Welcome to Saturday's Potluck

“Learn the rules like a pro, so you can break them like an artist.”
Pablo Picasso

Time passes quick it has been over a months since the last diary on Self Care. Observing and monitoring for changes in health is an important part of the practice. The tools range from simple observation and documenting paper to high tech applications for a smart phone. When using an application privacy of data varies with the vendor. If you are lucky enough to have a longterm relationship with a health provider who does this for you, be grateful. Majority of us have intermittent interaction.

These are the tools I use to establish baseline values. How often data is collected and the type will depend on health conditions and status. Unhurried calmness, patience to collect data consistently without judgement is a key factor in its usefulness. Most of the time it is boringly normal. If compared to my car the oil light has only come on twice in 40+ years of driving and one of those times it was important.

Bathroom scales - identify quick and gradual changes in weight. Daily checks for someone with congestive heart failure may identify an acute phase while it can still be treated without hospitalization.

Blood pressure cuff - like the wrist style to monitor for potential low and high pressure.

Thermometer - not everyone's normal is 98.6. Mild temperature increase can be a signal immune system has been activated.

Pulse oximeter - measuring blood oxygen can be purchased for less than 20 dollars. Easy way to know how much forest fire smoke or pollen is effecting breathing.

Blood glucose meters and strips - very low cost models are available without a prescription.

Personal experience with doctors and various family members is home home monitoring is appreciated when presented without pre-analysis. If offered with the statement "This shows I have a specific problem" doctor's mind immediately shift to ruling out the problem. If data is presented as "I noticed this change" or "This was odd, can you explain" doctor identifies the problem you suspected. Let them perform their specialty - diagnosing and ordering tests to confirm or rule out possibilities.

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Previous Open Threads related to Self Care.
Maintaining a private medical history
Finding basic information on medical conditions and medical diagnosis.
Finding basic information on drugs/medications.

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Obesity as a risk factor.

Normal-weight central obesity: Unique hazard of the toxic waist The Study.

Objective
To examine the mortality risk presented by normal-weight central obesity, to identify a clinical measure to aid in the identification of this phenotype, and to explore the means for mitigation of this risk.

Quality of evidence
Only prospective cohort studies (level II) comparing participants with central obesity at normal weight with those at higher levels of body mass index (BMI) were found. Good level I studies were available to demonstrate the effect of diet and exercise interventions on central obesity and mortality.

Main message
Participants with atherogenic dyslipidemia who are centrally obese at normal BMI are at similar, and possibly higher, mortality risk compared with those who are centrally obese and overweight or obese according to their BMI. Waist-to-height ratio might be the most pragmatic clinical measure of central obesity. The Mediterranean diet is an effective intervention to prevent ongoing weight gain while reducing abdominal girth. Low levels of exercise can also reduce waist circumference. Weight loss need not be an objective.
Conclusion

A waist-to-height ratio exceeding 0.5 at normal BMI identifies elevated mortality risk for cardiometabolic disease. This risk might equal or exceed that of centrally obese patients who are overweight or obese. Modest dietary and exercise interventions can be effective in mitigation of this risk.
...
Conclusion
Visceral obesity is increasing faster in the North American population than generalized obesity is and it has a more profound effect on morbidity and mortality. The simplest and most valid measure of central obesity is WHtR. This phenotype is closely linked to atherogenic dyslipidemia, which predisposes one to the deposition of cholesterol in the vascular endothelium and resultant atherosclerosis. Individuals with normal-weight central obesity are at equivalent, and possibly higher, risk than people with central obesity who are overweight or obese by BMI.

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Government policy effects the number of hospital beds available to provide care for its citizens. The past 50 years the US has been decreasing the beds available to treat physical and mental health conditions. Current average number of beds for the country is 2.8 per 1000 people. Washington at 1.7 and Oregon at 1.6 rank as the bottom 2 states. (aprox 11:30 min) (originally aired over a year ago in April 2020 )

Check how many hospitals in your area were at risk of closing at the beginning of this year. 50% of Washington rural hospitals are at risk of closing and 35% for Oregon.

More than 500 rural hospitals in the U.S. were at immediate risk of closure before the COVID-19 pandemic because of financial losses and lack of reserves to maintain operations, according to a report from the Center for Healthcare Quality and Payment Reform.

Nearly every state had at least one rural hospital at immediate risk of closure before the pandemic. In 22 states, 25 percent or more of rural hospitals were at immediate risk, according to the report.

The hospitals identified as being at immediate risk of closure had a cumulative negative total margin over the most recent three-year period, and their financial situation has likely deteriorated because of the pandemic.

Across the U.S., more than 800 hospitals — 40 percent of all rural hospitals in the country — are either at immediate or high risk of closure. The more than 300 hospitals at high risk closure either have low financial reserves or high dependence on nonpatient service revenues such as local taxes or state subsidies, according to the report.

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The shift of elective surgeries from inpatient to outpatient procedures continues to be used to lower costs.

Total knee arthroplasty (TKA) was removed from the Centers for Medicare and Medicaid Services (CMS) Inpatient-Only (IPO) list starting January 1, 2018. Many hospitals responded by instructing surgeons to schedule all TKAs as outpatient procedures, and some local Medicare Advantage contractors began to expect outpatient status for all or most TKA cases.

When possible over the years I have preferred to arrange outpatient procedures for family members. There is a deceased risk of hospital acquired infections, a chemical restraint being used and drug induced dementia.

Current literature is now suggesting same day discharge for hip and knee surgery for high-risk patients.

Same-day discharge after total knee arthroplasty (TKA) or total hip arthroplasty (THA) is safe in some patients classified as "high risk"—with no increase in complications or other adverse outcomes, reports a study in The Journal of Bone & Joint Surgery.
...
In both the THA and TKA groups, about one-third of patients were discharged on the same day as surgery, without spending a night in the hospital. Complication rates, emergency department (ED) visits, unplanned hospital readmissions, and mortality were compared for patients who underwent same-day or inpatient surgery.

For high-risk patients undergoing THA, same-day discharge was shown to be noninferior to inpatient surgery for most outcomes. At 90 days, same-day discharge showed no increase in complications, ED visits, or hospital readmissions. The study could not demonstrate noninferiority for mortality, as death was uncommon within 90-days post-discharge in both groups.

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What is on your mind today? (Responses to Covid questions and dialog to be conducted at The Dose diary)

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9 users have voted.

Comments

QMS's picture

Into one's own hands. We are being educated incrementally that the best advocate for our health
is no longer exclusively the medical establishment. Doc says "you need to be tested for X" and I go to find out what the parameters are. My crappy medicare insurance pays almost nothing towards these tests, and usually the specialist wants to see more tests. I'd rather forego the endless testing and not become another medical expense payee (brokee).

Just looking at the faces and into the eyes of the patients sitting in the waiting rooms of medical offices tells me enough to know this is not the path I care to go down.

TCM (Traditional Chinese Medicine) and listening closely to what the body needs is far more responsive than waiting and worrying IMO.

Thank you for another well thought-out essay. You are very reasonable and knowledgeable about your topics!

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7 users have voted.

@QMS

My crappy medicare insurance pays almost nothing towards these tests

Are you on one of those "Part C" scams?

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4 users have voted.

I've seen lots of changes. What doesn't change is people. Same old hairless apes.

studentofearth's picture

@The Voice In the Wilderness providers or do not get prior authorization it can get very expensive quick. I have always arranged Fee for Service for family members. Fewer surprise bills, but can still happen. Hospitals are keeping more patients in beds categorized as outpatient services (observation) vs admitting for inpatient service, sometimes for several days, plus switching back and forth. If an outpatient all services including labs and medications are billed separately. Patient is responsible for full payment and/or deductibles of their insurance plan.

If someone want to explore changing plans from one Medicare Advantage (Part C) plan to another or to a Fee for Service here are two links Medicare site and an online healthcare company.

Been a few years since I had to deal with the issue so a knowledge is a little rusty.
I see they removed Plan F for new enrollees.

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4 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

QMS's picture

@The Voice In the Wilderness

B comes out of my SS
The BCBS is "G -65" which is another $123/mo
Both B and G have deductibles, copays and denials
So anytime I see a doc, I end up paying more money.
My part D is another joke. It's only $120/yr, but they
won't cover almost everything. If they do it's about 10%.

If this isn't a scam, I don't know what is.
Although part C sounds worse.

Where is Molly when you need her?
She used to be a treasure trove on this stuff.

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5 users have voted.

@QMS Try Physicians' Mutual for their supplemental plans. Inexpensive, comprehensive, no co-pays, no deductibles.
The monthly costs off United Health Care came to over $700 per month for the supplemental coverages. PM costs about $375.

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4 users have voted.

@on the cusp
carried into retirement. Since Medicare is primary and they get the same premium as the non-retirees they don't play games (much). They have a cushy deal. I pay ~$500 a month (I'll look up the exact figures later). Uncle Sam pays around $1000 a month. That's for two people. I'll lookup exact figures later.
my dad had a similar deal from Gruman except he paid zero. He worked for them for a year and a half then they closed the plant. He was over 62 so he was eliglible for Health Insurance and a pension of $65 a month! (They paid him minimum wage). They made F-14 wing sections in a little plant in our rural county. Of course, your tax dollars paid for it also. At least you got value for your USPS dollars (past tense). Gruman... not so much if any.

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4 users have voted.

I've seen lots of changes. What doesn't change is people. Same old hairless apes.

QMS's picture

@The Voice In the Wilderness

My father-in-law worked for Grumman for 30 some years. They forced him into a retirement situation which he was not happy with. They shut down the plant on Long Island where he worked. His biggest disappointment was the failed company promise to reward the workers for their long years of service.

That was the beginning of the no-holds-barred screwing the workforce. Became Northrup-Grumman after that. Hardly lives on what is left of the pension. Much has changed with employee security. Long term relationships are a flash in the pan anymore.

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5 users have voted.

@QMS
I forget the year but Carter was President. I often wished that I had stayed with the Navy. But I read that Reagan got rid of 10,000 Navy civil servants. I probably would have been one.

Went from there to International Harvester. Three months later the big strike occurred. The rest is history.

I remember when IH called us in (February) to tell us that we had to take a 10% cut "to set an example for the Union". I made disparaging whispers to my partner. He said, "Don't you believe them, Tony?" I answered "I came here from Washington DC. I've been lied to by experts. These guys are not experts." I had had an interview with another company in December. They had offered me a 5% increase over my present salary. I turned it down. After the IH meeting I went home and called their Chief Engineer, "Keith? This Tony S, remember me?" "Yeah" "Do you still have that job?" "Yeah" "same pay?" "YEAH!" "I'll take it, Keith." I was the first to leave. Others trickled out. "Eliot called me in September looking for a reference." The remaining engineers loyal to IH were all laid off. The Department had gone from 66 to 6, the six managers."

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6 users have voted.

I've seen lots of changes. What doesn't change is people. Same old hairless apes.

@QMS
Just watch the commercials. everything free! They will even pay you $144 a month to take it!
RED FLAG WARNING. SOMETHING FOR NOTHING. FREE MONEY.
When I was a kid a popular saying was "You get what you pay for". My corollary: "Sometimes you don't even get that!"

They will pay you to take their insurance? Worthless care for sure.

EDIT: sp

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3 users have voted.

I've seen lots of changes. What doesn't change is people. Same old hairless apes.

studentofearth's picture

@QMS an imbalance or beginning of a problem. One can apply treatment until rebalanced then stop or do coarse correction to slowly move away from the problem. The philosophy seems more relevant than the actual methods of treatments Western or Eastern.

Thanks for the compliment. It seems the more I learn the more I realize how little is known.

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4 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

enhydra lutris's picture

general self care info. I find my self care trending more and more to the remedial, which is not good. That said immensely busy today and rest so week, so much I could be doing gets postponed again.

I do generally kill my 150 min per week (personal target is 120 per day, don't make it that often, but average is still pretty good); net effect? Nada. Typical.

Gotta run, be well and have a good one.

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3 users have voted.

That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

studentofearth's picture

@enhydra lutris Where do you get the energy and clear mind to be one of the most prolific writers at C99?

We do have the continual challenge of increasing years throwing more physical and mental issues at us. Sometime treading water is the best we can do.

Have a good one.

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5 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

I am old enough to remember when you stayed at the hospital until you got well. There is obviously no profit in that.
One nearby hospital closed about 5 years ago. The other nearby hospital was about to close about 2 years ago, but another company purchased it, and local prominent families made significant donations to keep the doors open. Both small cities are considered low income communities.
An interesting OT.
Thanks so much.

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6 users have voted.
studentofearth's picture

@on the cusp times have changed. Brings to mind an overheard conversion between a physician and a patient's Wife. Doctor told her Husband was fine, but he was staying in the hospital a couple more days so she could get some rest.

The physician would not have the option today with insurance companies directing criteria for medical services.

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4 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

@studentofearth back in the day. Those were the times of true, family health care.

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2 users have voted.
Granma's picture

Was not to tell the doctor was you think is the diagnosis, instead to say what has been happening with your body, letting the doctor do the diagnosing. That is important. It makes for a much more productive medical visit and better outcomes for you.

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3 users have voted.

@Granma I had a viral infection I picked up overseas, and at the same time had complications from a tick bite that would only occur in Texas in one-in-10,000 bites.
Drs. were testing me, giving me steroids, tests coming back negative, and the steroids were making things worse.
So, a friend said she knew a guy fresh back from Europe that had my exact same symptoms. Another friend said my symptoms mimicked her tick bite symptoms.
I specifically asked the dr. to test me for Parvo b19 and Rocky Mountain Spotted fever. She was furious at me for demanding them. When I showed positive for BOTH of them, I discovered there is no treatment for the Parvo b19, and I was past the window of time to receive treatment for the RMSF. When she read the results to me, she told me not to come back to her office.
Guess what drug is the absolute WORST you can prescribe for those conditions? Steroids.
I have never been the same. This led me to stop riding my horses. My hands have never recovered.
If you cannot give input to your doctor, you will be giving input later to your attorney.

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6 users have voted.
studentofearth's picture

@Granma required to obtain the right treatment. All other options remain available if they become necessary.

Thanks for stopping by on this gorgeous Fall day in Oregon.

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2 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

enhydra lutris's picture

as yesterday's 3.1. Assuming that these aren't preliminary tremors, that is a good thing, because that is the Hayward Fault which has the potential to create an area wide disaster. It is considered to be more dangerous than the San Andreas

be well and have a good one

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4 users have voted.

That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

studentofearth's picture

@enhydra lutris on the Hayward Fault. Hopefully simply easing some tension.

up
4 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

enhydra lutris's picture

@studentofearth

Definately do not want a major quake on the Hayward Fault.

It's about 3 to 4 miles west of me, we're definitely in the blast zone.

Hopefully simply easing some tension.

That's what I'm hoping and why I said it could be a good thing we had those.

be well and have a good one

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2 users have voted.

That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

Lookout's picture

Late to the party today, but fortunately in good health. Although I've been on medicare for a few years, I still have not used it. Other than dentists, I've not been to a doctor in many years...really only twice in the last fifty years and that was for a required check ups for insurance. Knock on wood!

In part it is good genetics (my Mom is 90 and still living independently), and also my self care... and in the last few years improved diet.

I know I'm lucky and value my good fortune. Wishing the same for you all!

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5 users have voted.

“Until justice rolls down like water and righteousness like a mighty stream.”

studentofearth's picture

@Lookout Been enjoying a longer season of fresh vegetables as my gardening skills improve.
Also, consider myself fortunate at this time of life.

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2 users have voted.

Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

Dawn's Meta's picture

was that eating good fats, cutting out sugars and wheat (mostly), eating good fiber, lots of veggies, narrowing the eating window daily so a small fast is had most days, all helped improve our general health and surprisingly lead to weight loss to a stable lower point. We were pleasantly surprised.

This was not intentional loss, just a by product of changing our diets.

The other thing we still work on because we both seem to have some forms of inflammation, is doing what we can to lower body-wide inflammation. This is a tougher nut and the result of tick-borne infections earlier in life and lots of antibiotics for too long. Mistakes were made.

So now we continue to try to mop up the mess. And to stay away from doctors.

Thanks for the OT! I miss Molly too.

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4 users have voted.

A society grows great when old men plant trees in whose shade they know they shall never sit. Allegedly Greek, but more possibly fairly modern quote.

Consider helping by donating using the button in the upper left hand corner. Thank you.

Lookout's picture

@Dawn's Meta

to Uruguay or was it Paraguay? I know they were working toward it. May be why we have not seen her. Hope she can get good internet service and let us know how it is going.

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5 users have voted.

“Until justice rolls down like water and righteousness like a mighty stream.”