Social Gracious

It's a Good Thing She's Not an Octopus

My in laws are practical people, when someone needs help, you help them, when something is broke, you fix it. My mother in law's knees, damaged by arthritis, had been bothering her for some time, and she made the decision that it was time to do something about it, simple as that.  One nice thing about my husband's family, UberGeek included, is that they are very positive in their focus.  They assess things, research their options and move forward, ready to implement their plan.  

My in laws researched the candidates for knee surgeons  and decided on Dr. Mary O'Connor at the Mayo Clinic.  We are lucky to have Dr. O'Connor, one of the best surgeons in her field, right here in Jacksonville.  Dr. O'Connor recommended the Brooks Total Joint Rehabilitation program for rehabilitation, and it was time to schedule the first knee. 

MIL decided on a few days before Thanksgiving for the first knee replacement.  The second knee was optimistically scheduled for Valentines, keeping up with the tradition of scheduling things around a holiday.  When people heard me say that my seventy something year old MIL was getting two knee replacements in three months, mostly they issued dire warnings. "She'll never get the second one done, the first one will be so painful." "Most people never keep up with the rehab, they don't rehab the knee properly." "The new knee won't ever work right." I listened and worried about my MIL endlessly, asking UberGeek what he thought.  Typically, he replied, "She has the best surgeon and my dad will make her do the rehab, she'll be fine."

The first surgery went as planned with a short recovery at her suite in the Mayo Hospital, then she was off to rehab at Brooks.  There they put her through the paces with rehab every day, several times a day.  She was amazed by all the different things the therapists had her do, and how her range of motion changed day by day.  MIL couldn't believe anyone would get a joint replacement and go straight home from the hospital without a stay at rehab.  After two weeks at the total joint rehabilitation program, she was discharged and continued her therapy three times a week at a Brooks outpatient clinic, with my father in law closely supervising. 

Tonight I went to visit my mother in law in the hospital where she is recovering after having the second knee replaced.  As my father in law said, "It's a good thing she's not an octopus."  She looked great and was in good spirits; for a hospital room, she had pretty nice digs.  So I'll just say the thing that gives UberGeek the most satisfaction in life, "You were right" and this is one time I'm happy to let him say "I told you so."

I Like to Move It Move It

So I was cruising the web, looking for a picture of an elderly woman on a motorized scooter, for a blog post I had planned on healthcare reform.  Tonight I read an article about a man's finger getting bitten off at a recent rally for health care reform when a senior citizen and another man threw down.  Anyhow, I was going to title the post, Hell on Wheels and discuss how out of hand things have gotten when we really need to be solving a serious and critical issue as a nation. 

All that went out the window when during my search for a suitable scooter image, I stumbled upon a strange and fascinating site called ScooterFatties.info.  Apparently the mission of this blog is to collect pictures of obese people riding motorized scooters.  I really tried to look away, to not click my mouse again and look beyond the first post but the lure was unexplainable. 

I find it disturbing that our solution to obesity involves giving people a motorized chair with wheels that enables them to walk the absolute minimum number of steps possible.  I do understand that obesity leads to complicating conditions making it difficult to walk.  Wouldn't it be more fitting for an obese person's health insurance to pay for a nutritionist and personal trainer for a three month conditioning and weight loss program?  In the long run it would be much less expensive for their insurance than a scooter and continued obesity.  Obesity is a chronic condition that must be managed.  The costs to society are great; because of obesity the current generation will be the first one projected to have a shorter life span than their parents.  Obesity also rivals smoking with regard to costs in health care spending.  The healthcare costs of obesity have doubled in the last decade to 147 billion in 2008. 

When I was pregnant I was confined to bed rest for ten weeks and only allowed out of bed for a brief shower or to use the rest room.  Six of those weeks were spent in a hospital room with only fluorescent lights and no access to the natural world.  I can tell you honestly that it was the worst challenge I have ever been through in my life.  After my children were born the first thing I wanted to do was get moving. Within four weeks I was running slowly around my neighborhood, earning an evil eye from my OB who nonetheless said he knew better than to say no.  I never wanted to be confined again and it was beautiful to be free, to run outside in the fresh air and have a body that was no longer a prison.  I try to share the joy of moving with my family, just to have a healthy body is a gift that we have a responsibility to care for and love.  I know one day my kids will want to watch more TV and play video games but I hope they always have the joy of movement. 

Get up and move while you can.

Living Will, What's the Beef?

I know there is a big hub bub brewing right now regarding advanced care planning. I'm not sure what the deal is, everyone should have a living will, and carefully consider advanced care planning. I am thirty five years old and I have had a living will since I was twenty five. I'm healthy, fit and have no serious health conditions, and tomorrow I could be hit by a very large bus. For the sake of my family and my physician, I want my wishes for care known in advance so my family won't be put in an even more difficult position. I don't want my family making the wrong decision because they love me too much to let me go. I want to be allowed to die if there is not hope for me to recover. They don't have to decide whether I would wish to live in a persistent vegetative state, kept alive artificially, because I have already made it clear that I do not.

I also name my husband as my healthcare surrogate so that it is clear that he is the person I wish to make decisions for me in the event that I am incapacitated and cannot make them for myself. That is particularly important. Although I would never anticipate a family feud, I do have a sister and a mother, and perhaps they wouldn't necessarily agree with what my husband decided upon, however, it's my decision ahead of time to choose him to make decisions for me. Remember, that if you do not designate a surrogate this is not necessarily clear.

As I age I will update my living will regularly, and if I become chronically ill I will consult with my physician to be sure it reflects those changes. If I am affected by a terminal illness I expect to speak with my physician frankly about my life expectancy and treatment options. I have seen physicians treat patients with chemo when they had crumbling bones full of mets, simply because the patient asked them for it. I want to know when it's time to call the treatments finished and head to Disney World with the strap on morphine pump. I am hoping for a long, long life without incident but I am prepared.

When I hear of senior citizens and the elderly who are against having a consultation with their physician about advanced planning paid for by Medicare I don't really understand. I certainly understand not agreeing with the entire Health Care Reform bill but what's the beef with page 425? It doesn't require you to have a Living Will, it just requires the consultation to be paid for every five years. Trust me when I tell you that you want your physician to talk frankly to you about advanced planning. The alternative to doing your own advanced planning is having others, and not necessarily those you would choose, do it for you when it is too late.

Tax the Fat, Pay for Health

Today I watched the White House's town hall meeting on health care reform, broadcast right to my computer at work. I was encouraged by the participation and the feeling that so many people know that something must be done. What discouraged me is that seemingly we overlook the obvious in our complex searches for solutions. Healthcare costs, a lot. However, the people who cost the most are the sickest. One of the reasons many healthcare experts cite for them being so sick is the fact that they may go many many years without comprehensive health coverage before reaching 65 or becoming disabled and qualifying for Medicare. At that point, they then have access to as much healthcare as they wish. The problem is, by that time most of their illnesses are no longer simply treated by good primary and preventive care, they now require major surgery and procedures at a very high cost.

A good example is heart disease, which can be prevented, especially for those with high cholesterol by maintaining a healthy lifestyle and taking a statin drug. However, if you have no insurance you are likely unable to pay the $150-200 doctor's visit plus $50 a month for Lipitor. You probably also will not be able to afford visits to a registered dietitian who will advise you to increase healthy fats like nuts, olive oil, and avocado and keep away from the nasty deep fried kinds. Instead, you will slowly get sicker until you reach 65 at which time we will all be happy to pay for you to have a triple bypass, lengthy hospital stay and rehabilitation. To me it makes a lot more sense to make affordable coverage available to everyone somehow and pay primary care physicians a reasonable office visit fee for great preventive medicine. We also need to treat primary care physicians like the gatekeepers to our health that they are, instead of as the low rent physician you see to obtain a referral to a "real" specialist. This is not to say there are not issues which should be treated by specialists, I just believe that a greater role and emphasis on primary and preventive care for everyone will result in lower cost.

This brings me to my next subject, we are fat in this country and it is costing us, lives and a lot of money. Why are we not taxing fast food and soda? (Probably because Ronald McD got a lot of lobby money) If you want to drink it, eat it and cost us all money that's your choice, but we are going to use your purchases to pay for your healthcare and healthy food for others, thanks very much. I think every fast food purchase should be taxed at a pretty hefty rate with perhaps the exception of some items meeting a 6g fat and 600 calorie limit, those can be put on a healthy choice menu. Tax soda too, if I see one more two year old with soda in a sippy cup I might flip my lid.

Fresh fruits and vegetables should be subsidized. For a country whose children will, for the first time, not live longer than their parents, we are not motivated enough. It is disgusting that in inner city neighborhoods children and their parents can find a convenience store full of inexpensive junk food and soda but not one banana. It's absolutely shameful. We have farm subsidies for millionaire agrobusiness owners, how about subsidies for people who want to eat American grown produce? Let them eat fruit and veggies, cheap!

How about encouraging employers and insurance companies to offer rate discounts for healthy behaviors? Maintaining a healthy BMI, not smoking or quitting, or if overweight following a dietitians plan and making gains toward healthy weight loss, attending a gym regularly etc. Even better, employers should be encouraged to have on site fitness facilities and allow extended lunch hours to staff who wish to work out during that time. Ooooh, you say, that extra 15 minutes could lessen productivity. Oh yeah? You ever looked up how much extra unhealthy employees cost employers in workers comp claims, sick leave and health benefits? They should be begging people to work out on their lunch break.

No more soda and candy machines in schools, bring in the apple cart, the yogurt vendors and bring back daily PE. I want to start a revolution! You want to really save on healthcare, make it more expensive to be unhealthy and less expensive to be healthy. Provide low cost coverage so that everyone can have preventive health care. We all pay, because at 65, everyone gets health insurance and it's in our best interest if everyone has had access to a healthy lifestyle and  health care up to that point.