Category Archives: Healthcare

Greensboro Man’s Battle With Cancer and How He Shared His Journey via His Blog

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A Greensboro man named Brian Stoll, whom I never met and had never heard of until today, lost his battle with cancer and passed away on July 15.  I’m not sure how I came across his blog but when I did I was captivated by how he shared his experiences from the original diagnosis until two days before his death.  His family wrote a final post on the 15th.

The blog is difficult read when you know that Brian has already lost his battle with cancer, but I think that by sharing his struggles he created a valuable resource for people who are just beginning their battles with cancer or those with a loved one recently diagnosed with cancer.  If nothing else they will get an idea of what lies ahead for them and perhaps they won’t be blindsided as often as they would have been without reading his blog.

Brian was a man of great religious faith so his writing alternates between being a straightforward account of his deteriorating health and an account of how his faith is an integral part of dealing with it.  If anything his faith got stronger as his body got weaker.  Here’s a sample from a post titled "Give me some oxygen, PLEASE…":

The outpouring of response from my Preparing to Die post has
been overwhelming. I haven’t been able to respond to everyone yet. My
lung capacity continues to shrink, making simple conversation a
difficult chore. Thank goodness for email and this blog. It is so easy
to communicate with everyone via the written word versus having a
conversation. This brings me to my next update. My physical ability is
so limited now. How so? Walking up a flight of stairs is darn near
impossible. I now have to sit on the bottom step, with my back facing
the steps, and “rear end” my way up the stairs over a two or three
minute process. Walk outside to get the newspaper? Thank goodness my
driveway is only about 50 feet long. Run around the house terrorizing
the dogs while everyone else laughs? No more. Go hiking with Brookie in
the mountains. Unfortunately, those days are gone. Play a round of golf
with friends? Never again. This has been one of the difficult mental
obstacles to overcome. I have so much time on my hands now, so I tend
to sit and think about all the fun stuff I have done in my life. Brooke
and I love to go hiking. It is classic daddy/daughter time, plus we
both love nature and the outdoors. I can’t do that anymore. Dammit,
that thought makes me very angry and sad at the same time. I am being
robbed of my ability to enjoy my family. That’s not fair! BINGO! Poor,
pitiful me. You selfish idiot. Why can’t you relish the fact that you
WERE able to enjoy these things in your life? Do you not understand
there are some people who will never go hiking, who will never see a
beautiful mountain stream, and never be able to enjoy God’s wonders?
Sometimes I feel so stupid. I really do have to work on getting away
from the selfish junk and being thankful that God has blessed me in so
many ways. The reality angel that sits on my right shoulder can really
give it to me sometimes.

Another mental obstacle that I have
finally succumbed to is the fact that I need a wheelchair to get
around. Truth be told, I simply cannot walk more than 50 feet without
getting winded. The wheelchair makes it so much easier to get around,
plus it’s a real snazzy new model. Lot’s of bling,ya know? I also got a
handicapped placard for my Suburban. Although I may not live to be 90
years old, I sure do feel like it now! I’m also very dependent on
oxygen. When your oxygen content in the bloodstream gets below 90% you
become oxygen starved. This causes panic, anxiety, disorientation,
restlessness, shakyness in my speech, etc. When this happens, I feel
like a fish out of water. Panic is the first thing to set in, and then
I realize I can’t do anything to help myself. This turns into a very
precarious situation resulting in a panicked frenzy. Kimberly will get
the oxygen machine turned on and puts the tubing in my nostrils. Then
she sets up the morphine nebulizer. Ah yes, the morphine nebulizer.
It’s a little machine that takes small amounts of morphine and saline
and turns them into a mist, which is then inhaled through a pipe. This
is starting to sound like illegal drug activity, eh?!? The morphine
calms down the lungs by changing the way it processes oxygen. Simply
put, it helps me to breath once again. Lately I have been taking 3-4
morphine treatments a day. The events leading up to the treatments tend
to be very frenzied to say the least. Never a dull moment.

In his last post Brian lamented about how he was no longer able to provide for his family and he quite openly discussed the financial devastation wrought by his cancer treatments.  I can easily imagine the frustration he felt and I’m sure it was extraordinarily difficult for him to write and ask for help, but that’s what he did with his last post.  His childrens’ college funds were spent on his treatment so his family set up a fund called "Breanne and Brooke’s Future" at Wachovia so that people who want to can help out (just visit any Wachovia branch to make a donation if you want). 

It takes a very big man to put aside his pride and ask for help and by doing so I think Brian showed exactly what kind of man he was.  After spending just a few minutes reading his blog I truly regret that I never had the chance to meet him. 

His family wrote, "Keep the family in your thoughts and prayers and remember that we were
blessed to have had him but Heaven is in Awe at what it has received."  The man obviously left a great legacy.

A Sleeping Pill You Won’t Catch Celeste Taking

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Celeste (my lovely wife) hates ingesting anything that makes her feel like she’s losing control.  She doesn’t mind the occassional drink, but she rarely gets drunk because she hates losing control.  Her parents never had to worry about her taking drugs because she wouldn’t have been able to handle the feeling of getting stoned.  Hell, I’ve seen her almost hyperventilate when she’s smelled someone smoking weed.

On the other hand Celeste is like most other women who have hit their 40s, have young teenagers and a pain-in-the-butt, no-good husband who snores like a bear in hibernation: she has a heckuva time sleeping.  Every once in a while she’ll take a mild over the counter sleeping aid, but I can almost guarantee you that she’ll endure massive sleep deprivation before she’ll take zolpidem, which in the US is known as Ambien and in Australia is known as Stilnox.  Apparently there have been some pretty interesting side effects reported in Australia:

A woman taking the drug "woke with a paintbrush in her hand after
painting the front door while asleep," the Adverse Drug Reactions
Advisory Committee said in a bulletin published yesterday.

Another patient reportedly gained 23 kilograms over seven months while taking Stilnox.

"It was only when she was discovered eating in front of an open
refrigerator while asleep that the problem was resolved," the bulletin
said.

The committee also received two alarming reports "which suggest the possibility of driving while asleep."

The new study marks the first time "inappropriate or strange automatic
behaviour" related to Stilnox has been noted in Australia since the
drug was introduced here in 2000, although cases have been reported
overseas.

The health department also received 104 reports of hallucinations and 62 of amnesia relating to the drug.

Found via Boing Boing.

Blue Cross Could Have Sent Some Vaseline Too

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Remember the truism that nothing is certain but death and taxes?  I think that needs to be revised to state "nothing is certain but death, taxes and massive annual rate hikes from your health insurer".  Actually that last could probably be better stated as an "annual screwing from your health insurer".

We recieved a letter from our health insurer, BlueCross BlueShield of North Carolina (BCBSNC), that begins as follows:

Dear Valued Blue Cross and Blue Shield of North Carolina Member:

Thank you for choosing Blue Cross and Blue Shield of North Carolina (BCBSNC) for your health insurance needs. We value your continued membership and want to let you know about some upcoming changes to your Blue Advantage premiums and benefits.

Most Blue Advantage subscribers will have a premium adjustment in 2007.   This will be your guaranteed premium until January 1, 2008, unless you switch plans, add dependents or purchase additional coverage.

Blue Advantage is the most popular individual insurance plan in North Carolina and currently serves more than 315,000 members. Your Blue Advantage premium adjustment is based on the health care costs of all Blue Advantage members and is impacted by factors such as where you live, your benefit design, your gender and your age. For example, if you had a birthday in the past year that put you in a new age-bracket category, it may have had an effect on your January 1, 2007 premium adjustment.  Your individual claims do not have an impact on your annual premium changes.

Here’s the thing: our premiums were about $595 a month this year, which was up about 10% over the year before.  This is a 35% increase from ’06 to ’07!  Celeste and I both turned 40 this year and so I went to the BCBSNC rate quote website and found that if I compared rates for us at the age of 38 and 40, the quote for age 40 was about 8% higher.  So where in the heck did the rest of the increase come from?

What kills me is that there are NO factors that say anything about our personal health choices.  Why can’t we get credit for exercise?  Why can’t we get credit for a healthy diet?  Why can’t we get credit for our general health?  They can lump us in with the rest of the people who are individually insured, essentially treating us as a group health plan, but they give us no control over how we might control costs.  This is BS!

Here’s something else that just pisses me off about this: BCBSNC is a non-profit that has been accused in the past of making too much profit and in fact they made a concerted PR push last year to point out that they were reducing their profits.  They were sensitive enough about it that they sued an advocacy group called ProCare over the group’s disclosure of what BCBSNC said were confidential business sources.  Of course that doesn’t mean that ProCare was wrong and one of the documents in dispute detailed how BCBSNC spent $478,000 to sponsor the US Open.  And my old employer, Atlantic Information Services, had a piece in ’05 about how states, including North Carolina, are going after the "Blues" for reserves that are too high.  The point is that non-profits have reasons for existing that go beyond profits which is why they get their special status and treatment from our friends in government, and I can tell you that if the non-profits I worked with spent money the way BCBSNC seems to they’d be in a heap of trouble.

We can change our coverage options (higher premium, higher co-pays, etc.) to bring down our monthly premiums, and we might end up doing that, but we’re also going to seriously consider a Medical Savings Account.  We’ve been looking at MSAs for a while, but we were kind of scared off by the "newness" of them.  I also remember reading about UnitedHealthcare getting ready to offer individual health coverage in NC (right now BCBSNC has a monopoly in the state) and we’re going to check them out as well. BCBSNC has given us a lot of motivation to look at ALL of our alternatives. 

Here’s my final observation about these jokers and another truism in the realm of business communications: any letter that begins with "we value your continued membership" is the setup for a royal screwing and out of kindness should be accompanied by a small package of personal lubricant.

By the way, this experience just gives me further evidence that Dr. Feld is right about the need for true competition and free market reforms in the healthcare marketplace.

BB&T to Offer HSAs

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BB&T, a rather large bank based here in Winston-Salem, announced
today that they will begin offering Healthcare Savings Accounts to
commercial clients through their employee benefit subsidiary.  From the
article:

BB&T Corp.
will begin offering health savings accounts, or HSAs, to qualified
clients interested in an alternative to traditional insurance plans,
the company has announced.

HSAs allow account holders to make tax-deductible contributions
that can be withdrawn tax-free when used for qualified medical
expenses. Unlike flexible spending accounts, money left unspent at the
end of a year remains in the account.  

Winston-Salem-based BB&T (NYSE: BBT) will offer HSAs to
institutional and commercial clients through its employee benefit
subsidiary Stanley, Hunt, Dupree & Rhine. The company will also offer the accounts to retail clients who are covered by high-deductible health plans.

Having been self-employed or owner of a small business for much of
the past 10 years I’ve been keeping an eye on these things.  The
biggest thing they have to overcome is the fear factor for people used
to traditional health plans and HMOs and the sticker shock many will
experience when they look at the out-of-pocket expenses before they
reach their deductible limit.  They’re also often confused with "use it
or lose it" plans so people are worried they won’t get to keep the
money they don’t spend.

Some view the HSAs as just another way for businesses to shift the
financial burden of healthcare to their employees, but especially in
the case of very small companies HSAs may offer the only way to provide
any health benefits.  And for the self-employed it’s definitely
something they consider.  Here’s some back of the envelope calculating:

Say you have a family of five, you’re with a traditional health
insurance company like BSBCNC and you pay $700 in premiums per month
which gets you 80/20 coverage for all medical procedures (you have to
cover 20%) and a deductible of $2,500 per year.  On top of that you pay
$30 per office visit and $15 per prescription.  Let’s assume that each
person in the family goes to the doctor once a year (very optimistic)
and gets one prescription per year and no one needs a medical
procedure.  That means your total expenditure for the year is $8,625
and if anyone in the family has to have an operation or stay in the
hospital you’re talking $10,000+ per year.

With an HSA, which is tied to a high-deductible health insurance
plan, you’re probably looking at premiums in the range of $300 per
month and a deductible of $5,000 per year minimum.  Assuming that
co-pays and drug benefits are about the same your looking at saving
$400 month in premiums or $4,800 year.  If you contribute the same
amount per month to your HSA account that you were paying in premiums
you’ll end up spending the same amount of money IF someone in your
family is sick and you exhaust your entire deductible. But if no one
gets sick you get to keep the money you don’t spend in the HSA account
and roll it into the next year, kind of like an IRA.  After a couple of
years you can actually reduce the amount you contribute each month
because you will have built up a cushion that more than covers your
deductible and incidental medical expenses.  With a traditional
healthcare plan your premiums are gone whether or not you’ve been
sick.  In other words the insurance company is keeping your money even
if you and your family have been as healthy as a horse.  The icing on
the cake is that your contributions to the HSA are tax deductible and
my understanding is that you can pay for things like over-the-counter
meds with the account as well.

One problem that HSAs have had in the past is that they’re typically
offered by
companies that no one has heard of so it makes people nervous turning
over such an important safety net to an unknown entity.  With name
brand companies like BB&T getting involved I think you’ll see these
things take off, so if you’re self employed or are a small business
owner you might want to check them out.

Also posted at Lowder Enterprises blog and Winston Salem Business.

Unexpected Benefits of Being a Wetmouth

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I have a few physical attributes that I find truly annoying.  First, I seem to be replacing all the hair I’m losing from my head with hair on the rest of my body, particularly my back.  I’ve seen guys with worse back hair (much worse) but I’m not happy that I’m starting to resemble Bigfoot.  Second is my amazing propensity to sweat.  It can be 50 degrees outside and if I walk more than a couple of blocks I’m in a full-on, shirt-drenching sweat.  It truly makes the summer miserable sometimes.  Third is my mouths ability to produce spit.  It usually doesn’t bother me that much, but when I go to the dentist it’s a royal pain in the ass.  If they don’t have that sucker thing in there just right I can drown in a matter of seconds while the hygienist is blissfully scraping away.

Well, I think I need to embrace my spit glands.  I just read this little item at Freakonomics:

As much as I generally dread the dentist’s chair, I always wind up
learning something. Yesterday was no exception. I was asking Dr. Reiss
about the causes of tooth decay—genetics vs. diet, etc. etc.—when he
began explaining why toothpaste is such a bogus product. Any claims
that toothpaste makes about preventing decay, whitening teeth, etc.,
are totally falacious, Dr. Reiss told me, because the F.D.A. can’t and
won’t allow the ingredients necessary to perform those chores in an
over-the-counter product that children can easily get hold of. (That’s
why he recommends an antibacterial product like GlyOxide, a fairly
foul-tasting but apparently effective means of killing the bacteria
that cause decay.)

The other thing I learned yesterday was
far more interesting, with far greater implications. He told me that
tooth decay in general, even among wealthy patients, is getting worse
and worse, particularly for people in middle age and above. The reason?
An increased reliance on medications for heart disease, high
cholesterol, depression, etc. Many of these medications, Dr. Reiss
explained, produces drymouth, which is caused by a constricted salivary
flow; because saliva kills bacteria in the mouth, a lack of it means
increased bacteria, which leads to increased tooth decay. Given the
choice of taking these medicines versus having some tooth decay, I’m
sure most people would still choose the medicines—but I am guessing
that most people haven’t thought about the link between the two.

So my spit is my friend!  Maybe I’ll discover equally encouraging news about my sweaty ape tendencies, but somehow I doubt it.

This is Your Brain. This is Your Brain on…

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So Bill Gates sets up a huge non-profit foundation with his wife that is funding some amazing projects around the world.  What has his old partner, Paul Allen done?  Well let’s see. 

Researchers at the Allen Institute for Brain Science
in Seattle are today celebrating the completion of a new digital atlas
of the mouse brain. The achievement will likely lead to a greater
understanding of how the human brain works…

Mice brains and human brains have significant differences, but are
similar enough that a complete "atlas" of the mouse brain is seen by
many scientists to be as important a milestone as the Human Genome
Project, which mapped the DNA sequence.

Paul Allen, who co-founded Microsoft 30 years ago with Bill
Gates and is one of the world’s richest men, donated $100 million to
create a searchable 3-D digital map called the Allen Brain Atlas. The map is the inaugural project of the Allen Institute for Brain Science…


Allen’s funding helped to assemble a dream team of scientists, who
methodically scanned ultra-thin slices of mouse brain with the aid of
robot helpers. Those scans help to identify how individual genes are
"turned on" in different areas of the brain…

Link to related text and images at Wired News.

You know I’m starting to feel a little better about all the cha-ching I’ve spent on Office and Windows over the entire span of my adult life.  Here’s a sample pic from the atlas:

Mousebrain

Apparently I’m Healthy, but That Doesn’t Mean There’s Nothing Wrong With Me

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So I’m closing in on 40 and apparently that fact has caused me to jettison my normal attitude of indifference towards my health.  The result is that I’ve had my first physical in years and I’ve begun to listen to my wife about my supposed issues which led me to voluntarily participate in a sleep study on Monday night.  Here’s what I’ve learned, first from my physical:

  • God has blessed me with a good ticker.  My resting heart rate is 47 beats per minute.
  • Having a hairy chest is not conducive to the pain-free administration of an EKG. Taking those little bastard electrodes off does NOT tickle.
  • I’m a wuss.  When they went to draw blood and missed the first six times I almost passed out.  My doctor assured me that it had something to do with my miraculously low heart rate but I think he was just trying to soften the blow to my manhood.
  • The little rubber hammer thingy doesn’t have any effect when it is used to repeatedly strike me in the knee. Apparently my wife was correct in her assessment that I am insensitive.

This is what I learned from my sleep study:

  • It is quite difficult to sleep comfortably with electrodes stuck all over your face and scalp.
  • For some reason they also stick electrodes to your knees; I believe it is to make it difficult to pee in the morning, which it is.
  • It is considered normal to wake up 1-5 times per hour due to changes in breathing, but it is a mild case of sleep apnea to do so 6-15 times per hour and severe apnea to do so 16-30 times.
  • I wake up an average of six times per hour.  Funny enough I wake up once an hour if I’m sleeping on my side and 12 times per hour if I’m sleeping on my back.  I spend equal amounts of time on my back and on my side.
  • The prescription they have for me is to learn to sleep on my side at all times.  Their suggestion is for me to sew a pocket on the back of a t-shirt and insert a tennis ball so that I can’t lie on my back comfortably.  They figure it should only take 4-5 months for me to be properly trained.  This smells suspiciously like common sense to me, which of course makes me instantly suspicious.  Where’s my magic pill?
  • My heart rate when I’m sleeping is 45 beats per minute and my oxygen level stays above 90% which is apparently good.
  • I still snore loud as hell. They couldn’t prescribe anything to help my wife with that.
  • In the world of the sleep study folks I’m considered a moderate snorer; I feel for anyone who has to live with someone considered a truly loud snorer on their spectrum.

I wish I’d taken a camera with me to have my picture taken with all the stuff plastered on my head.  I looked like something out of a bad 70s sci-fi movie. 

The final analysis is that it looks like I’m healthy as a horse which is a good thing. Knock on wood.  Luckily no one has looked into my mental fitness…yet.

Repairing the Healthcare System

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I don’t have any suggestions for repairing the healthcare system, but I’m hoping this blog does.  The blog’s author is the father of Brad Feld who is one smart dude and prominent blogger.

From his first post:

However, in 2006, the patient and the physician are generally listed last among “important” stakeholders by government, insurance companies, hospitals and policy makers.

Since
the patient is most important stakeholder. The patient should be in the
forefront of policy making. The physician is second.  All the other stakeholders are in reality simply facilitators for the patient and the physician. Everything done in the healthcare system should be done for the benefit of the patient first, and not for the economic bottom line of the other stakeholders. After all it is the patients’ healthcare system! Is it not?  The demand for repairing the healthcare system and action to fix it has to be made by the patient,

There’s Accountability and then There’s Accountability

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In an act that would scare the pants off of any doctor the Freedom of Information minister in Scotland ruled that the mortality rates of the patients of the almost 1,000 surgeons in the country could be made publicly available.  In other words each of the surgeons’ success rates are now public knowledge. (Read about it here).

The head healthcare dude for the country said that he didn’t understand why the data was made available "because it did not provide details of individual patient cases."  Well, I’d argue that it would then be in the best interest of the doctors to make sure that the details were made available so that the public could have some context, but it is definitely in the public’s best interest to have this data available.

Now before you jump all over me here I think this is a two way street.  If we’re going to hold doctors accountable (which I argue for) then we need to also protect them from frivolous lawsuits, and I actually think that this kind of "sunshine" on doctor data will help doctors.  After all if we can say that 90% of patients that have a certain procedure die (100% die without it) then we can’t hold the surgeon responsible if it goes wrong.  On the other hand if 99% survive a procedure and a doctor manages to lose 10% of his patients then that’s another issue.

Of course I don’t see this becoming an issue in the US.  The medical establishment will fight "sunshine" laws until their last breath and lawyers will never go for anything that would put a crimp in their market.

Reading List October 24, 2005

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  • The Entrepreneurial Mind Set (Moore’s Lore) – Dana Blankenhorn is entering the entrepreneurial realm himself and it has caused him to take that position that countries like China and India are developing more entrepreneurs, the US education system stinks and the Baby Boomers have killed the golden goose (the last are my words, not his).  It’s an interesting take on our society right now.
  • The Fall of the Warrior King (New York Times Magazine) – The story of Col. Nick Sassaman, his role in Iraq and how it led to his fall from grace.
  • Good News: People are Social Animals (Fractals of Change) – Tom Evslin talks about why peer-driven services on line have developed, and how/if they will continue to work.