Angst, Worry, OCD, or Dementia

Bob had a doctor's appointment this morning. On the way I noticed the leaves are beginning to turn and that is very exciting to me because fall is my favorite season of the year.

Angst, worry, OCD or dementia, I don't even bother to try to distinguish one from the other. Makes no difference. Whatever it is requires my attention in the same way, so I just deal with it and move on.

Bob is in heart failure and as it progresses he picks up additional problems that go with the disease. He's now retaining fluid, which is common in heart failure patients. It's a fairly new development for him. Yesterday I called the cardiologist for some guidance since it's now pretty clear this is here to stay.

My question was about managing Lasix (diuretic). It seems to me giving Lasix every day is probably not good if you can manage to do otherwise but what do I know?  I know Lasix drains the system of potassium because I have to give him potassium when I give Lasix.
1) How do I know when to give it?
2) How often do I give it?
Word back from the doctor was when he's gained 5 pounds give him Lasix for 3 days. If he's not returned to his base weight call him.

Seemed simple enough to me but boy did that throw Bob for a loop. The simple thing seemed to be to tell him not to worry, to just leave it up to me to manage it. He was having none of that. He was off and running. We are now into day two of angst over taking Lasix.

Off and on all day yesterday I explained the situation to him. He'd be okay for a while and then we needed to do it all over again.
1) What if I have a doctor's appointment on a day I'm taking Lasix?
2) Why do you tell me one day I need to eat more, and the next day say I need to lose 5 pounds?
3) Why take it for three days and not every day?
4) I can't read the scales (wearing his glasses would probably help).
5) Why is Dr. P (cardiologist) doing this when I see Dr. K (pulmonologist) for my breathing?

On and on it goes. Eventually he'll move on but I'm not sure when. Tonight I'll begin weighing him in his pj's, and I'll read the scales. That will give me a good consistent picture. I'm now in possession of the Lasix and potassium. I'll decide when he takes it.

What can I say, he's 84, in frail health, but still on his feet and moving. He's still walking unassisted (most of the time), still washes his own clothes, still attempting to cook, but that's requiring a lot more of my help, still able to take care of his own hygiene. I have good medical support. All in all, life is good.

Be Happy

I decided to make a conscious effort to be happy this week. Bob doesn't look very happy in this photo but he should. Yes, I replenished his supply of peppermint puffs, but I can also report he is feeling much better now that the cardiologist has taken him off blood pressure medication.

No more weak spells, no more dizzy spells, energy level is improved, and cognitive thinking is improved. I'm keeping a log of his BP readings as the doctor requested and will take that report in last of the week to be reviewed.

I'm prepared to fight if I need to on this one. I understand why a very low blood pressure works best for a heart like Bob's, I get that. My argument is quantity vs. quality of life. He has no quality of life when his BP is too low.  I'll take quality over quantity.

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I'm continuing to work on getting the shrubs outside our living room windows removed or severely pruned. Last week a worker came to assess the situation. If he'd brought a saw he could have taken care of the problem but I guess that would eliminate a job, the world needs 'assessors.'

This morning when I turned in my work order for the second time I suggested they might prefer I do it myself as it would be easy to do with our chainsaw.

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I'm back on my soap box that seniors need an advocate. If you're still with it enough to make your opinion known you need to speak up.  We have a friend and an extended family member who both have recently gotten caught in the web of bad medical practice. Fortunately both had good advocates in family members but it pains me to think of those who don't. I'm more convinced than ever seniors must not remain silent. We must think of those who may not have anyone to advocate for them and speak loud enough someone in administration gets the word. We must continue to push and insist on good medical care for seniors.

Wellness Check

Bob had an appointment this morning for his yearly wellness check. That's apparently something we're doing now as a result of the Affordable Care Act.  It's done on a yearly basis I think. I did mine a week or so ago and all went well, I was in and out in about 15 minutes.

Bob's visit was well over an hour. Even the doctor was worn out by the time it was over. These doctors are inputting information into a computer the entire visit. There are many questions that have to be answered. It takes a very long time to see a patient like Bob. I almost felt the need to apologize.

The doctor drew a circle on a piece of paper and asked Bob to fill in the numbers of a clock. This is the second time she's done this. Apparently it's never dawned on her a very big clock is on the wall behind her. Bob just copies the numbers on that clock onto the paper and he always gets that one right and flunks all the rest. Sometime I may clue her in but Bob probably would prefer I not do that.

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Remember this pink Physician Orders for Life Sustaining Treatment (POLST) form that I wrote about recently?  I had turned Bob's in. It was scanned and entered into a registry, and I learned there's another purpose to this exercise. This morning the doctor handed Bob's back to me and told me to attach it to our refrigerator. She says emergency medical personnel are trained to look for this form attached to your refrigerator when they make an emergency call to your home.

I can do that. I wondered how emergency medical personnel were going to know what to do about life sustaining issues in emergency situations. Now I know.

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I'm going to run something by you just to see what response I get given we're living in such heightened conditions about treating all people the same, as well as being super sensitive to anything that could be construed as racist.

The MA (nurse) this morning was from India. She had one of the heaviest accents I've run across. Bob couldn't understand a thing she said, and I had great difficulty. A watched her very closely, and as often as not I finally figured out what she was asking by context rather than the actual question. I was totally unsuccessful in having a phone conversation with her last week.

She clearly knows her job. I have no reservations about the quality of her work. I'm not quite sure what to do about this. I'm going to be in a meeting next month at the hospital where I can discreetly mention it to the man who oversees the hospital's four clinics and see what he thinks but I'm not sure if that's appropriate. I guess I don't know the politically correct thing to do in this situation. What do you suggest?

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If you need a laugh today I suggest you go to Time Goes By blog and read what to expect from the free Medicare Wellness Visit.

Uneventful Living

In spite of all the awful things that have gone on in our country this week, life in our little corner of the world has been uneventful. Uneventful living can get boring but it can also be welcome relief.

Bob and I played well together this week. I'm now convinced running frantically to keep him entertained was not good. Yes, he is still an extrovert but now he's an older and slower one. Constantly being around people sometimes causes him to have to think faster that he's really able to do these days. Short exposures are better, a chance to smile and speak a greeting, a neighbor stopping by, things that happen at our apartment or as he moves around the complex, even greeting people in the grocery store are better I think.

Having Safeway deliver groceries was a godsend. We still hit the grocery store two or three times a week but only for a very few items. No more loading and unloading large amounts of groceries.

This week we've been pretty quiet. Bob does pretty well given a little extra time to think. I need to remember not to rush him. He even did a small repair on the car this week, after thinking about it a couple of days.

He's still cooking. I'm in charge of what he cooks but he pretty much does the rest. We're keeping it simple. He's not eating much these days but I don't think it has anything to do with what we're cooking.

Weeks like this make me think we may make several more anniversaries and I would like that.

Next week he will have another blood test to check his platelet level. There was reason for concern a month ago so the doctor ordered another test in a month rather than six months. This test will tell us if he's in trouble or if the dip last month was just a fluke.
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I'm a bit put out with the world of medicine. I so fear for older people who have no one to stay on top of their medications.

Right now two of Bob's doctors think they're treating his blood pressure. They're both prescribing the same medication, one with an added ingredient, and one without. If he took the medications coming to our mailbox he would be dead.

Three time last week I had telephone conversations trying to straighten this situation out and still another bottle of the wrong medication arrived in our mailbox. Fortunately Bob knows there's something going on about that drug so he's been good about showing me the bottle and asking if that's the one he should take. I've been quickly whisking away the bottles he should not be taking.

At one point I called our mail order pharmacy and canceled delivery of the wrong prescription. To my horror the doctor sent a new one and another bottle arrived last week.
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I've been thinking some about the 60s and 70s, thinking about some of the personalities of those times. Remember Governor George Wallace of Alabama? My, my, did he ever strike fear in my heart.

Several Things

This week I'm listening to Elizabeth Warren read her book A Fighting Chance.  I like this woman and if Hillary becomes our next president I'm going to be very unhappy if she does not appoint Elizabeth Warren to a cabinet position.
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I do not suffer from arthritis so I don't take a lot of anti-inflammatory drugs, but occasionally I take Naproxen or Ibuprofen if I have aches or pains.  For years I've taken one Prilosec because a doctor told me this would protect me from getting ulcers if I took anti-inflammatory medications.

I chronically suffer from slight anemia which causes my doctor to fret. It's happened again. I had all the necessary scopes done nine months ago looking for the cause but nothing showed up. Now we're left to assume it's just me but she still wants to take some action. In addition to taking another round of iron she advised me never to take Naproxen or Ibuprofen but to take Tylenol instead. I believe there is now an arthritis formula Tylenol on the market. In addition, for a month, she wants me to take two Prilosec a day hoping it will heal any irritation, and then return to one a day.

I've never been one that paid a lot of attention to taking over-the-counter pain and anti-inflammatory drugs but I'm beginning to think perhaps I should be more cautious.
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This afternoon I had my yearly diabetic eye exam. The office is near Costo so I took Bob with me and told him we would stop back by Costco to pick up only a few things. I had a list, a short list. I'm not a fish person but decided I'd try some halibut so put a small bag in our cart. Leaving the store Bob asked did I know that little bag of halibut was $43? We were near the customer service desk so we made a quick turn and returned those little fishes.

In defense of myself and my strong dislike of Costco our daughter told me while she was here that our store is the largest she's ever been in, much larger than where she shops in Texas. Now I figure if this store beats the ones in Texas it's got to be humongous in size.

Remember me saying I found a chair and sat, sending Bob on with the basket to shuffle along and shop? She had him sit while she hiked to the back side of the store. Much faster she says.

Unexpected Adventures

I had to chuckle when I saw this picture on the Advanced Style blog with the admonition not  to dress your age but rather how you feel. I'll leave you to think on that.
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Today was doctor day for Bob and a revealing day for me. He had appointments with two doctors and a lab appointment to draw blood, all morning appointments.

The hematologist has ordered another platelet count in a month. That's all he can do. We just need to establish if this lower platelet count is a trend or if perhaps it was a one time thing. Had a very informative talk about Wafarin, and Aspirin and how they work in different ways as blood thinners.

Bob had lost 8 pounds since he saw the hematologist in December.  Bob surprised me by telling the doctor he thought his biggest problem now was mental.

Learned he's not been taking one of his medications properly. Came home and spent the afternoon preparing medication sheet with instructions to assist him in filling his pill box. He's always taken care of all that himself. I will now join him for that task. Also clearly labeled his pill bottles.

Watched old people coming and going at the different medical offices and thought, that will soon be us. I've never seen so many walkers, wheelchairs, canes, and caregivers in one place. Growing old is not easy.

It is very seldom we eat in a restaurant but there is one Bob enjoys near all the medical offices we were visiting so we went there for lunch when his appointments were finished.
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 I read a thought provoking quote by Dan Beckmann on Misadventures of Widowhood.

"Marvelous moments happen to us all the time. We're just usually not present enough to be aware of them while they're happening. Experiences feed a curiosity that carries you beyond your backyard, to find wonders big and small. Near and far. Extraordinary and ordinary. You can find adventure everywhere and anytime. Even late in your own game."

I urge you to pop over and read the entire post.

Two Tier Planning

We received word last night of something that happens far too often among aging adults. A widowed family member knew she needed to relocate near one of her children, and was very agreeable to such a move "when the time came" that she needed more help.  She was convinced she would know when the time was right for such a move. Wrong. The time came last evening and she was not where she needed to be. Now it will be up to her sons to make the decisions. Over and over, all across American this happens.

We hear a lot about planning our retirement years. Generally we're encouraged to downsize from the family home, find an exciting place we've always dreamed about, and move there. You've seen the ads, wonderful golfing, tennis, and all the rest. Some couples fulfill their dreams by full-time RV living and travel. That's all good for a number of years and then what happens? Oops, no plans.

When age related health issues develop and they can no longer play golf every day, or travel in their RV they often find they have a problem.  They aren't living in communities near doctors, hospitals and all the things they need close by.

When our children were young, and Bob and I were working, we bought a home in a neighborhood and stayed there thirty years. That was the right decision for our family at that time in our life.

When I was a year out from retirement I looked around my neighborhood and realized I would stagnate in that environment. I needed more stimulation. I began to read and think. We are native Texans but Texas was not a good fit for me. It was a good fit for Bob, anywhere is a good fit for Bob.

Our son, his wife, and son (only grandchild) live in Hillsboro, Oregon.  The first time I visited Oregon I knew this was where I was meant to be. In 2004 we sold our home and moved to Oregon. Best decision we ever made.

As an only child caring for my aging parents I learned the things I did not want to put on my children. When I retired I set about to make sure we had our business in order.

I did not want to leave a house for them to clean out and dispose of that we'd lived in for 30 or 40 years collecting 'stuff.' I wanted to travel light through the rest of my life uninhibited by material 'stuff.'

I never wanted to own property again. I hated owning a house. I wanted to be able to move easily if the need arose. Bob's health was not good and he wasn't up to the work it takes to maintain a house.

That's two stages in life. Now we're entering a third. One of us will eventually be left alone. What happens then?

This is the plan. Bob can handle very little stress these days. As long as he lives we will stay right where we are, convenient to doctors, the hospital and all the stores we need. We're in a good location.

Should I be the one left I will make changes. Bob is 84 and I will soon be 74. I would like to live in a high rise. Bob would hate a high rise. I want to live where I don't need a car. That's unthinkable for Bob. I want to have my groceries delivered. Bob hates that idea. You get the picture.

My point is people stop short when making retirement plans if they don't consider the second stage of retirement.  Very few people have the same needs at 65 that they have at 90.

Medicine Has Come A Long Way

Franklin D Roosevelt

The day before his death April 12, 1945

at 63 years of age.

Brain Games - Help or Entertainment

Brain games seem to be the rage now, nobody wants dementia or Alzheimer's.  For years we've been working all kinds of word games and puzzles trying to stay sharp mentally.  Is it helping or are we just getting better at working puzzles and word games?

I view this subject as rather like a dog chasing it's tail.  Who knows?  I don't spend a lot of time thinking about it or researching it but I did read an article that made me happy because it agrees with my way of thinking.

I don't particularly like word games or puzzles.  I keep crossword puzzle books in the bathroom, have a word find puzzle on my phone and work jigsaw puzzles on my phone but that's about it for me.

This author seems to think the goal is to keep your mind active, how you do it is your choice.  If you like word games and puzzles, great.  However, you can accomplish just as much by reading books, newspapers, visiting museums, and any other activity that stimulates your mind.

The goal is to stay mentally stimulated.  The brain needs exercise just as our bodies need exercise.  There are many ways to exercise our bodies and many ways to stimulate our brains.

Now I'm going to mark this subject off my list of things to worry about and go merrily on my way doing things I enjoy that stimulate my brain.

Do you do any activities with the goal of keeping your mind sharp?

Aches and Pains

Do you suffer more aches and pains than when you were younger? I seem to keep an assortment of things that aren't serious but very annoying.  Recently it's been my shoulder, it's very painful.

What really annoys me is knowing when to seek medical care. Past experience tells me if I live long enough this pain will go away.  In the meantime it's quite uncomfortable.

I could pay a visit to the medical world but I'm too frugal.  It's not my money being spent, but rather Medicare and my insurance company's dollars.  Nevertheless, I do not want to be a bad steward of medical care dollars.

If I pay a visit to my doctor, besides an office visit, there will no doubt be a charge for an x-ray that will almost certainly reveal nothing. At that point I will likely be referred for either a scan of some kind or perhaps referred to a specialist. It's unlikely anything will show up there either.  By the time I get in to see a specialist or get the scan the pain may be gone and I'll feel like a fool.

There was a time when doctors freely prescribed muscle relaxers and pain relievers but no more, you have to have a limb hanging by a thread to get either one these days.

Remember the tried and true Naproxen muscle relaxer?  I've taken a boat load of it when it was a prescription.  Now it's over the counter and doctors run backwards up a tree at the thought of a patient taking it.  Same thing with Ibuprofen.

I've never been a fan of Ben-Gay or any of those rub on remedies but I do like heat.  Yesterday I found a sale on these aromatherapy critters.  Pop them in the microwave and then snuggle up with one on my aching shoulder.  Feels good, sometimes helps, but a good dose of muscle relaxers would help even more.  

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I wrote in an earlier post about the ghost that visits our kitchen from time to time. I wish I could catch that rascal.  Last night it was the freezer  door.  Wonder what the purpose was for airing out the freezer compartment?
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What is your remedy for aches and pains?

Elder Organ Donation

Organ donation is not something I routinely think about but I'm very aware of the miracle of it.  I suppose, like so many, I thought we were too old to make such a donation.

Visiting the organ donor website I was surprised to read this paragraph.

"No one is too old or too young.  Both newborns and senior citizens have been organ donors. The condition of your organs is more important than age.  Someone 35 years old with a history of alcohol abuse may have a liver that is in worse condition than someone 60 years old who has never consumed alcohol.  Doctors will examine your organs and determine whether they are suitable for donation if the situation arises."

It seems having medical issues does not necessarily prevent you being a donor.

"You may still be able to donate your organs.  Doctors will evaluate the condition of your organs when the time arises.  The transplant team's decision will be based on a combination of factors such as your specific illness and your physical condition to determine which organs and tissues can be donated."

"As of May 2015, according to OPTN, there are 55,282 people between 50 and 64 years old on the national waiting list and 25,908 people over 65 years old on the national waiting list."

Go to the organ donor.gov website to read about the process of becoming a donor.

There's also a short brochure especially for elderly donors from the Health and Human Services Department.

For additional information check this website.  The story here of the 93 year old man's liver going to a 69 year old woman was interesting.

This is a subject we will definitely be discussing as a family in the next few days.

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Once again I am indebted to Ronni Bennett for the material used in this blog post.  You will find much more information if you visit her post on the Time Goes By blog.  I encourage you to read what she has to say.

What Does 75 Tell You

Close your eyes and pretend with me.  Visualize yourself as a doctor about to enter a treatment room where you will be meeting a new patient for the first time.  You see her birthday and know she is 75.  What does that tell you?  Think about that for a moment.

You could open the door to find a nursing home patient accompanied by a family member, a person of compromised mental capacity.

You could open the door and find a woman in a hurry because she's on her way to a League of Women Voters meeting and has other committee meetings to attend that day.

Why then do you suppose so much is assumed by knowing a person's age?  When do we become old?  In the current political campaign we have two candidates pushing 70 and one 75.  Is that old?

When children today hear the word 'grandmother' what picture forms in their mind?

Due to the advanced healthcare available today people are living longer and often in much better physical condition that ever before, but has the world's idea of old changed?

Have you experienced any discrimination because of your age? I can't say that I have.  Of course I've not tried looking for a job. I actually think I've had more positive than negative experiences being in the elder stage of life.

Would you like to see changes in the way people our age are viewed or are you happy just the way things are today?

Prescription Drugs Price War

The cost of prescription drugs is a big issue in providing healthcare in America.

"The chief medical officer, Steve Miller, at Express Scripts, the largest pharmacy benefit manager in the U.S., has been essentially auctioning off his 80 million customers to the drug companies that will give him the best deal.

Express Scripts and its rivals including CVS/Caremark and OptumRX manage prescription drug coverage for insurers and employers.  They're trying to spark price wars among drug makers by refusing to pay for some brand-name medications unless they get a big discount.

The result is that average costs for many drugs are falling.  At the same time, consumers are being forced to change medications, sometimes to brands that do not work as well for them."

This year more than half of all patients will have a prescription excluded from coverage.

"Express Scripts pioneered a strategy two years ago, when it announced it would no longer pay for 48 brand-name drugs.  Right out of the gate it took on some big-name products, such as Advair - the blockbuster asthma drug made by GlaxoSmithKline, now known as GSK."

"Advair's price had risen more than 20 percent in 2013... Then on Jan. 1, 2014, Express Scripts tossed Advair off its drug list and moved its customers to rival asthma drug. Symbicort."

"The results were immediate.  Sales of Advair dropped $1.8 billion that year.  The prices of both Advair and Symbicort fell 20 percent in 2014 and are still falling.  Advair was restored to Express Scripts' formulary last year."

What would you suggest is the best way to bring the cost of prescription drugs down?

Medicare vs VA Drug Formularies

Well rats, the Republicans are having another tantrum, this one involving the president's proposed budget. I'd like to call your attention to a few things that affect senior citizens that they're refusing to consider.

The Center for Medicare Advocacy laid out the impact the president's proposed budget, if passed, would have on Medicare drug policies.  I'm using the short version posted on Time Goes by.

~ Restore drug rebates for brand name and generic drugs to beneficiaries who do not receive the Part D Low -income subsidy (LIS)

~ Greater transparency in drug pricing

~ Negotiate prices with drug manufacturers for biologics and high-cost prescription drugs covered under Part D.

~ Close the Part D doughnut hole in 2018 - two years earlier than under current law.

This NYT article, titled "The Reason Medicare is a Lousy Drug Negotiator" is worth reading.

"The real problem is that Medicare can very rarely say "No way" to a drug company.  Medicare beneficiaries wanted the program to cover most drugs that older people would want to use.  So Congress put in place rules that strengthen the hand of the drug companies in negotiations."

"The government does have one program that can say "no" to drug companies, and it gets much better deals than Medicare.  The Department of Veterans Affairs negotiates hard with drugmakers. But it is also bound by fewer rules than Medicare, and one result is that it covers far fewer drugs."

From personal experience we have found the drug formulary for the military to be very different from the formularies of Medicare and private insurance companies.

Last year when Bob's twin was dying he needed a drug that was prohibitively expensive, more than $5,000 a month.  It was not covered by Medicare or his insurance company.  Fortunately he had served in the Navy and qualified to go to a veterans hospital.  He got the drug there for free. What if it had been his wife that needed that drug, where would she have turned for help?

I find all this troubling.  How about you?

Education by Drips

Perhaps you are one of the fortunate Americans with good health.  At our house that is not the case.  We spend a lot of time with the healthcare industry.

Our daughter is a nurse educator in a cutting edge hospital.  She tells me part of implementing the Affordable Care Act is a push toward educating the public. The medical world is finding they have a very steep hill to climb in doing this

Personally I've found Americans 65 and older tend to fall into two groups:

1) They view the medical world negatively from some past experience and have closed their minds against having a positive experience. They prefer complaining. It's much easier to complain and find fault that it is to become educated.  Education takes time and requires involvement.  Not interested.

2)  The folks in this group are still in good health.  It's depressing to think about the time coming they might need more healthcare.  They'll think about it if that time comes.  Not interested.

An educated public would significantly reduce the cost of healthcare in America.

No one can force you to be educated, they can however attempt to educate you using the drip method, drip, drip, drip.  These are some of the things I'm noticing in the hospital and clinics we use.

a)  More pamphlets and printed educational materials.

b)  Instead of music while you're on hold you may hear a healthcare message playing in your ear.  I noticed that for the first time this morning when I was on hold.  What a concept.

c)  The clinic we use now has a flatscreen monitor in the waiting room that plays a continual loop of healthcare messaging while you wait.

d)  Our hospital system has a portal where patients can access all kinds of good stuff.  Bob gets an email every time he has blood work done.  It contains a link to his medical records so he can review the results of that lab work.

I've received messages informing me it was time for a mammogram, and one about it being time for a colonoscopy.

I can email the clinic and ask for an appointment.  Much easier than waiting on hold on the phone if you don't need the appointment immediately.

I'm told they began in January rolling out text messaging through the system.  It hasn't made it to any of the offices we use yet but I'm eager for it to get to us.  I love text messaging.

e) Advertising on the side of buses.  Imagine my surprise the other day when I stopped next to a city bus, looked over and there was my doctor smiling at me with a healthcare message from the side of the bus!

Be prepared to be educated by drips.  Education is a cost cutter.

Scarcity of Geriatricians

This week Ronni Bennett wrote about The Scarcity of Geriatricians on the Time Goes By blog. After reading her post I feel grateful we were able to get Bob under the care of a geriatrician.  Apparently they are not easy to find and their practices are full if you do find one.  She refers to an interesting article in the New York Times.

I won't cover ground here that she covered in her blog but I encourage you to read her post.

What I want to talk about here is what we have experienced with care under a geriatrician as opposed to a regular family practice physician.  A geriatrician is a physician already certified in internal or family medicine who has completed additional training in the care of older adults.

Bob's geriatrician is a woman from Slovenia so there is perhaps some cultural influence in the care she gives.  Here are just a few things I have noticed that are different about her care.

1) She is not in a hurry.  You get as much of her time as you need.  That said, you pay for this by sometimes waiting a while to see her.  She's often not on time but you know when she gets to you she will give you her full attention.

2) She has a different approach to medications.  Medicines sometimes act differently in older people.  She talks about studies of senior adults taking a drug, not studies of the general population taking it.

3) There is a psychological difference in how she approaches the patient.  More awareness of what may be going on mentally in an older patient.

4) She believes in what she calls "a tincture of time."  She uses that phrase often.  She believes "a tincture of time" is often good medicine. That may be cultural but I use that term often myself.  I also believe "a tincture of time" takes care of a lot of things.

5) She believes in keeping it simple, no more than is necessary.  Too many medications and you often  get additional problems.

6) She speaks in a loud clear voice, mindful older people often have hearing issues.

7) Her nurse calls to follow up.  Once Bob was in the emergency room and we got a call from her office the next day when the ER report reached her office.

8) The first time Bob saw her was shortly after the death of his twin.  She took both Bob's hands in hers and told him she was sorry about him losing his brother and knew he was grieving.  Said there was not a pill she could give him for being sad but he would begin feeling better.

Keep in mind she is in our community hospital owned clinic, not in private practice.  Geriatricians are a good thing, we need more of them.

PaceMaker Time

Bob had needed an engine tune-up for some time but was resistant.  The time came that even he was ready to do something so in August a pacemaker was installed.

It was a day surgery procedure which still amazes me.

He came home with this transmitter that sits on his bedside table.  Sometime during the night it wakes up and silently 'talks' to his pacemaker.  If all is normal it goes back to sleep.  If it detects any unusual activity has occurred it sends a report to the cardiologist and we get a phone call.

It has sent a report only one time and we did get a phone call.  For some unknown reason he had eight heart beats that were too fast.

For years Bob's cardiologist did the pacemaker procedure himself when it was needed.  But times have changed and this group of cardiologists now refer their patients to a heart rhythm speciality group of doctors.  Bob wasn't happy because he likes one doctor to do everything.  I thought it was a smart move for everyone involved.  I was pleased.

I've long thought medicine needed to get out of the contest of every hospital and clinic having the most expensive equipment and stop trying to top each other.  It's much cheaper to do it this way.  Our referral was to a group of heart rhythm consultants at a hospital in Portland.  Oddly enough we live about the same distance between our hospital in Hillsboro and the one in Portland.  It also troubled Bob to have to use a different hospital.  So be it, we were off to see what these new docs had to say.  I thought it was a much preferred way to do things.  These doctors deal exclusively with heart rhythm issues and the procedures involved.  Lots more education and practice.

Like many patients Bob has conflicting ailments.  He has a hematology problem that conflicts with his heart problems.  He always has a low platelet count and he also needs to take aspirin and Coumadin/Warfarin. I was anxious to see what we would need to do about these medications.  Imagine my surprise when the surgeon said to do nothing, they do not take patients off blood thinners to put in a pacemaker and his low platelet count was still high enough he didn't need medical intervention before surgery.  Can you believe that?  Wow.

We were released after the procedure and told to see our regular cardiologist in a week.  We'll probably never see those doctors again unless he develops a pacemaker problem.

I wish I could say all this process has been without anxiety but that would not be true.

But at last we're back to something we can live with.  At last we can say he's feeling better than before he received the pacemaker.

He's driving some again; able to go to the grocery store alone; walks up to get the mail; and in general has more energy.

Finding A New Doctor

When our Doctor changed his practice to concierge medicine we were left to find a new family practice/internal medicine physician.  I cannot begin to tell you how much I dislike the process of finding a new doctor.

I had had read doctors in private practice can refuse to see Medicare patients but hospitals cannot.  I was pretty burned by our experience and decided it would not be wise to choose another doctor in private practice.

The hospital in our community owns several clinics in the area.  I decided our safest bet would be to choose a doctor in one of those clinics. I don't know how these doctors are paid but I'm guessing they are paid a salary by the hospital.

Choosing a doctor in a hospital owned clinic meant we would likely be getting a different doctor from time to time as doctors entered and left hospital employment. 

It also meant chances were greater we would see a doctor of a different ethnicity than our own.  That's sometimes problematic for Bob.  He doesn't hear well and accents can be difficult.  The other thing we have to consider is humor.  Bob is a tease and humor doesn't always translate well.

Bob's hematologist is married to a doctor working in one of the hospital owned clinics.  I figured she was not likely to move as his speciality practice is well established.  She is Vietnamese.

She works great for me but was not as good a fit for Bob.  Eventually we switched him to a doctor with a geriatrics speciality.  She is from Slovenia. That situation seems to be working well.

Our community hospital also has some urgent care clinics.  One is located near us and I've used it a few times.  It's very nice to walk in and all your information already be in the computer.  All you need to do is have a seat and wait your turn.

I feel good about our decision to choose a hospital owned clinic.

Aging Eyes

When I was about six years old both my parents came home wearing new glasses.  I was impressed and made wearing glasses one of my life goals.

By the time I reached forty wearing glasses was no longer one of my goals in life but they began printing paper items in smaller fonts and I was forced to take a look at non-prescription reading glasses. I loved them.  I had them in many colors and in every room in the house.  I could push them up into my hair when not in use.

Then things got serious, no more reading glasses, it was trifocals time.  For the next thirty or so years I wore those, and they were not nearly as fun as wearing reading glasses.

Eventually aging eyes caught up with me and it was time for cataract surgery.  I learned if I paid the $1,000 Medicare would not pay on a lens to correct my astigmatism I could almost certainly go back to non-prescription reading glasses.  I was excited.

I had myself a good time at the $1 store in those early days after surgery.

Then I became more selective.  I like the very narrow ones. I was no longer shopping at the $1 store.

Then it was on to some online shopping.

The difference these days is I can no longer remember where I laid my glasses and my hair's now too thin to hold them if I push them on top my head.  I lost a pair I'd stuck in a vest pocket.  I've now ordered this item to wear when I leave the house that will hopefully keep my glasses safe when not on my face.

I've also realized it's too much effort to keep up with multiple pairs of glasses.  Most of these are now relaxing in a drawer waiting for the opportunity to be passed on to someone else having cataract surgery.
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A fun article: Jon Favreau, Speechwriter