgery, brutal, hacksaw treatment that it is. I'm grateful for that.

Why Can't It Be Over?

A few problems post-surgery, after being so careful with my carbs and blood pressure and resting and taking my meds right and being appropriately active, etc. Dang. I'm hoping it will all resolve with new antibiotics. I wonder if my labile moods are due to the instant menopause. I haven't noticed any other symptoms though--I think I've just reached the end of my rope on this whole thing. Of course if I'm not actually done then I'm not done, it's not like I can quit. But I sure wish I could.

Health and Fitness*

My blood glucose has been creeping up lately, and so I'm tracking health and fitness again. I do pretty well with the exercise, meds, drinking water, not at all well with sleep and relaxation, and I have to be sooo careful with eating, because of my compulsiveness.

Dieting is probably the most prescribed, ineffective, and harmful intervention ever in the history of medicine and physical health. Many dieters lose weight over the short term; most gain it back and more. Repeated dieting with weight loss and weight regain totally messes with your metabolism. And something like 2% of dieters keep off the weight they've lost for more than five years. What other industry is based on something which yields such poor results? The interaction in dieting of biology (which says when food is restricted--"whoa, we're in famine, I better shut down my metabolism to survive") and psychology (where food is connected to self-care, nurturing, safety, etc.) creates a veritable perfect storm of FAIL.

But, the blood glucose is creeping upward, despite an hour per day of exercise which makes me able to walk without pain, keeps my blood pressure at a manageable level, and makes me feel normal. I don't want to take meds yet, because that starts a whole other balancing act. I have lost weight before--about 20 lbs at a time--sometimes by cutting out fat and sometimes unintentionally by being in a different situation (walking more while traveling, no extra food available, an emotional crisis--although usually of course that's when I gain).

My main trouble is that I have an anxious and compulsive personality, and complex carbohydrates are both a great way to avoid work that is difficult or that I'm anxious about, and a sedative which makes me then able to get back to the work. A perfect self-perpetuating reinforcement circle. Like this: impending work (usually writing of some sort) --> anxiety relating to the work --> avoid (negative reinforcement [r-] of the avoidant behavior) while getting a carbohydrate snack (positive reinforcement [r+] of the avoidant behavior) (which because of its sedating effect is also negative reinforcement [r-] of the avoidant behavior because it decreases the felt anxiety) --> so that now, less anxious, I can go back to work and complete the task successfully (positive reinforcement [r+] of doing my work and staying in the cycle) --> until I have a new task, new day of work, which then elicits anxiety --> and so forth.

When I was younger, in bad jobs, getting through grad school, doing some really hard stuff, maybe I absolutely had to have this coping mechanism. Now, not so much. I love my work, I love my life, I'm just in the habit of being anxious. The anxiety from my regular life is perfectly manageable. But I know that if I start restricting my eating, all kinds of other psychological issues will kick in--"we're going to starve! nobody loves us! we hate you! you don't care if we die from starvation, so we'll show you--we'll die of overeating, and we don't care either!" Rationality does not live in that world.

But the blood glucose is inching upwards. Restricting backfires--always has. I gain weight when I restrict. Writing down what I eat backfires. Counting calories backfires. It doesn't work--maybe it does for some, but I'm one of the 98 out of 100 that it doesn't work for.

So instead I'm going for the gentle approach--a little nudging toward the vegetables, planning ahead and anticipating meals, allowing for a sweet when I want one, making sure I always get my 3-4 carb units per meal (but not more).

On my desktop I have an XL file with the following list:
Sleep (3 points): to bed by 10:30, up at 6:00, nap
Measurements (1 point): weight, blood pressure, blood glucose
Meds (1 point)
Water 8C (1 point)
Exercise (3-4 points): bike, back/stretch, weights, swim or walk
Relax/meditation (1 point)
Eating (3 points, 1/meal): 3-4 carb units [15 grams] (2 grain and/or starchy veg, 1 fruit, 1 dairy)/meal, 1 protein unit/meal, 5+ veg per day, 1 small sweet/day <--> fruit or carb unit.

That's it. I think about the food as I'm planning the meal--I don't write it down or anything, I just give myself a point if I was mindful and did it. My perfect goal would be to lose 1 lb per month, just so I know I'm losing, not gaining. If I do everything on the list I get 14 points MWF, 13 points T Th, 11 points on the weekend. I'm already doing most of the list--things I have to work on are getting to bed, taking a 20-30 minute nap (yay!), walking 2-3/week in the evening, and doing daily relaxation/meditation (mostly because I'm seeing a lot of anxiety clients now, and I need to remember how it works).

And just a little nudge with the eating. I plan to enjoy eating--recipes, cooking, eating out, salads, fish, pasta, breads, desserts.

That's all. I'll report later.

*Definitely skip this post if you think it looks boring--because it IS.

Protecting Insurance Companies

Protect Insurance Companies PSA from Will Ferrell

I don't quite dare post this on my psych blog,
since it's listed on several insurance companies' web sites.

Be Afraid, Be Very Afraid

Death Panel Advisors - watch more funny videos

(found on Ezra Klein's blog)

Why It's Important Not to Give Up

As I commented on Dave's immigration blog:

It's so discouraging to see the administration abandoning the public option. I have begun to mistrust the words "stakeholders" as much as I now mistrust "family values"--it means something different than what appears on the surface. At this point, "stakeholders" as it applies to health care reform, means "the companies who have made an obscene amount of money over past decades and want to put off true reform for at least another decade of obscene profits." It's also very disheartening to put one's faith in a a party and politicians, and discover (as one suspected all along) that they really are bought and paid for by industry lobbyists.

And as Dave reproved me:

who is this lurker? :) thanks for commenting! you should know as well as anyone the machinations of the insurance companies, fighting them as you do and having uninsured and underinsured children with children of their own.

i realized tho that the party isn't very good, but i think obama is trying to move things forward. he can't do it on his own, tho--we have to make the change ourselves, we have to be the change we want to see. no one else is going to do it for us.

Why I Love Dan Froomkin and the Washington Post Was An Idiot for Firing Him

Let's be blunt. The public option -- emphasis on the word "option" -- is a way to hold the insurance companies accountable should they (entirely unexpectedly, of course) fail to live up to their promises, ignore the rules, and keep doing things the way they have for the past several decades....

The public option is a grave threat to the regime of obscene profit-making that has left the health care industry with plenty of cash to now throw in reform's way. The growing "opposition" to the public plan is a direct result of that money. This is -- remember -- exactly how money works in Washington. It buys congressmen. It buys message. It generates publicity. It even makes presidents flinch....

Are you really confident, for instance, that the insurance industry will work hard to control health care costs? Our health insurance chieftains have been talking about that for decades. But rather than do it, they seem perfectly happy taking a big cut of an ever-bigger pie -- and focusing their cost-cutting energies on denying coverage to people when they need it. This seems to work for them. Changing the rules under which they operate may have some modest impact on their behavior, but not nearly as much as will looking over their shoulders and seeing a government-run program bending the cost curve, lowering rates, and improving service.

The presence of an alternative -- a choice -- is critical. It's also about as American as apple pie. The insurance companies themselves understand this very well. The industry-backed PR firms that are bankrolling and inciting ostensibly "grassroots" protests understand this. That's why they encourage talking points about a "government takeover" of health care, rather than anything based in reality.

Dan Froomkin

Amen.

Interestingly, I have not met one actual health care provider who does not believe that single payer, universal health care is the economical, sensible, eventually inevitable, and moral way to go. I could talk about the frustrating hours every month that I spend dealing with insurance companies. I could talk about hidden deductibles in the thousands of dollars, premiums that cost 50% of a family's income, people trapped in jobs solely for the health benefits, treatment decisions made by insurance demands rather than by the needs of my patients. But worst of all are those who get no health care because they have no coverage.

I understand that Medicare recipients are afraid that if others are cared for, they will lose their own fragile health security. I blame the insurance and drug companies for fanning those fears. If we lose this battle, those companies will be able to rake in the profits for another decade or so--exactly analogous to the tobacco companies fighting regulation through years and decades while they sucked up every last possible drop of money.

Wisdom Teeth B Gone

Chris is holding up pretty well with lots of ibuprofen and ice packs. His friends come over with smoothies and to cook for him, which also helps.

Bill Moyers on the Health Insurance Industry

You suspect these things, and then you find out that they're true. Single payer, universal health care is insanely overdue in this country, but the vested interests who buy Congress will keep it from happening for several more decades. John and Chris and I have good coverage. Our adult kids, not so much. Must be that they're lazy, reckless, and irresponsible, right? Or the free market would take care of them.

Big Pharma/Big Med Research Protects Its Own...

...from someone disclosing the symbiotic relationship between drug companies and researchers (the Wall Street Journal via Crooked Timber):

The Journal of the American Medical Association, one of the world’s most influential medical journals … , says it is instituting a new policy for how it handles complaints about study authors who fail to disclose they have received payments from drug companies or others that pose a conflict: It will instruct anyone filing a complaint to remain silent about the allegation until the journal investigates the charge.

The JAMA editors said Dr. Leo was guilty of a “serious breach of confidentiality” by writing about the problems with the JAMA study while the medical journal was still investigating the matter.

[JAMA editor] “flat out” threatened him and attempted to bully him during the conversation....“He said, ‘Who do you think you are,’ ” Dr. Leo said. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.”

As per Crooked Timber comments,

Biz is biz.

Medical Report*

I've become organized! Unfortunately, that seems to mean less time for blogging. Not that my organized phase is apt to last very long, given my history.

The IHC diabetes management people kept calling and sending letters telling me to come in for my education Tuesday Wednesday Thursdays--afternoons or evenings!--but since that's when I have my office hours I just gave up on it. They are persistent, however, and scheduled me in my own 3-hour slot to talk to a nutritionist and a diabetes specialist. It was actually quite inspirational. I'm not technically diabetic, but borderline, with some chance of keeping my glucose levels down by "lifestyle" changes, and not having to take meds. They gave me (or charged DMBA for, no doubt) a cute little purple glucose tester that is the coolest toy ever. My doctor said check two or three times a month, but it's a lot more fun to do it twice a day, with its techie little chip-strips. Yesterday at the farm we all tested our blood sugar levels. Mine remain borderline. Maybe it takes more than ten days watching my carbs before I get it under control. I have lost the holiday 7 lb weight gain though. Yikes! Seven lbs! That was a lot of cookies!

And, I am noncompliant with my blood pressure meds. I bought another cute little computerized techie toy at Wallgreens, a blood pressure monitor, and despite the various meds--beta blocker, calcium channel blocker, ACE whatever inhibitor--my blood pressure was still incredibly variable. I read some post or something about some non-Big Pharma-funded study which showed that of all the BP meds, diuretics alone worked as well or better than the expensive drugs. So I just quit. And my BP seems the same if not better. It still ranges a little too far up there at times--no more than it did before with the meds--but maybe with my current (organized) diet and exercise it will come down on its own.

OK, boring stuff over.

*This post is for middle-aged people or older, or for people who are very interested in my health--my life insurance beneficiaries perhaps.

Single Payer, Universal Health Care

In today's Trib, from Clark Newhall, a local MD and attorney, a succinct and angry account of what is going on in American health care:

The price of our privately run, profit-driven medical-industrial complex has caused this famine. About one-third of every dollar going to health care pays for administrative costs -- for utilization reviewers, for computer programmers, for advertising, for sales managers, for executives of all kinds, for billing clerks, for coding clerks, for CEO bonuses in the millions and hundreds of million -- and for profits.

We are not talking about government waste. We are not talking about the cost of actually treating the sick and nurturing the healthy. We are talking only about the cost of running our profit-making health insurance industry.

One third of the health-care dollar -- that amount is far more than enough to give excellent medical care to everyone in the nation. It is far more than enough to fund the (privately-owned) surgical centers and imaging centers and Lasik centers that sprout up on every corner. It is even more than the amount we have given to Wall Street to bail out financiers and bankers from their hubristic near-demise.

The famine has grown while insurance companies charge higher premiums and reduce coverage, while employers cut their contributions and increase deductibles, while legislators reduce Medicaid and Children's Health Insurance Program budgets, and on and on.

I agree. We are not just at the brink, we are over the edge and falling fast. The current system is unsustainable, and little tweaky fixes that keep the current players rich is not going to stop the whole thing from crashing.

It is time for national single-payer health insurance. It is time to remove
the profit-making middleman from medical care. It is time to see health care for
the public good that it is and not for the profitable business it has become.
Support Medicare for all.

Walking, Eating, Sleeping

Dorchester is a very small place, maybe like Payson, Utah, but less spread out. It is the smallest county town (capital) in England. From Fordington on the East, where we went to church, to Poundbury on the west, is probably less than a mile and a half. Which is good, since I walked it three times Sunday and will probably walk it at least twice daily while we’re here, since I have not yet seen a number 31 bus, which is supposed to stop just down the street. Good exercise, up and down gentle hills. Its uphill to the B&B, and it’s so hot and humid I have to take off my clothes and stand still to dry off once I get back to our room. I think some of it is body temperature dysregulation from my blood pressure meds, a common side effect, (or maybe menopausal hot flashes just happened to hit right when I began this new prescription).

Anyway, I remember from previous trips how stripped down to basics one becomes when traveling like this. We had to remember to buy bread and cheese and fruit on Saturday, because last time we made an extended stay in Dorchester over the weekend (when Chris was eight years old), nothing was open on Sunday. I don’t think that’s actually true anymore, but we had a nice lunch in the Borough Gardens, on a bench as usual. Here is the town clock, and the bandstand, where there may be music and/or theatrical pieces later. John went on a walking tour of Dorchester sites and I walked back to the B&B to work on my novel, but fell asleep for four hours instead. Sleep like drowning in the heat. But I think I’m over jetlag.

Karla hits 50; 50 hits back*

The big 5-0 hit several months ago, but I'm just getting damage reports from the medical profession--high blood pressure, high cholesterol, borderline glucose levels. Plus the hormonal chaos that goes along with what is laughably called menopause, meaning what has been as predictable as the tides for the past 39 years is now--ahem--not predictable anymore. I don't need surgery, but I'm facing a choice of several unpleasant alternatives. All have nasty words associated with them, like ablation, and stirrups, and some discomfort. Not to mention the lecture on diet and exercise (I know, I know, and I don't even really mind the lecture, it just makes it hard to face going back after hearing the same lecture last year).

So, enough pills to supply half my day's nutritional needs all on their own every morning, swimming at the BYU pool, and riding my exercise bike every day. There is still hope. And I guess the two hemiplegic ladies I see for psychotherapy twice a week at the care center (stroke victims) are a reminder as well. Getting old is actually not so bad, given the alternative--death in childbirth, a couple of centuries ago. I'd lots rather see my grandchildren grow up.

*Phrase stolen from the Vorkosigan books by Lois McMaster Bujold, my favorite space opera series of all times. Start with Cordelia's Honor and work forward.