No matter who wins the presidency, there will be some major changes in health care in the coming years.....are they going to get it right?
I have been a Registered Nurse (RN) for over 32 years (ugh!) and have worked in several different areas. My first job was working with handicapped and developmentally delayed children, then I worked general medical and surgical floors in a couple of fairly large suburban and urban hospitals. I've worked in cardiac and intensive care as well as a cardiac monitoring center. I've worked in dozens of nursing homes. In addition to direct patient care, I've done utilization review and case management for an insurance company, a physician's group and a large, nationally known hospital. Currently I work for a company that has several electronic products for doctors, nurses, case managers and others in health care fields.
I've also been an avid reader and researcher of several medical issues including new drugs, vaccines, and devices; the pharmaceutical industry; the management of diseases like heart disease and diabetes; and various other health related issues. With theInternet it is possible to get more information and varying opinions, which allows one to make informed opinions.
It's very disconcerting to see some of the issues and realize that the very people that are making these bad policies are likely going to be the ones that will advise our next president. The very people that advocate drugs, drugs and more drugs are going to be making their recommendations. The people that are advocating treating diabetics with high carbohydrate diets, the people that are in favor of treating cholesterol levels that have no influence on heart disease, the people that are claiming fat is bad for us and grains are good, and the people that want to vaccinate everyone against everything (even if the vaccine isn't effective or the risk is minor).....these are the people that are going to be having their say about what the future of health care should be.
Are we going to hear from the people that have been damaged by unnecessary and/or ineffective treatment? Are we going to hear from those that have serious doubts about the healthfulness of certain diets? Are we going to hear from those that believe that currently the health care industry is broken? That the FDA. ADA, AMA and others are in the pockets of the pharmaceutical industry? Probably not.....and even if we do, they will be the minority and ignored.
Our costs are out of control because of poor policies. Our costs are out of control because anyone with insurance can get almost any test, drug or device they want. Our costs are out of control because there is too much emphasis on something that doesn't matter (high blood cholesterol) while something else is ignored (high blood sugar), and the ignored factor is much more dangerous and damaging!
Monday, October 27, 2008
Saturday, October 11, 2008
PRA update
Today isn't the greatest day, but things could be a lot worse. Right now my left knee and my right hand/wrist are bothering me. Not enough to take pain med for, but enough to notice.
Over the past few months I've been doing well. In early summer my symptoms started to intensify, but still not too bad. I had been having trouble with my stomach and difficulty swallowing, so my doc did a repeat gastroscopy to see if I might be having a reaction from the Doxycycline I'd been taking for the PRA. Fortunately I didn't have what he was concerned about (Eosinophilic esophagitis), I had another stricture, which was dilated. After the scope I restarted the Doxy and have been doing well on it.
Since the first of August I've been taking Doxycycline 100mg twice a day on Monday, Wednesday and Friday only. This dose seems to be keeping symptoms mostly at bay without upsetting my stomach.
Over the past 2 weeks I've also been trying something different. My doc had given me Voltaren, which is an anti-inflammatory or NSAID (non-steroidal anti-inflammatory drug). Voltaren has been on the market for a long time, and according to my doc, safer than the newer NSAIDs. I'm not convinced of this....they all seem to cause problems related to heart disease. Because of this, I decided to try and get off the Voltaren and switch over to plain aspirin.
Aspirin is not felt to be a drug that leads to heart disease, in fact it's used to treat heart disease. I've also done some research and it appears that aspirin works just as well as the prescription NSAIDs. So, a couple of weeks ago I stopped my Voltaren and started taking aspirin. I'm taking the "enteric coated" aspiring, which makes it less upsetting on the stomach as it's not broken down until it hits the intestine. I also make sure to take it with food and lots of liquid to make sure it doesn't get stuck in my esophagus.
So, right now I'm taking aspirin 2-3 times a day at most and doing fairly well. I'm still having some pain, but mostly quite tolerable. I've also been using Arnica gel on my hands, and other areas as needed. It seems to be working, but doesn't last too long.
Over the past few months I've been doing well. In early summer my symptoms started to intensify, but still not too bad. I had been having trouble with my stomach and difficulty swallowing, so my doc did a repeat gastroscopy to see if I might be having a reaction from the Doxycycline I'd been taking for the PRA. Fortunately I didn't have what he was concerned about (Eosinophilic esophagitis), I had another stricture, which was dilated. After the scope I restarted the Doxy and have been doing well on it.
Since the first of August I've been taking Doxycycline 100mg twice a day on Monday, Wednesday and Friday only. This dose seems to be keeping symptoms mostly at bay without upsetting my stomach.
Over the past 2 weeks I've also been trying something different. My doc had given me Voltaren, which is an anti-inflammatory or NSAID (non-steroidal anti-inflammatory drug). Voltaren has been on the market for a long time, and according to my doc, safer than the newer NSAIDs. I'm not convinced of this....they all seem to cause problems related to heart disease. Because of this, I decided to try and get off the Voltaren and switch over to plain aspirin.
Aspirin is not felt to be a drug that leads to heart disease, in fact it's used to treat heart disease. I've also done some research and it appears that aspirin works just as well as the prescription NSAIDs. So, a couple of weeks ago I stopped my Voltaren and started taking aspirin. I'm taking the "enteric coated" aspiring, which makes it less upsetting on the stomach as it's not broken down until it hits the intestine. I also make sure to take it with food and lots of liquid to make sure it doesn't get stuck in my esophagus.
So, right now I'm taking aspirin 2-3 times a day at most and doing fairly well. I'm still having some pain, but mostly quite tolerable. I've also been using Arnica gel on my hands, and other areas as needed. It seems to be working, but doesn't last too long.
Sunday, July 13, 2008
Palindromic Rheumatoid Arthritis
I'm 54 and was just diagnosed last November (2007) with PR. I am sero-positive, but my doc feels my symptoms are "still PR, not RA".
I'm really not sure exactly when my PR started, but I know it was at least 2 yrs ago. For many years I've had osteoarthritis and of course any aches or pains are attributed to the osteo getting worse. I think the initial symptoms started in my feet and knees. There were times that my feet would hurt so much it was hard to walk. My feet/ankles would hurt for a few hours or days and then all would be good for a few weeks. Other times it would be my shoulders, or my wrists, or fingers. Initially I had little swelling and no redness, no matter what joint or how severe the pain was.
Since I didn't have a primary care doctor (PCP), I didn't do anything about the pains for several months....until my shoulders really flared up. Both shoulders, over a matter of a few hours, became very painful and any movement made it worse. I could lie on my shoulders (I always sleep on my side), but the least movement sent sharp pain down my arm. I went to see an orthopedic specialist about my shoulders and was diagnosed with bursitis. The day I saw the doc my pain was only about a 2 or 3 (not the 7-8 it could get to!) and I could freely move both arms. I had an ultrasound done and, since there was nothing abnormal seen, the doc declared that he was right, it was bursitis! (HUH?) The only treatment offered to me was cortisone injections, which I refused.
After a few months the shoulders suddenly were back to normal. If this was bursitis, it was certainly atypical!
A few weeks after my shoulders improved my ankles started to hurt. Most of the time it was just a bit painful to walk or move my feet, but every once in a while they would ache enough for me to take an over the counter (OTC) pain med (Acetaminophen, ibuprofen, etc), but got little relief. Again, I ignored the ankles.....I was still overweight (obese, bordering on morbidly) and figured with my age and weight it wasn't surprising that my ankles hurt....but wondered why there was no relationship between the amount of pain and the amount of walking I did.
One day last March (2007), my right ankle started to hurt and within a matter of hours it was so painful I could barely walk. Since I still didn't have a PCP, I went to urgent care and was told first it was gout, then it was "just an injury", even though I was positive I hadn't injured it! I was given a prescription NSAID (non-steroidal anti-inflammatory drug like ibuprofen) and the pain, swelling and redness was gone the next morning...completely! Either that was one heck of a medication or something else was going on.
This was the first time I noticed redness and swelling of a joint that was hurting....but it wasn't the last. Most of the time, if I get redness and swelling it's one of my fingers or my wrist. My shoulders and knees will be hot to the touch, but no redness and little swelling.
About 3 months after the ankle incident I finally had my appointment with my new primary care doc (PCP). This is a doc I've seen in the past, but had to go elsewhere because of insurance. I liked him, and after going to 3 different docs and not being happy with any of them, I decided to try this guy again. Initially he wasn't accepting new patients, but after a few months I found out he was and was able to make an appointment.
Of course the day of my appointment nothing was inflamed, so my doc told me to call for an immediate appointment the next time i had something flare up. About 2 weeks later my right wrist and index finger flared up and I was able to get an appointment. My doc looked carefully at my hand and wrist, declared I needed to see a Rheumatologist and ordered some blood work (Rheumatoid factor, sed rate, etc).
When I went to the rheumy I again had no symptoms, but he listened to me and diagnosed me within a few minutes. My rheumatoid factor (RF) was positive as was my Anit-CCP. Inflammation markers (CRP, Sed rate, etc) were normal or very close to normal. I don't have any nodules.
My pain varies...one day it may just be a twinge or stiffness in a joint or two....other times it feels like I've been beaten. Sometimes the pain lasts for just a few hours, other times it lasts for days or weeks. Most of the time I have no redness or swelling in the joint that's bothering me.
On the recommendation of my rheumy (after I told him I didn't like the idea of the newer RA meds), I've been taking Doxycycline, an antibiotic, I started the Doxy in January, and I think I'm getting good results, but I'm told it's too soon to tell if it's the Doxy or I'm just in a natural remission. I think it's the Doxy as the amount of joints involved and the amount of pain is MUCH less that what I'd had prior to starting it.
I am also trying to stick with a natural unprocessed diet that is low in carbohydrate, but lately that hasn't been going too well. I've had a lot of stress over the past 8 - 10 months and I'm a stress eater....and of course it's always the food that are the least healthy I reach for. I take probiotics and am going to look into digestive enzymes to see if they will help.
Unlike others, I have no real idea of what might have set my PR off. I've had plenty of infections, including urinary tract, intestinal (diverticulitis), and respiratory, but cannot link any of them to the onset of my symptoms. But, I firmly believe the theory that this is a latent infection, so will continue to use antibiotics to treat it. If one doesn't work I'll try another....and only go for the "heavy duty" RA drugs if all else fails. Maybe I'd feel differently if I had joint destruction, but at this point I am taking medication to relieve pain and inflammation.
I'm really not sure exactly when my PR started, but I know it was at least 2 yrs ago. For many years I've had osteoarthritis and of course any aches or pains are attributed to the osteo getting worse. I think the initial symptoms started in my feet and knees. There were times that my feet would hurt so much it was hard to walk. My feet/ankles would hurt for a few hours or days and then all would be good for a few weeks. Other times it would be my shoulders, or my wrists, or fingers. Initially I had little swelling and no redness, no matter what joint or how severe the pain was.
Since I didn't have a primary care doctor (PCP), I didn't do anything about the pains for several months....until my shoulders really flared up. Both shoulders, over a matter of a few hours, became very painful and any movement made it worse. I could lie on my shoulders (I always sleep on my side), but the least movement sent sharp pain down my arm. I went to see an orthopedic specialist about my shoulders and was diagnosed with bursitis. The day I saw the doc my pain was only about a 2 or 3 (not the 7-8 it could get to!) and I could freely move both arms. I had an ultrasound done and, since there was nothing abnormal seen, the doc declared that he was right, it was bursitis! (HUH?) The only treatment offered to me was cortisone injections, which I refused.
After a few months the shoulders suddenly were back to normal. If this was bursitis, it was certainly atypical!
A few weeks after my shoulders improved my ankles started to hurt. Most of the time it was just a bit painful to walk or move my feet, but every once in a while they would ache enough for me to take an over the counter (OTC) pain med (Acetaminophen, ibuprofen, etc), but got little relief. Again, I ignored the ankles.....I was still overweight (obese, bordering on morbidly) and figured with my age and weight it wasn't surprising that my ankles hurt....but wondered why there was no relationship between the amount of pain and the amount of walking I did.
One day last March (2007), my right ankle started to hurt and within a matter of hours it was so painful I could barely walk. Since I still didn't have a PCP, I went to urgent care and was told first it was gout, then it was "just an injury", even though I was positive I hadn't injured it! I was given a prescription NSAID (non-steroidal anti-inflammatory drug like ibuprofen) and the pain, swelling and redness was gone the next morning...completely! Either that was one heck of a medication or something else was going on.
This was the first time I noticed redness and swelling of a joint that was hurting....but it wasn't the last. Most of the time, if I get redness and swelling it's one of my fingers or my wrist. My shoulders and knees will be hot to the touch, but no redness and little swelling.
About 3 months after the ankle incident I finally had my appointment with my new primary care doc (PCP). This is a doc I've seen in the past, but had to go elsewhere because of insurance. I liked him, and after going to 3 different docs and not being happy with any of them, I decided to try this guy again. Initially he wasn't accepting new patients, but after a few months I found out he was and was able to make an appointment.
Of course the day of my appointment nothing was inflamed, so my doc told me to call for an immediate appointment the next time i had something flare up. About 2 weeks later my right wrist and index finger flared up and I was able to get an appointment. My doc looked carefully at my hand and wrist, declared I needed to see a Rheumatologist and ordered some blood work (Rheumatoid factor, sed rate, etc).
When I went to the rheumy I again had no symptoms, but he listened to me and diagnosed me within a few minutes. My rheumatoid factor (RF) was positive as was my Anit-CCP. Inflammation markers (CRP, Sed rate, etc) were normal or very close to normal. I don't have any nodules.
My pain varies...one day it may just be a twinge or stiffness in a joint or two....other times it feels like I've been beaten. Sometimes the pain lasts for just a few hours, other times it lasts for days or weeks. Most of the time I have no redness or swelling in the joint that's bothering me.
On the recommendation of my rheumy (after I told him I didn't like the idea of the newer RA meds), I've been taking Doxycycline, an antibiotic, I started the Doxy in January, and I think I'm getting good results, but I'm told it's too soon to tell if it's the Doxy or I'm just in a natural remission. I think it's the Doxy as the amount of joints involved and the amount of pain is MUCH less that what I'd had prior to starting it.
I am also trying to stick with a natural unprocessed diet that is low in carbohydrate, but lately that hasn't been going too well. I've had a lot of stress over the past 8 - 10 months and I'm a stress eater....and of course it's always the food that are the least healthy I reach for. I take probiotics and am going to look into digestive enzymes to see if they will help.
Unlike others, I have no real idea of what might have set my PR off. I've had plenty of infections, including urinary tract, intestinal (diverticulitis), and respiratory, but cannot link any of them to the onset of my symptoms. But, I firmly believe the theory that this is a latent infection, so will continue to use antibiotics to treat it. If one doesn't work I'll try another....and only go for the "heavy duty" RA drugs if all else fails. Maybe I'd feel differently if I had joint destruction, but at this point I am taking medication to relieve pain and inflammation.
Wednesday, March 12, 2008
You drink the Kool-Aid"
Ex-Drug Sales Rep Tells All
To sell their drugs, pharmaceutical companies hire former cheerleaders and ex-models to wine and dine doctors, exaggerate the drug's benefits and underplay their side-effects, a former sales rep told a Congressional committee this morning
Shahram Ahari, who spent two years selling Prozac and Zypraxa for Eli Lily, told a Senate Aging Committee chaired by Sen. Herb Kohl, D-Wisc., that his job involved "rewarding physicians with gifts and attention for their allegiance to your product and company despite what may be ethically appropriate."
Ahari claims that drug companies like hiring former cheerleaders and ex-models, as well as former athletes and members of the military, many of whom have no background in science.
"On my first day of sales class, among 21 trainees and two instructors, I was the only one with any level of college-level science education," Ahari told ABCNews.com on Tuesday.
During their five-week training class, Ahari claims that instructors teach sales tactics, including how to exceed spending limits for important clients, being generous with free samples to leverage sales, using friendships and personal gifts to foster a "quid pro quo" relationship, and how to exploit sexual tension.
"The nature of this business is gift-giving," says Ahari. He claims that he's heard stories about sales reps helping to pay the cost of a doctor's swimming pool and another doctor who was routinely taken to a nightclub where a hostess was paid to keep him company.
Drug reps develop a positive view of their drug and a negative view of the competitors, according to Ahari. "You drink the Kool-Aid. We were taught to minimize the side effects and how to use conversational ploys to minimize it or to change the topic.
According to Ahari, the benefits could be lucrative for sales reps, who tended to earn more than researchers. On top of a base salary for starting reps of $50,000, "there were four quarterly bonuses, an annual bonus, stock options, a car, 401K, great health benefits, and a $60,000 expense account."
Read the rest here.
Preaching to the choir, I know....but maybe it will bring about some changes!
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