Sunday, December 30, 2007

The Name Game

Yesterday, I got off my lazy ass and went to Rob's 3 hour spin class. This was my first time back at spinning, always smart to jump in to an endurance class after a long absence. The music always has a theme. This time it was Names- so Bad, Bad, Leroy Brown, In the Name of Love, Mambo Number 5, etc.

I also learned how to play "Screw Your Buddy" which kept me entertained while I bruised my booty beyond repair.

Screw Your Buddy:
The first person chooses a torture the class will endure for a set time period, like a minute.
The person next to them has to work harder than the rest of class, and gets to pick two other people to share in the misery.
Next round person two picks the torture and their two buddies to share the pain.
And so on and so forth.

If you chose someone to feel the burn, chances are you'll be their buddy next time.
If you chose a torture the class especially hates, you'll be everyone's buddy.

Torture options:
Seated climb
Standing climb
Freezes: low resistance while standing where you try to maintain a perfect circle
Jumps: Stand up, sit down, stand up, sit down, sort of like mass on wheels.

I got home, took a shower, and ate an entire calzone.

Thursday, December 20, 2007

Cancer quicker to claim the uninsured

Election year coming up. And a picture of who suffers when health care legislation is neglected:

Patients with no insurance twice as likely to die within 5 years
The Associated Press

ATLANTA - Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.

People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.

The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say — even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.

Those dealing with cancer and inadequate insurance weren’t surprised by the findings.
“I would just like for something to be done to help someone else, so they don’t have to go through what we went through,” said Peggy Hicks, a Florida woman whose husband died in August from colon cancer.

Edward Hicks was uninsured, and a patchwork health care system delayed him from getting chemotherapy that some argue might have extended his life.
“He was so ill. And you’re trying to get him help and you can’t, you can’t,” said his 67-year-old widow.

The new research is being published in Cancer, the cancer society’s medical journal. In an accompanying editorial, the society’s president repeated the organization’s call for action to fix holes in the health care safety net.

“The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year,” Dr. Elmer Huerta wrote.
Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don’t say whether those who died were insured.

Annual cancer death tollAn Associated Press estimate — based on hospital cancer deaths in 2005 gathered by the U.S. Agency for Healthcare Research and Quality information and other data — suggests that at least 20,000 of the nation’s 560,000 annual cancer deaths are uninsured when they die. Experts said that estimate sounds reasonable.

That’s around 4 percent of the total cancer death toll. One reason is that most fatal cancers occur in people 65 or older — an age group covered by the federal Medicare program. Another is that more than 80 percent of adults under 65 have some form of coverage, including private insurance or the Medicaid program for the poor, according to various estimates.
Some are enrolled in Medicaid or other programs after diagnosis, when the condition worsens and their finances erode. But such 11th hour coverage can be too late; early detection is the key to catching many cancers before they’ve grown beyond control, experts said.
“Insurance makes a big difference in how early you are detecting disease,” said Ken Thorpe, an Emory University health policy researcher.

In the new study, researchers analyzed information from 1,500 U.S. hospitals that provide cancer care. They focused on nearly 600,000 adults under age 65 who first appeared in the database in 1999 and 2000 and who had either no insurance, private insurance or Medicaid.
Plight of uninsuredResearchers then checked records for those patients for the five years following. They found those who were uninsured were 1.6 times more likely to die in five years than those with private insurance.

More specifically, 35 percent of uninsured patients had died at the end of five years, compared with 23 percent of privately insured patients.
Earlier studies have also shown differences in cancer survival rates of the uninsured and insured, but they were limited to specific cancers and certain geographic areas.
The new findings are consistent across different racial groups. However, the fact that whites have better survival rates cannot be explained by insurance status alone, said Elizabeth Ward, the study’s lead author.
The researchers were not able to tell if the numbers were influenced by patients’ education levels, or by other illnesses.

Experts said the study also hints at problems with quality of care after diagnosis: such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.

Blaming quality of care “The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggests that problems with quality of care may be an important reason,” said Dr. John Ayanian, professor of medicine and health care policy at Harvard Medical School. He didn’t participate in the cancer society study.

The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.

A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment — or decided not to get it — because of the cost.
Such was the case of Edward Hicks.

The retired laborer, had surgery for colorectal cancer in 2005 and was thought to be clear of the disease. Chemotherapy was suggested after the surgery, but he didn’t get it.
In February of this year, his wife grew worried when he lost energy and appetite. In April, he told her he felt a lump in his stomach.

Hicks, who lived in Fort Meade, Fla., couldn’t get an appointment with a specialist, but a family doctor checked him into a hospital and specialists saw him in late May. They said he was terminal but that chemotherapy might extend his life a little, his wife said.

She was able to get donated chemotherapy drugs from a pharmaceutical company, but it took time to arrange the treatments, which didn’t start until mid-June. Meanwhile, her husband’s health deteriorated. In July, after just a few treatments, he stopped the chemo, saying it was too hard. He died on Aug. 21, at age 64.

Friends and family told Peggy they believe he would have lived longer had he got chemo earlier, when he was stronger. She doesn’t agonize over that, she said, trusting in God’s will.
But the devil’s in her mailbox — she is facing a $21,000 hospital bill and other costs from his death.

© 2007 The Associated Press. All rights reserved.
© 2007

Monday, December 17, 2007

Erin Go Brrrrrrrrrrr

Friday, I got cleared to go forth and exercise, which was lucky since I had signed up for the Celtic Five Miler which was the next day.

It's not that I enjoy running in the freezing cold on hills, I don't. It's that this race always has the most awesome premiums. Gorgeous celtic designs on Brooks running gear. And cheap. I had already paid for the jacket and I couldn't very well wear the jacket without running the race. So Lead Legs Kevin and I hiked up to Baltimore for the privilege of running in sub-arctic temperatures.

It turned to be a pretty morning, clear and COLD. And a fair number of both the tri team and the tri club were there. I had a good time. It felt good to run. And I wasn't last, I was second to last, but I wasn't last. And that was fine considering all that had gone on in the weeks before, and that I stopped at the car to divest one of my fourteen layers of clothes. And I'm finally on the board with the USAT challenge.

People who run faster than me.

Monday, December 10, 2007

All the king's horses

Last Friday, I went back to see the ortho since my progress in PT had pretty much stopped. I opted for surgery and signed release forms to both rip it free under anesthesia and to arthroscopically excavate the scar tissue. The expectation was that the shoulder wouldn't give under anesthesia enough to make a difference and the surgery was pretty likely. This was kind of rushed given the holidays coming up. If I waited until after the holidays, it would continue to hurt and freeze more. If I did it right before the holidays missing a bunch of PT, it would re-freeze and I would enjoy a third visit to the hospital. I was scheduled for surgery 3 days later and tacked on to the list of patients for that day.

Tuesday, I went in to the hospital.

New Boy took me, maybe to make up for the last time. It was a point of honor. He was very sweet the whole time.

Last time I was at the surgery center, this time I was at the hospital. Given the choice, I would go to the surgery center instead of the hospital. Overall, the surgery center just seemed cleaner and the staff of a higher calibre. Although the hospital didn't make me pay in advance so there's something to be said for that, but they made me take a pregnancy test (???!) so whatever.

After contending with a nurse(?) of dubious competence (she dropped needles on the floor and didn't wash her hands), meeting with the most fabulous anesthesiologist ever, and fending off the deadly antibiotic, I went under expecting to wake up with a new set of scars.

Turns out they were able to wrench it free so no new scars. I was in the OR for a total of like 20 minutes. The ortho came out and gave the news to New Boy and said he'd be able to see me soon. Well apparently I was a little cranky about not eating breakfast and as I'm wont to do when anesthesia isn't involved, once I've skipped a meal I will continue to sleep until someone wakes me up and forces me to eat. So I didn't come out for close to 2 hours. This made New Boy a little nervous.

I was concerned because at first my shoulder was worse. It was tight, inflamed, and cranky. Couple that with us getting snow right after the procedure and I had lost all faith. My PT, the Dr, and Jopoppa all told me to quit whining and ride it out. It's been a couple weeks and it seems better now. I can even wash my hair and put it in a ponytail.