I am not a painkiller kind of guy (Punkadyne Labs (Punkwalrus))

Monday, I visited the dentist, and had my temp crown fitted with my permenant one for tooth #14 (if anyone wants to look at a dental chart). It doesn't fit quite right, but in all honesty, the right side of my mouth is missing a lot of the molars since that horrible accident back in 1996 anyway (and it would cost $6000 --yes, six THOUSAND-- to repair, and that's AFTER the insurance part), so it doesn't have anything to match height with, so minute adjustments might be more pain than they are worth.

Pain. Yes...

It hurt. Not in a "oh no, something's gone horribly wrong," hurt, but an "ow, this is normal, but still sucks," hurt. The process took maybe 20 minutes. I spent 15 in the waiting room, 5 in the chair. The doctor plucked my temp crown off, slapped my new one on, said it would hurt for a day or two. "The pain is because it's a tight fit, as it should be. The tissues will adapt, but it will be sore for a little while. Don't eat anything for a few hours." Then I walked home.

I took my last two Alieve, and it helped a little. I tried to eat comfort food, but it was hard to chew, since I only have that one side of the mouth to chew with. I ended up chewing with my tongue and the front parts of my teeth. Tuesday the pain was less, but when I accidentally bit down too hard, my whole jaw hurt. Last night I started to grind my teeth, and I have been unable to sleep very soundly.

I took Tylenol, which either keeps me up too late, or if I take it right before I go to sleep, it makes me groggy as hell in the morning. I am also sleeping on my back wrong, which isn't helping.

I don't know about you, but more than half the time, painkillers make things worse for me. Posted in: dentist , medicine , painkiller , tylenol

Massachusetts: a less than perfect healthcare model (rianjs.net (Hanser)) by Rian

I will have a large writeup on real, honest-to-God ways we can reform healthcare in this country without resorting to re-distributionist tactics in the next couple of days. No hand-waving. No pie-in-the-sky. I promise. But until then…

By Frank Micciche from the New America Foundation/Providence Journal:

439,000 people have acquired health insurance since the reform became law — an astonishing 9 percent increase in coverage at a time when the national rate increased by one-half of 1 percent.

Nearly 200,000 of the newly insured acquired private, unsubsidized coverage, mostly through their employers.

Written another way: "More than half of the individuals are subsidized with taxpayer money."

Libertarians will have a field day with the other piece of puzzle: many individuals would rather pay the fine associated with forgoing the mandatory medical insurance than pay the premiums. Why? The fine costs less. Many healthy people simply don't want to buy health insurance. The original projections for the number of unsubsidized signups ended up being wildly optimistic:

Massachusetts' financing challenge emerges from its success in covering the state's neediest residents. Enrollment in the fully subsidized Commonwealth Care program has been higher than expected, while enrollment in the unsubsidized Commonwealth Choice plans has been lower than anticipated. Therefore, costs to the state have risen dramatically.

Micciche spins it another way:

The state's success enrolling lower-income households in the subsidized "Commonwealth Care" program has driven overall costs above original projections, but the actual cost per person covered is lower than expected, as is the average premium.

From an economic standpoint, enrolling lots of lower-income households is not success unless it is offset by sufficient numbers of unsubsidized enrollees.

Obviously it follows that the average premium is lower than anticipated because the majority of enrollees are subsidized and therefore pay lower premiums.

This isn't rocket science econometrics, folks.

In the fiscal year before passage of health-care reform, Massachusetts spent $710 million to reimburse hospitals and community health centers for unpaid bills. 81 percent of these costs were incurred by individuals without insurance.

Now we spend that money getting these people the insurance they need so when they go to the ED, they aren't "uninsured". Instead we buy these people insurance with taxpayer money so we don't have to spend taxpayer money reimbursing hospitals directly.

What's not mentioned is that this is good for the hospitals. A lot of "free care" ends up not being reimbursed at all, meaning hospitals have to eat the costs of treating those who cannot afford to pay. The upside for hospitals is that now that these folks have insurance — subsidized though it may be — hospitals can get reimbursed for services they provide that wouldn't have been reimbursed in the past. It will be interesting to see if there's an effect on the number of hospital closures and bankruptcies going forward from here.

Costs aside, all agree that sporadic treatment of the uninsured through emergency rooms and clinics is much less effective medically. The commonwealth took on the problem by diverting much of its uncompensated care pool dollars into subsidies to buy private insurance by lower-income individuals and families. Quarterly costs for free care have subsequently dropped 40 percent.

From one money hole to the next. Yes, that has "sustainability" written all over it. Payments to hospitals have dropped by 40%, and that's a good thing. Except that that money went to the Commonwealth Care program instead. Instead of being red ink in one set of books, it's red ink in another.

Clearly there's a difference between red ink and politically-acceptable red ink. At the end of the day, though, the same people end up paying the piper:

The subsidized insurance program at the heart of the state's healthcare initiative is expected to roughly double in size and expense over the next three years - an unexpected level of growth that could cost state taxpayers hundreds of millions of dollars or force the state to scale back its ambitions.

State projections obtained by the Globe show the program reaching 342,000 people and $1.35 billion in annual expenses by June 2011. Those figures would far outstrip the original plans for the Commonwealth Care program, largely because state officials underestimated the number of uninsured residents.

Back to Micciche:

And the individuals who acquired private insurance now receive coordinated, cost-effective care that will improve overall health outcomes and reduce the need for more expensive late-stage intervention.

An oversimplification. Many of the patients that are now insured — both subsidized and unsubsidized — cannot find primary care physicians because the program didn't even attempt to solve one of the major problems with healthcare today: there aren't enough practicing primary care physicians to handle the influx of new patients. Why? Because being a PCP isn't a financially attractive proposition. Attempts to alter the landscape of our medical system are continually undercut by talk of reducing Medicare reimbursements to primary care physicians — the very people who will bear the brunt of that manufactured demand. This, in turn, sends the wrong signals to medical students weighing a career in primary care as opposed to a more lucrative specialty.

This dearth of PCPs isn't unique to Massachusetts, either.

Look, I'm all for increased access to healthcare when it makes sense, and I don't think ED overusage and overcrowding is sustainable or desirable. I know that health outcomes are worse when non-emergent cases are seen in the ED. ED care is also inherently more expensive. In short, you get less bang for more bucks — and it potentially endangers those who are at the ED for real emergencies by diverting the limited resources to non-urgent cases.

I would like to think that everyone in this country can have their own primary care doctor, but I know that our infrastructure cannot support it. I am not a Darwinian capitalist. I don't hate poor people. But I do know what is sustainable and what isn't.

It worries me that if the nation looks to Massachusetts as some kind of prototypical model to be copied, we're going to be manufacturing big problems, because coverage is only a superficial issue.

Healthcare coverage is not the same thing as healthcare access, even though it is politically expedient to conflate the two concepts.

Universal health coverage will manufacture healthcare demand in dramatic fashion, and the existing healthcare infrastructure isn't equipped to deal with the kind of patient influx that that kind of universal program would create. We don't have the human capital to meet that demand. We need to work on our healthcare infrastructure before we dump millions of new patients into the system overnight.

–

The most interesting thing that strikes me when you look at these numbers is what they say about real demand. Demand for universal health coverage by those that can afford to pay for it is less than our models predict. Even by making health insurance mandatory and enforcing it with a fine, many people are still opting out; they find that their money is better spent in other ways.

Maybe we need to revisit our models and (certainly) our cost projections.

Posted in: economics , healthcare , massachusetts , medicine , politics , primary care

Benjamin Franklin on vaccination (rianjs.net (Hanser)) by Rian

Ben Franklin is one of my all-time favorite historical figures; there are few people who have been universally successful in all they've done: business, politics, science, and humanitarianism. Franklin was one of these, and he's left a guidebook for those who wish to follow in his footsteps. (And really, how can you beat $2.50 for a brand-new book?)

I've been reading through it lately, and while it's easy reading, it's so chock-full of wisdom that I find it slow going. Lunchtimes and evenings find me with pencil in hand, underlining and annotating the bits that especially speak to me, and there are many.

I came across this paragraph, and I was astonished. With the anti-vaccination crazies gaining influence and mindshare, this earthy bit of common sense was a breath of fresh air, written in the 1700s by someone who knew a world without vaccines, and saw the devastation caused by these diseases — smallpox, polio, and many others — first-hand.

In 1736, I lost one of my sons, a fine boy of four years old, by smallpox, taken in the common way. I long regretted him bitterly and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and therefore that the safer should be chosen.

Simple and profound. Alas, I don't think the anti-vaccination types will take his advice to heart, and we are all the poorer for it.

Posted in: anti-vaccination , ben franklin , culture , history , medicine , smallpox , vaccines

My back hurts a lot. From a sneeze. (Punkadyne Labs (Punkwalrus))

This morning, I went "aaa--CHOO!" and I felt this "balloon" of muscle in my lower back blow out like a cheap tire. At first, it was nothing, but as the day went on, I got more and more sore. By this evening, my back was stiff and mild sparks of pain shot down my limbs. It's been hard to walk, and moving from sitting to standing hurts a lot.

Dude, if I hurt my back, I want it to be dramatic, like shark attack or wrestling an angry bear at a truck stop from a cup of morning coffee. Not from a simple sneeze.

323 Posted in: back , fnord , health , medicine , pain

Flu shot? (Punkadyne Labs (Punkwalrus))

I never get flus shots. I used to get them, many, many years ago, but I found that flu shots made me sick. It would get what would feel like a mild cold for 3-4 weeks: sniffles, achiness, mild dizziness, and I felt ridiculously tired like I had run for hours. I guessed this was because they gave you something that competed with the flu and while it gave you a cold, you'd never get flu-sick, and I was just overly sensitive.

Later I heard that most flu shots inoculate you against a limited set of known flu strains anyway, and you're SOL is you get a new strain or one it doesn't cover. The whole thing seemed like more a miss than hit, so I have declined ever since.

This last doctor's visit, they asked if I wanted one, and my knee-jerk response was "NO," but later that night, I wondered if they have improved flu shots, and if I am now 39 and not in my early 20s and should consider it. My doctor said, "Well, if you want it..." and seemed surprised I declined, but didn't press the issue when I said I always got ill from them. I also though, "Man, what if I get the flu, but become a carrier and not get sick, and give it to dozens of other people like a Typhoid Mary?"

What do you guys think? Should I get all shot up and flu-free? Posted in: flu , medical , medicine , shots

What's wrong with CR (Punkadyne Labs (Punkwalrus))

The current theory by the pulmonologist , based on symptoms and scans, is that he is violently allergic to formaldehyde. I told him not to drink the stuff, but kids these days... and pressure treated lumber is very resistant to bugs, too. Okay, seriously, he was exposed to it at school in his new anatomy and physiology class. It was necessary for his vet tech certification, and now we're at a loss because, well, you can't be in any medical profession without formaldehyde.

CR has decided through all this he wants to be a chef. I think there was always this narrowing down of what he would be capable of in the veterinary field with his asthma. I mean, at our vet's office, two people have asthma, and one of them has like 10 cats and 5 dogs in her house (one of the "calamities" one usually faces working in a vet's office is ending up with a lot of spare animals, ask anyarm). While CR excelled at his chosen profession, it looked like he would never get higher than a vet tech, which depressed him a little. This was sort of the final blow.

On top of all this, they think he got a raging sinus infection during his downtime, which may have led to sleep apnea, and possible acid reflux (which is a genetic issue on his mother's side). So he's on more meds, and will get a cat scan or MRI (I forget which) to check his sinuses because if he has the kind that they think he has, it requires a 45-90 day treatment of various stages of antibiotics. Makes me wonder if he needs a neti pot.

Anyway, that's the story so far. He went back to school again today, after being absent about 17 days out of 20. His school is trying to get him accommodated, and I want to thank Chantilly High for not being bastards about this whole thing. There are some people working there who have really been helpful, and while there are still some bureaucratic snags, we hope to have them resolved by the end of the second quarter so he can graduate in 2008. Posted in: asthma , cr , medicine , school , sick

Hayfever medicine that works (Kilala.nl (Cailin Coilleach)) by Cailin Coilleach

I promised a few of my colleagues to look up the name of my current hayfever medicine. Thing is that previous medicines never did anything for me, but this one actually seems to work.

Guys... It's ceterizine 10mg and is part of the Samenwerkende Apothekers brand.

Posted in: ceterizine , hayfever , hooikoorts , medicine

Someone is offering to pay me to take the MCAT (rianjs.net (Hanser)) by Rian

One of the comments that ended up in my spam filter was this one. I let it through for sheer “WTF” purposes. Someone wants to pay me to take the MCAT for them.

Ostensibly this person wants to become a doctor. So he’s willing to cheat on the MCAT.

Paying someone to take an exam seems diametrically opposed to the moral standards we hold doctors to, doesn’t it?

Technorati Tags: Med school, cheating, ethics

Posted in: culture , medicine

I’ve decided to go to med school (rianjs.net (Hanser)) by Rian

Last night while waiting to board my flight in Charlotte, NC, I signed up for Harvard’s intensive 8-week Organic Chemistry I and II classes (+ labs). Ironically it’s cheaper than taking them at MCP (and nearly as inexpensive as taking them at UMass), and they’ll be over more quickly. I tend to do much better in classes when I completely immerse myself in the material. E.g. Calc II, biology 1, college writing II.

$4600 including student health insurance, and it includes the labs — which are usually more expensive than the actual class. I have free parking a 10-minute walk from campus at Paul’s place, which is completely awesome. I intend to get A’s, which won’t be a problem if I actually study.

However I am getting ahead of myself, so I’ll back up a bit.

After turning in an undergrad performance that more closely resembles this cat than a decent education, I have decided to forgo pharmacy school entirely. Instead, I’ve made up my mind to attend med school. Where, I don’t know. Nor do I particularly care, to be honest. Any med school I attend will give me the tools I need to pass all three steps of the USMLE, and then it’ll be up to me to learn during residency.

I feel like I’ve been fighting this decision for a long time. Probably two or three years. I’ve been resisting it because of the way healthcare policy in the country is set up. I have issues with things like EMTALA being an unfunded mandate, inclinations toward socialized medicine, medical malpractice insurance premiums, residency, and personal shortcomings. In a bizarre way, I feel like I’m better equipped than most who desire to go to med school who have their idealism ripped right out from under them when they hit the Real World because I don’t have any in the first place.

I’m not worried about the MCAT. I rock at standardized testing, and I actually plan to prepare for this one. I never prepared for the SAT, and I did extremely well, and MCATs apparently correlate fairly well with SAT scores. How much better could I do on the MCAT if I prepared rather than going in blind, tired, and unprepared like I did with the SAT? I’m hoping to score at least a 33, which is easily within the realm of possibility.

My personal statement will be excellent because I’m a good writer, and I’ve thought about med school from a real world perspective more than I’ve thought about anything in a long time. I’ll have recommendations in spades; I have a list of 16(!) different people, all of them in the medical field, who have agreed to write me a recommendation if I ask them. Many of them in unique positions of influence. This is a comfort to me because of:

My main trouble will by my GPA. I’ve got to rip up and repave my undergrad career in a few key places: organic chemistry, microbiology, and (perhaps) general biology. This will take some money, and probably six months to a year. If I decide to apply to a foreign medical school — which holds a great deal of appeal to me — I could probably forget retaking basic biology. Oh, and I’ll probably have to take Physics II (+ lab). Not a huge deal there.

Looking back at my old transcripts and thinking about how I used to (not) study makes me cringe. It’s like looking someone else’s life and saying “And did you want to set yourself up for failure later?”

Anyway, regarding personal shortcomings. Two main things stand out to me: I tend to follow the path of least resistance. It is, for example, easier to watch TV than it is to study. I’ll have to watch myself carefully. The other is sleep. I worry that residency will be a disaster because I’m one of those unlucky fools who needs 7-8 hours per night, otherwise I’m useless.

But I’ll have to get there first.

Posted in: medicine , personal

Printing to PDF: the awesomest thing since sliced bread (rianjs.net (Hanser)) by Rian

I haven’t written anything in a while, mostly because I don’t have much to say that others would find interesting. However, I would just like to say that printing to PDF absolutely kicks ass. I discovered this nifty little thing a couple of months ago, and I’ve been using it religiously ever since.

For those of you non-Mac users, and those who are but haven’t noticed, OS X has a built-in print to PDF feature — made much more useful if you click the print page link, or printer-friendly link that most sites have before printing to PDF. (Click for full-size.)

For the last couple of months or so, I’ve been creating my own little library of research papers of things I’m interested in, or have had occasion to use:

I’ve actually been accumulating material faster than I can read it thanks to school and work, but I’ll have time to catch up in the coming weeks. When I want to find something that I know I read, just Command-Space and I can search the contents of all of the PDFs instantly using Spotlight.

Lots of people complain about Spotlight, but it’s better than anything Windows has out-of-the-box.

All of this can be accomplished on Windows, as well, but it’s just easier on a Mac. I save CEs, journal articles, whatever I find interesting. It’s also interesting that a lot of what you read in medical news and journal articles is 1) uninteresting 2) unremarkable and 3) useless. It seems it’s always fun to compare things to placebo when it would be much more interesting (and useful) to conduct head-to-head tests of drugs.

There is no “best-of-breed” drug for a given condition most of the time, thanks to the near-infinitely variable nature of complex higher organisms. There are very few absolutes in medicine, but there are trends that usually emerge. It’d be nice if researchers started going out of their way to look for them. That’s somewhat difficult, though, when most of the big studies are funded by large pharmaceutical companies with a vested interest in seeing their drug perform well. You’d be a fool to hundreds of millions of dollars for a big study only to have your drug not perform as well as a competitor’s… Sometimes the NIH funds head-to-head studies — the only entity besides Big Pharma with pockets deep enough to do so — but only when there is a significant amount of money to be saved by establishing a “winner”.

If I get bored someday soon, I’ll post some of the names of the huge studies to which I refer in this mini tangent…

Technorati Tags: Apple, OS X, Spotlight, Tiger, Mac, PDF, library, digital library

Posted in: medicine , productivity , reading , technology

A breath of fresh air (rianjs.net (Hanser)) by Rian

So I’m not in pharmacy school at the moment — though I hope to return in Fall 2007 — so I’m taking courses at UMass Lowell. I’ve changed majors to psych just to make it easy in the meantime. Anyway, I wasn’t expecting it to be quite this easy. I haven’t taken courses that required so little effort since I was in early high school. While I am getting mostly As, I find myself dissatisfied because the work is so utterly unchallenging.

Fast forward to yesterday morning around 7.30am: I discovered yesterday that I had a research paper due today by 11.59pm. Between then and midnight tonight I’m scheduled for 15 hours on the Pharm. Oops. Anyway, of the 5 topics on the list, the one that seemed the least interesting at first glance ended up being the most interesting upon closer inspection, and now I find myself biting into a fairly information-dense biochemistry paper discussing the viability of using ADAM 12 — a disintegrin-containing metalloprotease — as a breast cancer screening test. Since it can be isolated in urine, it’s far less invasive than other tests.

It’s actually been pretty fun so far. I’m feeling the crunch (been up since 4am), which is not something I’ve felt in quite a little while, and it’s invigorating. The material is pretty cool, and it’s relevant to medicine and pharmacy, and since that’s what I’m truly interested in, it’s been a nice breath of fresh air.

It’s also nice to have something challenging to sink my teeth into for a change.

Posted in: medicine , personal , writing

My vacation trip to Californiathe ER. (rianjs.net (Hanser)) by Rian

This is one of those stories I really don’t feel like telling, but ultimately it will be easier for me to simply write once and point people here rather than re-tell the story 100 times. I haven’t edited it for grammar or smoothness. As such it probably won’t read that well. But I don’t care.

Anyway, some of you know I’m on vacation in California visiting my friend David. Got here Wednesday night, and I’m here until Tuesday (tomorrow). On Friday, we were supposed to go up to Big Bear Lake, and we did. We were planning on going fishing and maybe playing some tennis and relaxing. Unfortunately, I started getting sick on Thursday night. Bloating and waves of pain about once every 3-4 minutes. It felt a bit like lactose intolerance, but taking lactase enzyme didn’t help, so it obviously wasn’t that.

I didn’t want to go to the hospital because I knew what they’d do to figure out what was wrong: more barium and a CT scan. I HATE barium. I’d almost rather die than drink barium. More on that later.

Things got worse as we drove up to the mountains. We didn’t think of it then, but it probably had a lot to do with the lower air pressure as we went up. (Big Bear is around 6500 feet up.) Anyway, I had to go to the ER pretty much as soon as we got there.

The hospital was pretty small which was both good and bad. I got brought in to the ER almost immediately, and it’s bad because it’s just a little out-of-the-way hospital. It wasn’t comforting to overhear one of the nurses ask the ER doctor — yes, there was only one — how often something could be given only to hear him get the drug classification wrong.*

So the ER tech took my information, and they started giving me IV fluids to rehydrate me. They had taken an urine sample, and said I was dehydrated. It was dark, but not as dark as it had been the first time I was in the hospital. (See my Crohn’s disease category for more.) I had played tennis in the morning and not urinated since. The doctor — who got the drug question wrong — came in, talked to me, and informed me that he thought I had acute appendicitis. I disagreed.

(As a side note: I bled all over myself when the nurse ran the catheter. This has never happened before. Then again I’ve never had anyone but an IV nurse run catheter, so that could be why. Seriously, it was a mess.)

His examination consisted of putting his fingers on my belly button, my hip bone, and telling me my appendix was there, and touching it. Since the discomfort was actually in my stomach, and about once an hour I burped which gave me some relief, I was inclined to disagree. I am familiar with the concept of referred pain, but I knew I wasn’t experiencing it. The fact that my stomach was bloated was also a giveaway.

Mr MD informed me that their surgeon wasn’t on that night, so they’d have to transfer me. (Somewhere during this time, they took some X-rays as well.) I wasn’t happy about being transferred, but I also wasn’t happy staying where I was, knowing I wasn’t getting the best care.

They wanted to send me to Loma Linda Medical Center which is a pretty good hospital. Unfortunately, they didn’t have the space for me, so they ended up sending me to Redlands — a place I know nothing about, but which would almost certainly be better than where I was.

The people at the Big Bear hospital were certain that I was pre-op, so that meant no drugs. Talk about suck. I really wanted fentanyl, knowing it has a fairly short half-life, but I didn’t say anything. The nurse came up with the idea herself, and the doctor agreed, so they gave me 100mcg along with some IV Rocephin (ceftriaxone). I was pretty loopy for about ten minutes, and forgot I was in pain. (The nurse actually asked me if I was still in pain and I had to think about it before I could respond. Oh, the wonders of opiates…)

So I took my first trip in an ambulance. (Had it been the winter, I probably would have been flown by helicopter, which would have been super cool.)

An hour or so “down the hill” to Redlands. Somewhere about halfway through the trip down the hill in between my ears popping, my stomach stopped hurting.

Arrived there. They wouldn’t let me off the ambulance gurney. I felt terribly foolish, knowing I could walk and such. Anyway, they hooked me up to a bunch of machines. (Pic!) I felt like I was in the ICU. It was f’n aggravating — all I wanted to do was sleep.

The Redlands ER was pretty crowded. People out in hallways and such. I think maybe because it was a Friday night. I had a room, though. Naturally, they pinched and poked me and such, and I think maybe they gave me some more IV fluids. I really can’t remember, I was so tired. I remember David and I sitting there making terribly stupid jokes looking like zombies.

Anyway, it was on the ambulance ride over (no sirens or lights) that my bag of crap got lost. They made me change into a hospital gown, and they had put my stuff in a bag. The bag stayed on the ambulance, along with my wallet and cell phone. I was a little annoyed because I had been texting a few people. All of my family is in the Northeast, and I’m in California.

Another brief side note… shortly after I got to the hospital at Big Bear, I very keenly felt homesick. I honestly don’t mind getting sick at home — though it rarely happens — because I’m 40 minutes from one of the medical Meccas of the world. That 40 minute drive becomes a five minute walk from Beth Israel, Brigham and Women’s, and Children’s Hospital — all of which are Harvard Med teaching hospitals — when I’m at MCP. Not to mention my parents are within an hour’s drive, and most of my friends live in Boston. I was very glad David stayed the whole time. I tend to be pretty good humored even under the worst of circumstances, but having family around can help. I missed Kim, too. She’s family even though she doesn’t know it. :P I’m happy to say that I was pretty positive up until probably 4am when I just wanted to sleep and they wanted to poke me and such. FFS, I wasn’t going to die or anything…

They took some blood — about five vials worth if memory serves. I wanted to strangle the guy. From my other arm.

Anyway, the doc came and talked to me. Nice guy, a lot more knowledgeable and (more importantly) willing to listen. We talked about some things, and right off the bat, he told me that he didn’t think it was acute appendicitis, which I already knew. It was nice to have confirmation, though. So no surgery.

Which meant the barium swallow, as I had predicted. 900mL. Woohoo! I told the nurse/orderly/whatever I’d need an anti-emetic otherwise I’d be throwing up on the floor. She kinda snarkily asked me if I had a preference. “Promethazine, ondansetron, whatever. I don’t care, but I need something.” She kinda looked at me a little funny and made a comment about pharmacy students. She ended up giving me some promethazine, which almost immediately made me sleepy. I told David he might have to wake me up to get me to get everything down in time. He did.

Anyway, they had me hooked up to the machines and whatnot, which set off alarms if various vital signs don’t stay within certain parameters. I set off the heart rate one. The orderly came over and examined it and told me my heart rate was up. I told her it was because I hated barium. She told me it wasn’t stress related because my blood pressure was normal. I got a little annoyed at her and demonstrated that the alarms went off as soon as I took a swallow.

Some people hate tapioca. Some people hate broccoli. Some people hate chocolate. Well I hate barium. I don’t care how “good” it tastes — David thought it tasted good, he’s obviously crazy — I do not like it and I never will like it. It takes superhuman effort to suppress my gag reflex. In that respect, it’s not unlike tapioca. She left, still convinced that my heart rate was up due to some other cause. Which, of course, it wasn’t. As soon as I got it all down, I was fine.

So then came the CT scan some time later. Boring, whatever. The technician was hot, though. We started talking about auto-immune diseases. She asked me if I was taking Prednisone, and I told her “OMG no.” or something to that effect. Thanks to Mr. Promethazine, I was pretty out of it and I rambled about how it was better to take monoclonals rather than steroids. (She had arthritis, and was probably 25, a friend of hers had Crohn’s disease, so it was a natural topic of conversation.)

She needed to adjust my IV so she could inject iodine, which is a rather warming experience. It was actually kinda neat. Had I not been completely out of it, it probably would have been more fun.

Back to my ER room. Results of the CT scan make it seem as though everything’s fine. Which it mostly was, since I wasn’t in pain any longer. Probably a bowel obstruction caused by something unknown which later cleared itself up. The Rocephin may have helped, I think. The inflammation in my terminal ileum consistent with Crohn’s was still mostly there. I don’t know if the thickening was better or worse since I don’t know how bad it was in the first place. (I’m curious to see how well the Pentasa performs in a objective sense.)

Some time later they adjusted my IV, redoing the padding and sticky thing holding it in place. Thanks to that, the inside of my right elbow is fairly bruised and is still sensitive, two days later. I also have pinpricks on both sides. It makes me look like a heroin addict. But I’m out, thankfully, my torso mostly intact, and I still have my appendix.

I think I would rather have had all this happen while at home. This whole skipping fishing and a beautiful mountain lake to spend my time in the ER is for the birds.

* The question was how often simethicone could be given. The doc responded “Oh, that’s the same thing as cimetidine, isn’t it?” — which is certainly is not. Cimetidine (Tagamet) is an H2 blocker; simethicone is anti-gas medication used to emulsify large gas bubbles into smaller ones by changing their surface tension for easier digestion. H2 inhibitors block the release of Histamine-2, thereby blocking the release of acid into the stomach. Ultimately it didn’t really matter — cimetidine is usually given 2-4 times a day, and simethicone about 4 times a day. Nonetheless, it wasn’t comforting.

Posted in: crohn's , medicine , personal

The $15,000 delivery error (rianjs.net (Hanser)) by Rian

I just posted this over at OnThePharm, but I thought you guys might like to read the story, too.

I got call before work this morning to swing by and pick up a mis-delivered crate on my way in. Its contents was worth over $15,000. Underneath all the packaging, how much did the goods weigh? About 2 ounces.

If you enjoy reading it, please digg it.

Posted in: medicine