Wednesday, September 30, 2015

A Little Health Insurance Humor (Courtesy: yananow.org)



FAQ on HMOs

Q. What does HMO actually stand for?

A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes.

Q. I just joined an HMO. How difficult will it be to choose the doctor I want?

A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. These doctors basically fall into two categories-those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan. But don't worry; the remaining doctor who is still in the plan and accepting new patients has an office just a half-day's drive away, and a diploma from a Third World country.

Q. Do all diagnostic procedures require pre-certification?

A. No. Only those you need.

Q. Can I get coverage for my preexisting conditions?

A. Certainly, as long as they don't require any treatment.

Q. What happens if I want to try alternative forms of medicine?

A. You'll need to find alternative forms of payment.

Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the Generic Medication, but it gave me a stomach ache. What should I do?

A. Poke yourself in the eye.

Q. What if I'm away from home and I get sick?

A. You really shouldn't do that.

Q. I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a radical prostatectomy right in his office?

A. Hard to say, but considering that all you're risking is the $15 co-payment, there's no harm in giving him a shot at it.

Q. Will health care be different in the next century?

A. No. But if you call right now, you might get an appointment by then.

Ultrasound Update

I had the renal ultrasound today to see if there's anything wrong with my kidneys that be contributing to my ongoing hypertension.
It took about 30 minutes as I had to have two separate tests because of a minor miscommunication between my doctor and the lab.
Other than having to hold my breath for prolonged periods, the whole thing was a non-event, as I expected. Should have results in 24 to 48 hours.
The bladder was very cooperative through the whole process (thank goodness!)
I was worried about that because they have you drink 20 to 30 ounces of water beforehand to insure the bladder is as full as possible. (As an incontinent, I was dreading that!)

My weight seems to be remaining at about 265 or 266. It's kind of hard to tell with our scales.
If that's true, it's great news!
It means that I'm not gaining any significant weight despite my occasional binges.
The fact that my wife's cooking for me and regulating my portions seems to be helping a great deal.
If I do the cooking and serving, I almost always overdo it.

Nothing much going on other than that.

Cheers!



Tuesday, September 29, 2015

The Story Of My Life!


Blog Timeline Issue Corrected (Please read)

This post is for anyone who actually has the time and inclination to read this journal from start to finish.

I made the startling discovery just a few hours ago that the entire blog timeline was totally out of chronological order. (At least up to the most recent entries)

The issue has been corrected and I sincerely apologize to any and all readers.

Please feel free to leave a comment if you feel something's not right with the blog and I will do my best to fix it in a timely manner.

Cheers! 

Monday, September 28, 2015

Renal Ultrasound Scheduled For Wednesday

Got an appointment for my kidney evaluation this Wednesday. They want to see if there's anything there that might be contributing to my hypertension.
The only downside to this is they insist that I have a full bladder! Considering the fact that I have been totally incontinent for the past few weeks, this promises to be an unpleasant experience.
The procedure should take no more than 20 or 30 minutes but that is an eternity if you have no bladder control. We'll just have to see what happens.

Next on the "procedure" list will hopefully be a lumbar MRI (Magnetic Resonance Imaging) to see what the hell is wrong with my back. It's possible that I have a disc issue resulting in nerve compression. I lifted a heavy object years incorrectly years ago at work and my lower back has never been the same since. It might also be causing the numbness in my feet.
Dr E thinks it's diabetic  peripheral neuropathy but I'm not so sure.
Whether I can get this done or not depends on whether my health insurance will approve it as it is an elective procedure.
Basically, I just want to know what's causing the issue. Whether I get anything done about it, which would likely mean surgery is up in the air.

I finally got through to Dr G, my cardiologist today and we seem to have resolved some of my questions. Turns out his office had my phone number wrong and they had been trying to reach me for a couple of weeks.
Unless he has real problem with it, I think I'm going to forego the nuclear stress test he recommended, at least for a while. I need a break!!

It's a nice evening outside with a few clouds and time for dinner inside. :) Gotta go.

Cheers!

Sunday, September 27, 2015

'Supermoon' And Diapers

Hey, I thought that was a catchy title!

We're out here on the back porch trying to get a decent view of the so-called 'supermoon'. At this moment, it is in total eclipse. I can't imagine anything more exciting to do except possibly watching a live session of Congress. On a scale of 1 to 10, this event rates a 2.
Nah...just kidding!
'Supermoon' Total Eclipse 2015
Here's a pic from our backyard. It was pretty cool! It was high in the sky just at the end of the eclipse.

In other news:

Looks like I'm gonna be in diapers full time now. I can't even stand up and walk around without urine just pouring out. This is getting old real fast, folks!
I guess I'm going to give it another couple of weeks to begin to resolve on it's own. If it persists, I'll have to see Dr F again. I hope this doesn't mean more surgery!
I'm compiling a list of procedures that I've peen putting off for months now because of cost. I've finally met my yearly health insurance deductible and won't have to pay any medical costs until the first of the year. Time to get these things done.

On the lighter side, this really happened down near Nogales recently. Why can't something like that happen to me?  ;) The poor dog wasn't home at the time, I guess.

Enough for tonight.

Cheers!




Bitstrips


Friday, September 25, 2015

Update On The Urinary Tract Issue & Other Things

I'm beginning to feel old again! The bleeding from the bladder seems to have stopped, which is great but now I'm stuck wearing goddamn diapers.
It's all good when I'm sitting or lying down but as soon as I get up I wet myself. There seems to be no sphincter control since I had the last surgery.
If things keep up like this too much longer then I'll be back in Dr Fs office way ahead of schedule.

On another note, I'm actually feeling better overall than I have in a couple of months. I actually have enough motivation to get outside and do a few things. Probably sounds contradictory to the first paragraph but it's not, really. Ya gotta be there to understand. *smiles*
I suspect it's mainly due to having some wine a few nights ago. Yeah, that's it, I'm just not drinking enough! Lol!

It looks like were going to be getting solar panels installed on our roof in the next couple of months. This will require me to climb up into our attic crawlspace to remove some stuff. It will test my current level of physical fitness to the max.
I hope I don't piss myself up there! :(

Finances are really tight right now. The wife's and my social security is barely cutting it. If my health continues to hold out, I'm hoping to find some kind of work that someone in my position could do.
Job opportunities in Phoenix are few and far between, especially for folks in my situation.
All we've got so far is three weeks in October working for the Elections Dept. That will get us a little bit caught up but it will be gone in a flash. *sighs*

I've rambled enough for tonight. I'm gonna try to be in bed before three tonight.

Cheers!




Wednesday, September 23, 2015

Erectile function post-radical prostatectomy: the past 20 years

This is very disappointing news for a lot of us. Especially those who are now impotent and still have active disease.
You would think that after 20+ years, medicine would have made a little more progress.

Article courtesy: The "New" prostate Cancer Infolink

It would not be unreasonable to think, some 30+ years after Dr. Pat Walsh started to do nerve-sparing radical prostatectomies at Johns Hopkins, that there might have been a gradual — if small — improvement in the quality of erectile and sexual function post-surgery on average over time. So a group of Austrian and Swiss researchers set out to see if they could demonstrate this.


We need to be clear that their interest was exclusively in whether there had been improvements based solely on surgical technique — regardless of the use of other “aids” — and most especially other aids like new drugs and similar forms of assistance. So what they did was the looked for all the data they could find from the control arms of trials designed to test whether things like new drugs (and most commonly new drugs like sidenafil/Viagra, tadalafil/Cialis, etc.). In other words, they were interested in the erectile/sexual function of the men in these trials who were given the placebo in the trials.


Schauer et al. were able to identify a total of 11 randomized, controlled trials of penile rehabilitation therapy following radical prostatectomy. These trials were all published between 1997 and 2014. They included a total of 2,009 patients, and 685 of those patients (about a third) were treated with a placebo of some type — or they were just observed without additional treatment — in the control arms of the 11 trials.


Assessment of erectile function in the trials was carried out through use of either the Sexual Encounter Profile (SEP) (in eight of the trials) and/or the International Index of Erectile Function (IIEF) (also in eight of the 11 trials). Here is what Schauer and his colleagues report:
The rates of positive response to SEP3 (i.e., erectile function sufficient for successful intercourse) in the control arms of the eight trials using this evaluation ranged from 20 percent in 1997 through 10 percent in 2003, 19 percent in 2004, 25 percent in 2008, 21 percent in 2010, 67 percent in 2011, 10 percent in 2013, to 22 percent in 2014.
The rates of positive responses to the IIEF-EF in the control arms of the eight trials using this evaluation ranged from 9.2 in 2003 through 13.3 in 2004, 8.8 in 2008, 25 and ≥ 22.0 in 2008, 17.4 in 2010, 58 and ≥ 26.0 in 2011, 9.3 in 2013, to 11.6 in 2014.


The authors conclude that their analysis suggests that (a) the rate of undisturbed erectile function is in the range 20 to 25 percent in most studies and that (b) these rates have not substantially improved or changed over the past 17 years.


In other words, any improvements in the quality of surgery over the past 17 years, on their own, have really been having a very limited impact on the quality of erectile/sexual function for radical prostatectomy patients over most of the past 20 years.

Sunday, September 20, 2015

Cost of medical marijuana in Minnesota leads some to return to illegal sources

It was only a matter of time before this started.

As usual, it's all about the money. To hell with the patient!

Talking To Myself

Ahoy mates!
Did you know it's 'International Talk Like A Pirate Day' me hearties? Arrgh! Well, it won't be by the time anyone besides me reads this but I thought I'd share it anyway.

All righty then!

It is a very quiet Saturday night here. Probably bad for me as it tends to lead me into introspection.
Since I haven't been drinking, I tend to be even more wakeful at night, sometimes staying up as late (or early) as three or four am.
I can't seem to shut my thoughts down until I get so tired that I fall asleep automatically.

I seem to have become obsessed with all the things that are going wrong with me as I approach old age. The transition from middle age is not going as expected. I feel alone in an unfamiliar world that I used to be happy in. Nowadays, it seems like the whole world is crazy.
Every night it's a nearly constant stream of loud cars, even louder motorcycles and fire and police sirens. This hostile, extreme modern world makes me tired...and scared.
It seems like no one can be happy with the simple life. Everything must be extreme now.
America is clearly going to hell in a handbasket. Why can't more of us see that. It seems so clear to me.
I don't fit in anymore. I've always been different from others in myriad ways but now I feel like I've outlived my time.
I constantly worry that I will lose my wife of 24 years and then be truly alone but yet I don't want to precede her because she has seen enough death in her life and I don't want to put her through that.

Drinking used to ease the obsession. I would still think about our respective problems but bourbon would take the edge off and I would sleep.
I'm fully aware that I'm not the only one in the world with these issues yet knowing that doesn't seem to help.

A little bit of good news. We've been asked to work at the Department of Elections  again, for three weeks in October. This will get both the wife and I out of the house and focussed on something other than our problems for a while. I just wish the job lasted longer.
Of course, three or four weeks is probably enough as this job pays quite well. If we make too much money in any calendar year it can negatively effect my government health insurance subsidy. That could theoretically leave my without health coverage and that is something I cannot risk.

It's nearly 11:00pm here in Phoenix and I am getting sleepy but if I lie down I'll just wind up getting right back up again. All this drivel is just a little part of my racing mind.
I'd smoke a little weed which would definitely let me sleep but I'm a bit leery of doing that so soon after that nasty bout of atrial fibrillation. The last thing I want to happen is for that to happen again.
If AF goes on to long there is a real possibility that it may become permanent.

Well, enough of this for tonight. Probably no posts till the early part of the week. See if you can contain your excitement!

Cheers!

P.S. Please consider supporting Bernie Sanders (I -Vt.) for president.







Thursday, September 17, 2015

"Look Ma...No Catheter!"

Saw Dr F today. He did elect to remove the catheter which was a great relief.
The weird part was that for the past six days, my urine has been totally clear of all visible blood...until today. When I got up this morning, it started to bleed again for no apparent reason. Not nearly as hard as before but clearly noticeable.
Dr F doesn't feel this is significant at this time. We are basically going to watch it and wait for the other shoe to drop. If and when it does, there is a good possibility that I'll wind up facing more surgery. The problem is that there are still a lot of unstable capillaries in the bladder that haven't been cauterized yet.
I have a follow up appointment in November. Hopefully, this will remain stable.

Cheers!


Wednesday, September 16, 2015

6th Day With Catheter (Update)

Today is the 6th day wearing the Foley® catheter. Urine is negative for visible blood since last Thursday.
I will get it removed tomorrow at Dr Fs office. This time, we will verify that there is no bleeding before we leave the office!

We will also be making a proactive plan as to what steps we're going to take if my PSA continues to rise.

Cheers!

Sunday, September 13, 2015

Worth A Read (Healthcare Article)

I'm not at all sure if this change is going to help or hinder our already taxed healthcare system.

Either way, I see a lot more physician burnout on the horizon.

I'd be interested in reader comments.

Cheers!

Friday, September 11, 2015

I'ts All About Me...As Usual. Lol!

A few well chosen pics of me in the middle of my latest escapade. (Courtesy: Karen)

PreOp Courtesy: Karen
PreOp Courtesy: Karen





PreOp Courtesy: Karen
PreOp Courtesy: Karen

PreOp Courtesy: Karen
PreOp Courtesy: Karen

Wednesday, September 09, 2015

So...The Following Morning

So this morning, (Friday) I wake up to a nearly full catheter bag. It looks good, a little concentrated but little or no visible blood.
I'm having my coffee when Dr F calls and wants to know how my night went. I told him all the details including the fact that I didn't get too much sleep, mainly due to frequent bladder spasms.

He is good with that and suggests that I remove the catheter as soon as possible which, frankly, was welcome news! He told me to call him back when I had done that and peed a couple of times.
No biggie.

However...

It wasn't more than 10 or 15 minutes after I removed the catheter that I felt like I had to go again and, guess what? Almost pure blood! Also, quite a mess!

I called him back immediately and caught him in the middle of surgery. He said it was possible that we removed the catheter prematurely and to meet him at his Glendale office at 1:00pm and he would put in another. (Oh goody!)

He saw me within 10 minutes or so of arriving. He did a bladder ultrasound and put in a new catheter.
I have to wear this one for five days instead of one. *sighs*
At least I have a smaller, more portable collection bag this time.

At last look, all is clear. Wish me luck at my next appointment this Thursday.

Cheers!




Tuesday, September 08, 2015

Emergency Bladder Surgery

I'm writing this at 1:30am Friday morning.
I had my appointment with Dr F  2:30pm today. He is excellent! His first priority was to scope out the bladder to find the root cause of the bleeding.
He spotted the problem area immediately and then to our surprise, he said that, because of the extent of the bleed, he would like to admit me to the hospital (again) and address the problem surgically.

He was shocked to hear that they didn't admit me when I went into emergency a few nights ago.

A couple of hours later, I was admitted to John C Lincoln hospital.

His plan was straightforward. To go in with a cystoscope with a wider angle view than the one he used at the office and cauterize the affected area. (This was done under general anesthesia.)

The whole procedure took about 30 minutes and left me with a Foley catheter for 24 hours. (The same setup that I had after the prostate surgery in 2012) Annoying but not too uncomfortable.

The problem area turned out to be radiation scarring from the course of IMRT that I had after the surgery. This is not bladder cancer, thank goodness!
Part of the scarring issue is the formation of tiny, friable capillaries which are extremely sensitive to any kind of trauma and will tend to bleed at a moment's notice. The biggest issue here is that I was on an anticoagulant medicine for the atrial fib.
This makes the bleeding harder to control. The medicine usually takes four or five days to fully clear the system and there is no antidote.

Fortunately, I was able to return home but not before it was nearly midnight. A perfect way to spend a Thursday evening!

Cheers!


Urologist Appointment

I finally managed to book an appointment with Dr. F this Thursday. Now maybe we can get to the bottom of this damn bleeding!

As I mentioned before, my two greatest concerns are that the cause is either recurrence or spread of the original prostate cancer or if not that, bladder cancer.
Unfortunately, I have all of the risk factors for the latter. :(
We will just have to hope that we've caught it early if that is the case.

Cheers!



Monday, September 07, 2015

Midnight Emergency Room Visit

It seems I just can't stay out of hospitals lately!

We wound up taking me into our friendly, local emergency room at midnight last night due to the extent of the urinary blood issue. We were there for about an hour. (Where else would I want to be on a Sunday night?)
The amount of passed blood had gotten abruptly worse so I felt that it would be wise to at least get it looked at.

Turns out, they didn't feel it qualified as an emergency so they just did a quick examination and a urinalyses which was negative with the exception of the obvious presence of blood.
I was hoping they would do a cystoscopy on the spot so we could get to the bottom of the issue right then.

(Not gonna happen.)

They said that the main concern right then was to make sure the bleeding cleared on it's own and I was to follow up ASAP with my new urologist. (Well duh!!)

The wife and I finally got to bed around 2:00am. It just doesn't get any better than that!

Cheers!




Friday, September 04, 2015

New Urologist... Maybe?

Well it looks like we may have found me a new "pee doc"! That may not sound like big, exciting news but it is for me! We will refer to him as "Dr. F.
I have not seen him yet but his stats are excellent, he's close by and, best of all, it appears that he takes my health insurance! Yay!
If the wife and I are both comfortable with him, he will probably replace Dr. K.
I'm going to set up an appointment ASAP to see if we can get this hematuria thing resolved.

In other news:

Dr. G, my cardiologist, has still not decided whether we're going ahead with the nuclear stress test.
I feel pretty good myself and I still think my slight shortness of breath which prompted the idea of a stress test to begin with was caused by a combination of morbid obesity (yes, I'm fat) and the high dose of Amiodarone that he had me on. Additionally, my pulse rate has been averaging 45 to 50 BPM since he put me on that stuff. Normal resting pulse is around 72 BPM unless you're a long distance runner or something. That tends to sap the energy a little bit too.
Still, it might be a good idea to have one anyway to rule out anything else.

Made a few changes and additions to the page. Please feel free to use them as they were put there for a reason. Also, feel free to comment. The are a number of ways to do that here.
I always like to hear from those who are bored enough to actually read this stuff. Lol!
When you have millions of devoted fans like I do, and you don't hear from them once in a while, it starts to get lonely.

At any rate, I'm beginning to get sleepy so I'm gonna sign off for tonight.

Cheers!









Thursday, September 03, 2015

What A Day! *sighs*

It's been a pretty busy day for this old man. I didn't get as much sleep as I could have since I chose to stay up till three AM this morning.

Slept in as long as I could till the 'pee alarm' got me to get up. (It's very reliable!)

Had lunch and then it was time to go get our flu shots.
Note: If you are in our age bracket (60+), it is very important to get both the seasonal flu and also the pneumonia vaccines! Influenza can and does kill hundreds of people yearly.

So anyway, we got done with that and I started to do some work on the blog. I'm trying to lure in the 'Googlebots' so I can get some web traffic.
Unfortunately, somewhere along the line, I lost virtually all the formatting for the page! Man, was I PISSED!
Took the rest of the day to put the damn thing back together again.
The real funny part was that ever since I migrated all the data over here from the other site, I never remembered to back it up. Lol! You better believe it is now!

I guess that's about it for tonight. I still have other stuff to do so it'll probably be a late night again.
Now that I'm so to speak, 'on the wagon', at least for awhile, I find it really hard to get to sleep.
It's a damn good thing I'm retired and usually don't have to get up at any specific time!

Cheers!

Tuesday, September 01, 2015

Memories Of 2012 (Warning: Graphic Content)

I really don't remember whether I posted this a long time ago but for those who are interested (or just morbidly curious), this is what you get left with after an RRP.

This was an open procedure, not laparoscopic.

Can I do a 'selfie' or what?  Lol!

For my next trick, I'll post a movie of my last colonoscopy. (Just kidding!)
Photo six inch prostatectomy incision 2012
My Six Inch Incision From RRP (Radical Retropubic Prostatectomy ) In 2012

Blood In Urine Back Again

After taking a couple of weeks off, the intermittent bleeding is back. I have no idea what is going on here. All I know is that unexplained bleeding from any orifice is not desirable!

Just had a comprehensive urinalyses done and the values were all within normal range. WTF?
As I said in a previous rant, I just hope it has nothing to do with the cancer.
I wonder if it could have something to do with the radiation therapy I had after my surgery?

Been off the booze for over a month now. I miss it! It's a bit of a record for me, *smiles*. I find it difficult to fill in the "happy hour" gap in the evening. The wife isn't drinking either so that makes abstaining a little easier.
Weight is down to 268 lbs. Somehow, someway I've gotta get to 260 come Hell or high water.
Actually, the lack of booze should help to facilitate that goal.

On a more cheerful note, I couldn't resist the temptation to post this beautiful photo. It was taken by my wife last night at sunset.
Direction of view is southwest taken from our backyard. Hope you enjoy!

Cheers!



 Photo of evening sunburst in Phoenix from back yard.
Evening sunburst in Phoenix