Tuesday, July 8, 2014

Does getting medical care really have to be this hard?

["Can't you please just fit
me in somewhere?"
18th-c. engraving]
If you're my friend (or have read my blog), you know I'm (a) grateful for American medical specialists who have taken excellent care of my heart problems and (b) frustrated by the American medical system in general. It should not be so difficult to get good medical care.

Here's my story this week.

Late Wednesday afternoon I apparently had a TIA. It lasted less than 10 minutes, but TIAs shouldn't be ignored: they can mean a stroke is waiting to happen. To be safe, I went to the ER. They tested me and advised me to see my primary care physician or cardiologist early this week for follow-up tests.

Ideally follow-up tests for TIAs are done within 48 hours, but this was the Fourth of July weekend and my risk factors are low. I decided to call for an appointment after the weekend when medical offices reopened.

Monday, however, I learned that my primary care physician is on vacation. The PCP's triage nurse faxed my cardiologist's office an order for an echocardiogram, but they couldn't do it for two weeks or so. (If they did it earlier than six days from now, they told me, I'd have to sign a waiver saying I'd pay for the whole thing myself if my insurance company wouldn't. I have no idea what Medicare thinks about echocardiograms, so I demurred.)

Actually, though, my discharge instructions say that I need more than an echo. I also need a "an outpatient stroke workup including a carotid ultrasound ... and possibly additional testing." Because I don't have a physician's order for any of that, I need to see a doctor before getting the tests done.

So I called the cardiologist's office directly and learned he too is on vacation, and besides, he doesn't have any openings until September.

Next I called the hospital whose ER I visited, and they referred me to their cardiology team. Unfortunately the lady who answered the phone interrupted me (so I'm not sure if she knew what I was looking for) and connected me to a cardiologist's voice mail box. I hung up.

Next try: a different cardiology group. They neither answered their phone (after 15 rings) nor offered voice mail.

So I called the Johns Hopkins Heart and Vascular Institute. The man who took my call thought he could get me in to see a doctor 45 minutes from my home on Wednesday or Thursday, but before I could make the appointment, the call dropped.

I called right back, and the woman who took my call said the first available opening was a week from today, which is nearly two weeks after the TIA, also 45 minutes away. ("These appointments fill up fast," she explained.") I took it.

 I'm probably fine. It's very unlikely that any further problems will develop in the next week (or however long it takes to get the tests done after I see the doctor). If they do, of course, they could be major, and they could affect the rest of my life. But I'll just have to take my chances. What else can I do?

The American health care system is excellent - if you can figure out how to work it, and if you don't mind waiting, and if you aren't scared that you might get an enormous bill after the work is done.

Tuesday, June 24, 2014

Our summer vacation: 10 ways that moving house is like 2 weeks in Yucatán

[Chichen Itza, Yucatán]
[Our new front door]
July is the month when everybody in our neck of the woods goes on vacation. Everybody but us. We're not going on vacation, but we are moving to a new house. And really, there's not much difference.

1. We will spend two weeks without doing any paid work.

2. We will pack and unpack repeatedly (and when we arrive, we'll realize we brought a lot more stuff than we needed).

3. We will take our dogs to the dog sitter.

4. We will go to a place where we don't know where the light switches are or how to set the thermostat.

5. It will be hot.

6. We will be surrounded by people who speak with strange accents.

7. We will eat in fast-food restaurants.

8. We will climb stairs.

9. We will spend a ton of money.

10. And when it's all over, we'll be so happy to be home again.

Sunday, June 15, 2014

What's missing in the fight against puppy mills

Another day, another puppy-mill outlet.

I was distressed to learn yesterday that Naperville, Illinois - the next town over from where I used to live, and in most aspects a very progressive community - is allowing yet another puppy-mill-sourced pet store to open within its limits. Some residents of this wealthy Chicago suburb are rising up in predictable - and entirely justifiable - outrage (the blog post I just linked to is headlined "Naperville: The puppy mill outlet capital of America").

The blogger says she isn't trying to shut down pet stores; she just wants them to "go humane...to switch to an adoption model with rescue dogs instead of continuing to sell puppies at the expense of the parent dogs left behind in puppy mills...breeding litter after litter."

[My favorite pound puppies]
I get that. I got my own little dogs through a rescue group many years ago. Tiggy the mini-schnauzer mix was a young mother whose previous owners surrendered her, very pregnant, to the pound because, they said, they had "too many dogs." Muffin the toy poodle mix (and empress of the universe) was running wild in one of Chicago's meaner streets when animal control picked her up. The dogs are now at least 13 years old, and I love them dearly. I am a big fan of rescue groups and of the people who work tirelessly so animals will have better lives.

But something important is missing from nearly every call to shut down puppy mills. Folks, we've got to look at why puppy mills exist in the first place. It isn't just so the people who run them can make money. It's because lots of people want puppies.

Try this thought experiment: Imagine that every puppy mill in the U.S. was shut down, and every dog owner made sure their dog was spayed or neutered, and every pet store worked with shelters and rescue groups to re-home rescued dogs. A lot fewer dogs would be discarded, to be sure, and a lot more discarded dogs would quickly find homes, and that would be wonderful.

But very quickly all the available puppies would be gone, along with all the bright and attractive young-adult dogs, and the only dogs left would be the old ones, the ugly ones, the dangerous ones - the very dogs that are so hard to place right now.

And then where would people go to get puppies?

Good breeders, you say? Have you ever tried to find one?

The Humane Society publishes an excellent document called "How to find a responsible dog breeder." If you're looking for a puppy, you should read, mark, learn, and inwardly digest it. But it has two problems, if we really want to solve the nationwide puppy-mill problem. First, such a breeder tends toward very small-scale operations and "doesn't always have puppies available." More realistically, such a breeder tends to have puppies available once every year or so, and the waiting list may be extremely long.

The second problem is that such a breeder requires you to "sign a contract that you will spay or neuter the dog unless you will be actively showing him or her." The aim, of course, is to cut down on unwanted puppies. The result, however - if all breeders followed the Humane Society's guidelines (this is a thought experiment, right?) - would be that the only available dogs would be potential show dogs.This could lead to genetic problems with the whole dog nation. It would certainly lead to extremely high prices for puppies. And there would be no more havanoodles and schnorkies and goldendoodles.

What's missing in the fight against puppy mills is a long-term solution. Shutting down the mills, adopting rescued dogs, spaying and neutering pets--good as these things are, they are all interim solutions. We need to come up with new ways to provide healthy, happy (but not necessarily purebred) pups at a reasonable price to families who can't afford potential show dogs, and whose children want a dog now and not three years in the future when their name finally comes up on the responsible breeder's waiting list.

One way to accomplish this would be strict regulation (with frequent inspection and adequate enforcement) of all pet breeders nationwide. I'm guessing this won't happen: it would cost money, and taxpayers who aren't willing to fix the ten percent of American bridges in urgent need of repair probably aren't going to open their wallets to help puppies.

So what's the solution? I wish I knew. One thing I never read about: large-scale (or even back-yard) puppy breeders who take good care of their dogs. Do these people exist? If so, could we learn more about them? Could we hold them up as examples?

Shaming cruel puppy mills is important, but it hasn't shut many of them down. Offering practical alternatives might be more effective. Can we do both?

What ideas do you have about better ways to connect puppies with the people who want them? Please comment!

Thursday, May 29, 2014

The worldwide obesity epidemic - bad reporting, fairly useless advice, and government subsidies

[(c) Showface|Dreamstime Stock Photos]
One of this morning's headlines from Worldcrunch "While You Slept":

Don't choke on your doughnut until you've looked at the statistics. No matter how much you hated high-school math, surely you can do better than the people who wrote this headline and the accompanying article.

First, note that 2.1 billion is not a "more than a third" of the world's population, which has passed 7.2 billion. It's more like 29%.

Second, don't be unduly alarmed by the article's report that the number of oversized people has increased from 875 million in 1980 to 2.1 billion today. Remember that there weren't as many people 34 years ago - fewer than 4.5 billion. Even in 1980, nearly 20% of the world's population was overweight or obese.

Bad reporting aside, however, we still have a problem. We still have a worldwide overweight/obesity rate that's 45% higher than it was in 1980. This would not be important if it were only a question of good looks. People come in all sizes, and all can be beautiful. What's scary is not people's appearance, but their health. 

Sadly, "the number of Americans with diagnosed diabetes has more than tripled" since 1980, says the Centers for Disease Control.* And by the way, up to 20% of people with Type 2 diabetes are neither overweight nor obese.

Cue the "experts" - we're eating too much, we're exercising too little. Well, that's probably true for most of us, but it doesn't adequately explain the statistics, and it certainly doesn't explain those skinny diabetics. Here's a better explanation from Mark Bittman's summary of another recent study:

White table sugar. Molasses. Maple syrup. All those deceptively labeled ingredients like "cane juice" and "fruit juice concentrate." And, of course, high fructose corn syrup - heavily subsidized by the U.S. government and exported all over the world. According to the study, Bittman writes,
 it’s not just obesity that can cause diabetes: sugar can cause it, too, irrespective of obesity. And obesity does not always lead to diabetes. The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s.... And just as tobacco companies fought, ignored, lied and obfuscated in the ’60s (and, indeed, through the ’90s), the pushers of sugar will do the same now.
Thanks for reading. You can choke on your doughnut now.
*The CDC is right about tripling: the number has gone from 5.6 million (1980) to 20.9 million (2011). But of course the U.S. population also increased between 1980 and 2011, so I did the math. The diabetes rate in 1980 was 2.46%; by 2011 it had climbed to 6.71%. That's a 273% increase.

Monday, April 21, 2014

Papa don't preach - but family-friendly work policies would be nice

[Alfred Stevens, "The Widow," 19th c.]
"Single moms are rarer in America than France, Sweden, New Zealand, the UK, or the Netherlands" screams today's headline by Matthew Yglesias on vox.com.

"And honestly, it's no big deal," sighs an exasperated Swiss friend of mine, weary of conservative American Facebook memes. Unmarried mothers apparently do just fine in Switzerland (though admittedly the Swiss rate of 20.2% of births to unmarried women is considerably lower than the American rate of 40.7%).

Actually, though, it is a big deal in the United States, for several reasons.

1. An unmarried mother is not necessarily a single parent, and America has a higher percentage of single parents than any of those other countries.

Some couples choose not to marry, but they raise their children together. They are unmarried, but they are not single parents. Others marry briefly, but they divorce while their children are small. They become single parents.

The majority of children in France and Sweden are now born to unmarried mothers, but only about 20% live in single-parent families. Compare that to the United States, where over 40% of children are born to unmarried mothers, and about 30% live in single-parent families. America may have fewer unmarried mothers than France or Sweden, but it has half again as many single parents--and being a single parent isn't easy.

2. Single parents fare better in countries whose policies support working women than in the one developed country - the United States - whose policies don't.

And not just single parents. As Judith Warner details in an excellent New York Times piece published yesterday, women fare better in countries and states that mandate paid family leave (including maternity leave) and sick days; and that provide affordable early childhood education, child care, and workplace flexibility for all workers, not just highly paid professionals.

In other words, women in general - and single parents in particular - fare far worse in America than in any other developed country, because the United States is the only developed country that does not provide at least some of these benefits to all who need them.

3. America's haphazard family policies and programs have led to America's high rate of economic inequality.

Ms. Warner's article is titled "To Reduce Inequality, Start with Families."  We Americans, to our shame, have failed to support families, and our inequality score is 41 on the Gini scale (where 0 is perfect equality and 100 is perfect inequality)--worse than that of France (33), Sweden (25), New Zealand (36), the United Kingdom (36), the Netherlands (31), or Switzerland (34). "If we want to strike at the roots of inequality in America," Ms. Warner writes,
we’ve got to start at its source, in the family, at the very beginning of children’s lives. We have to make it possible for mothers — two-thirds of whom are now breadwinners or co-breadwinners for their families — to stay in the work force without the sort of family-related job interruptions that can greatly limit their lifetime earnings and even push some families into bankruptcy. We need to make it possible for all parents to give their kids the kind of head start that is increasingly becoming an exclusive birthright of the well-off.
4. As long as Americans refuse to provide the social supports that allow women to flourish, single- parent families - 86% of whom are headed by females - will continue to bear the brunt of economic inequality.

On April 20, the same day that Matt Yglesias listed unmarried motherhood statistics and Judith Warner's piece appeared in the New York Times, the Wall Street Journal published an article headlined "Ignoring an Inequality Culprit: Single-Parent Families."  In it, Robert Maranto wrote that "the strongest statistical correlate of inequality in the United States" is "the rise of single-parent families during the past half century." If only we could persuade poor people and racial minorities to get married, he seems to think, poverty would decrease, upward mobility would increase, and we would solve all manner of emotional, psychological, educational, economic, and behavioral problems.

To be sure, growing up in a two-parent family is a child's best hedge against poverty, not only in America but in the other OECD countries as well (even Switzerland). But the reality is that a high percentage of children around the world are growing up in single-parent homes.

And the shameful reality is that if those children are American, they will suffer more than they would if they were French, Swedish, British, Swiss, Kiwi, or Dutch. In spite of the fact that many Americans think America is a Christian nation. In spite of repeated biblical admonitions to care for families without husbands and fathers.

Monday, April 14, 2014

Killing people is hard to do

[Moose's last photo]
Twelve years ago we took our beloved Maltese dog, Moose, to the vet and came home without him. Moose was in the late stages of congestive heart failure, and many times each day he was wheezing and crying out in pain. While my daughter held the little dog, the vet gave him a shot. It was over very quickly.

Why don't we treat death row prisoners at least as well as we treat dogs?

"Secret Drugs, Agonizing Deaths" is the headline on an article in yesterday's New York Times. Back when executioners wielded axes, they tended to wear hoods so people wouldn't recognize them. Nowadays states still conceal executioners' identities - and much more. "In the past year, Georgia, Missouri, Tennessee and other states have expanded the reach of their secrecy laws to include not just the execution drugs used, but even the pharmacies that supply them. These laws," say the authors of the article, "hide the information necessary to determine if the drugs will work as intended and cause death in a humane manner."

Too often they don't.

European drug manufacturers, opposed to capital punishment, have stopped producing the drugs that once killed American prisoners quickly and painlessly (read about it here and here). Americans have tried a number of substitutes, causing a lot of pain in the process.

The problem isn't that it's hard to kill someone without inflicting pain. Our vet could do it. 

But of course he wouldn't. And most of the world's drug manufacturers wouldn't. And of those who would - some American lawmakers, some American prison officials, some American executioners - few want the details made public.

The problem is that killing a fellow human being, even one who has incontrovertibly committed heinous crimes, is  a disgusting business. Even for people who favor capital punishment.

In his newest book, A Call to Action: Women, Religion, Violence, and Power,  President Jimmy Carter points out that "the United States is the only country in NATO or North America that still executes its citizens, and Belarus and Suriname are the only exceptions in Europe and South America."

Maybe our aversion to knowing the details about capital punishment is a first step toward joining the rest of the world with a more humane policy. Maybe instead of closing our eyes to what we are doing, we should open our eyes wide - and then stop doing it. If we are too humane to ask veterinarians to kill prisoners painlessly, let's be too humane to kill them at all.

Life in prison is punishment enough. And though it's expensive, it's not nearly as expensive as execution. As Fox News has pointed out, "Every time a killer is sentenced to die, a school closes."

Friday, March 28, 2014

Liminal Living vs The Impossible Dream

[A. Casolani, 16th century]
We are househunting.

Will our new place be a relatively new condo with no exterior maintenance, plenty of storage, an open floor plan, lots of bathrooms, and no stairs?

Will it be a city rowhouse that is older than we are, has arches and built-in cabinets and red oak plank floors, and is walking distance from a university, bookstores, and libraries?

Whatever we dream of, will our retirement income be sufficient for both the house and, say, groceries?

And will we still be able to live in it when we're crippled, incontinent, and demented?

I've been asking myself that last question with every house I inspect, which is probably why I've been getting more and more depressed. Medieval folk kept cheerfulness at bay by contemplating skulls. An afternoon of looking at potential retirement homes, I've found, also works.

Last week I blogged about our liminal lodging - the apartment we've rented for a few months to tide us over until we find our, um, final resting place. (Snap out of it, LaVonne!) This morning I had one of those blindingly obvious insights that you sensible people have understood all along: Life itself is liminal.

As I mentioned last week, it's good to put a threshold between one phase of life and another. Living in our  rented apartment is allowing us to do that. But I'm deluding myself if I think our next house is going to be permanent - just as suitable to our life in 30 years, when we're 95 and 96, as it is to our life today. I'm glad I figured that out, because I'm not all that excited by houses that would presumably appeal to nonagenarians.

In my search for the permanently perfect place, I've been driving my realtor to distraction ("I keep getting mixed messages from you," she says, and then five minutes later she says, "But you have such specific requirements"). Bless her, she persists in spite of me. She's even cheerful, or at least pleasantly resigned.

However, she did tell me about a friend of hers who made himself miserable for years because he wanted so badly to give up smoking and thereby live forever, and he simply couldn't do it. At age 42, having stopped to help a stranded motorist, he was struck and killed by a drunk driver.