Medical reversals

We all hate them. These are when you received a medical treatment and find out months, years, or even decades later we find out from new research it wasn't helpful or could have even been harmful. We justify it to ourselves that it is because the medical world was using the best information available to them at the time and they had no way of knowing.

I have found this out for myself numerous times with my medical history. Treatments that I received are no longer accepted practice.

Now there are a couple of doctors out there who wrote a book on how we need to change these 'flip-flops' in clinical practice. They are actually called 'medical reversals' (not the most aggravating thing you can find out about your medical treatments). Here is a quote from the article:

"...hormone replacement therapy as being sort of the seminal reversal for doctors of his generation.

The thing that really was seminal for me was the routine use of stenting for stable coronary angina. It's a very costly and invasive procedure, and it continued to be done in a very widespread fashion. The evidence for it was always unclear and then in 2007 with the publication of the COURAGE trial, a lot of the evidence was contradicted."

We all remember HRT was found that it was later shown to actually increase the patient's risk for breast cancer.

"In every case of our book, we found an example of something that was perfectly logical, it was incredibly plausible, it made perfect biological sense, but it was broadly accepted without those definitive confirmatory studies to really prove it actually does what you think it does. And in the years that followed, people over time became a little bit more skeptical of it and eventually some brave investigators said hey, you know what? Let's sort this out once and for all. Let's put this to the test.

Their point is that we need a huge overhaul of our medical system to prevent these 'reversals'.  I couldn't agree more. The old way of doing things, based on traditional ideas and ways of doing things, needs some change.

"...we do advocate for a complete overhaul. A couple of chapters talk about how doctors are trained and how academics should work. A couple of chapters talk about how drug and device regulation should work. A couple of chapters talk about what our professional responsibilities are."

They advocate for a lot of change which will take a good deal of time. I think this sounds like a great first step in identifying how we are now able to say, and should say more often 'more research is needed' and 'are we really doing this the right way?' I know I get frustrated when I hear about a medical breakthrough that might help me and then hear that more research is needed. But now I understand better why this is said.

There's nothing good about thyroid cancer

Thyroid cancer is often called the 'good' cancer. There is nothing good about any cancer. Even though thyroid cancer is slow growing and results in proportionally fewer deaths than most other cancers, it does have significant impact on the patients.

Now new research shows that there is a significant decrease in quality of life after thyroid cancer diagnosis and treatment. Personally I am very glad to see this study as I have always felt me it threw me for a (really big) loop and took me a long time to recover.

"A quality-of-life assessment tool measuring physical, psychological, social and spiritual effects was completed by all participants. Researchers also collected data on demographics, medical comorbidities, tumor characteristics and treatment methods. Most participants were recruited from survivorship groups (79.2%)."

I think that because of the unfortunate increase of thyroid cancer rates that this research was warranted.

"Distress of initial diagnosis, distress of ablation, distress from surgery, fear of a second cancer and distress from withdrawal from thyroid hormone yielded the lowest individual quality-of-life scores."

Um, I could have told you all that. Decades ago. And yes my worst fear did come true when I was diagnosed with a second cancer.

There's basil in my coffee and other worries

If there is one thing I have learned over the past eight years of health crap is to roll with the punches. I need to deal with what I can and learn to cope with the rest. I try to keep my life on an even keel as much as possible. I usually do unless 'something' happens.

I don't have the energy to go overboard at any little thing. I need to save my strength to cope with it all and not lose my sanity, or anything else important. Because I have no way of telling what could be next.

It has been more than eight years of medical crap. Ten years ago I had a hysterectomy and then 18 months later breast cancer and so much more since. But I think I am doing okay these days, although some may disagree.

My latest health aggravation is my knee. Not being a candidate for knee surgery has put a damper on my hopes for life without a knee brace. And my knee isn't bad enough so I could have a knee replacement - but I have always believed there is no reason to have one of those unless absolutely necessary. And Its not necessary. But I will whine bitch about it to my therapist and rheumatologist and see if any solutions come along. Or medical research comes up with a new way to fix it.

And life goes on. I will cope and move on.

This morning while making coffee way too early, I thought I grabbed the bag of mulling spices so I could throw a few in to the coffee grinder to add some flavor to the coffee. Nope, it was basil. I tried to pull most of it out but there is a hint of basil in it. But its not bad. I can deal with it.

3000th blog post

My blog post is not about numbers or volume or anything like that but recently I realized I was nearing 3000 blog posts. Today is number 3000. My blog started June 2, 2007, 3089 days or 8 years, 5 months, 14 days ago.

I set out blogging as a way to vent my feelings and keep my friends and family updated through breast cancer diagnosis and treatment, which would be a year or so and then I would return to my 'new normal'.

It didn't work out that way. Not many of my local friends or family read my blog. I am still working on that 'new normal' (and if anyone ever finds it, please let me know where it is), and my health still sucks, even though there have been no new cancer misadventures.

I still benefit from my nearly daily blogging. It allows me a way vent my feelings on my sub-par health which is really what I need. I also like to think my so called 'words of wisdom' have helped others deal with breast cancer and other not so fun medical crap.

Along the way I have also met many wonderful people online who are dealing with their own medical crap and they have become friends, although we have not nor do I think we ever will meet in person. But we are friends. And as a result I have a bunch of greatly appreciated supporters when I go through my own bumps in the health roller coaster.

I think I will keep blogging, I see no reason to stop as long as it continues to help me.

The costs of health insurance, or what to do when that tree falls?

Before the Affordable Care Act, there were millions of Americans with no health insurance and facing bankruptcy due to medical bills. Now with the ACA, there are still millions of Americans facing medical bills. The biggest problem is high deductible health insurance policies.

As a way to keep costs down, many people opt for high deductible plans. These are ones with deductibles as high as $13,200, which is the out of pocket maximum expense allowed under the ACA. So there are some very unhappy people who still cannot afford medical care.

Okay, I get this. People try to keep their insurance costs low and opt for high deductible plans. This makes sense. But if you have any health issues its not going to help you. If you have health issues, you need a plan with a realistic deductible that fits your medical needs.

At a previous job, available health insurance policies varied. My office was next to a guy who was married with four kids. For me it was a no-brainer, I needed some coverage and I didn't mind paying a higher co-pay to reduce my premiums (because I used to be relatively  healthy), and only went to the doctor a few times a year. But for my co-worker with four young children who went to the doctor regularly it was in his best interest to keep the co-pay low as he was going to be using his insurance much more frequently. Everyone's needs vary.

The whole point of insurance in general is to cover you in case of an issue. With your mortgage, you are probably required to have home owners insurance in case a tree falls on your house. No one wants to have a tree fall on their house, but sometimes s**t happens and a tree falls. Would you rather pay your home owners insurance policy every year or cross your fingers and hope that tree doesn't fall? And the more expensive your house, the more expensive your policy will cost. But if you didn't have insurance and that tree fell and damaged your house and your neighbor's and your car, you might be facing a $50,000 bill.

Medical insurance is the same thing. You want insurance in case the tree falls on you (and your house). There is no way to predict when that tree will fall but sooner or later, it probably will. So you want insurance just in case. If you have a low income, the math gets more complicated. If you want to keep your premiums low and opt for a high deductible plan, that needs to be part of your plan for daily living and budgeting.

If that tree falls without insurance you would be faced with some big bills and if you don't get medical care, you might not make it or face long term medical issues if not treated. So what would you do then? How would you pay for that care? What would you do? Crossing your fingers and hoping for the best is not a good choice.

Ideally we could all save enough to cover our potential medical expenses, and for that exotic vacation we all dream about and have that six months living expenses set aside in case of job loss. But reality tells us that is not always possible. The lower  your income, the more difficult it is to save any amount.

With insurance you know what your maximum out of pocket expenses will be so you have an idea of what size bill you can expect. Even if you are low income, you need a plan. Would it be a second job, a shop on Etsy or reducing your living expenses?

Its not really about the costs of health insurance but the costs of staying healthy.