Two weeks ago yesterday my mother-in-law sumitted for a colonoscopy upon the recommendation of her physician. My wife and I were opposed to this due to her age and existing health conditions, but trusting in her doctor, she proceeded.

The physician administering the procedure perforated her colon and she passed away from infection yesterday afternoon. I hope to never see such horror again in my life.

Next time you have an eager doctor that wants to do something rude to you, make sure your high beams are on, and radar is turning. How do such idiots keep their licenses, and is the Hippocratic Oath just wallpaper?

I am getting tired of this business of dying.

Dan, soory to here about your continuing tribulations.

Personally, I have little or no use for "doctors". I doubt that they truely know what in the hel!, they are doing to their patents. I had a great aunt, who at the age of 88, was persuded to have (3 or 4 way) heart by-passe. They killed her. But the hospital got to bill an invoice. And that is what they are all about.

Hang in there Dan and Mrs. Dan.

Hog Killer

Dan, at our age we are going to have to get used to losing our older friends and relatives. Unfortunate but true!
As to that doctor, perhaps an optirectomy from the cape gun would make the wife feel a bit better since a lawsuit cannot bring back a lost parent. derf

I watched my grandmother suffer with cancer for 5 years.

It was throughout her body, and untreatable. She couldn't walk or even sit up on her own in bed. Towards the end she couldn't keep food down, and was hemmoraging blood from her mouth and rectum (not for a few days, but the last several months).

As much as I tried to persuade my grandfather to just let her go, he wouldn't. And the hospital kept pumping new blood into her, sometimes 4 or 5 pints a week, just to keep her going.

Her kidneys had failed, and she was building up some sort of fluid in her abdomen - I've forgotten the name of it now, but they had to go drain this fluid off her all along.

I was around, right up until the day she died, and that morning she was laying in the hospital, in ICU unconcious and non-responsive and with a steady morphine drip - after MONTHS of prolonged suffering and agony, and her doctor comes up just a couple hours before she dies and orders more blood and bone tests done on her for cancer.

All I could keep asking myself while they're in there taking bone samples and stuff from her is WHY! are they doing this? And sure enough, we get the bill for all the labwork pretty as you please, two hours before her heart finally gave out.

My grandfather now has diabetes, congestive heart failure, a tracheotomy from where he had his larynx removed and has lung failure from cigarettes. He lives his whole life in his recliner in front of the TV these days. He can't get up and walk around because he needs an oxygen machine to breathe, and he stays tethered to his breathing machine.

And family friends and folks that help look in on Papa while I'm at work get mad at me for bringing him things like saltwater taffy that he loves, saying "He's a diabetic and I don't need to encourage him to eat sweets or stuff."

I say F**K 'em ... if my 80 year old grandfather strapped to his breathing machine with bad lungs, and a failing everything else wants a piece of taffy, then by God I want to get it for him. Let the man enjoy himself for a change and give him a little dignity instead of slapping his hand when he reaches for something, then chastising me for bringing it to him.

You really have to wonder about a lot of these doctors out here ordering tests on folks that in my opinion, really don't need tests, or a doctor, to diagnose what's going on.

Medical science has gotten to the point where we can keep a body alive, by draining off it's extra fluids, kidney dialysis when the kidneys have shut down, pumping in extra blood when the body can't hold it's own ... but we can keep that body GOING, long after God and nature have said it's time to go.

In the case of your mother-in-law, I'm very sorry. I'm just naturally suspicious of any doctor and any lab tests they recommend. The whole medical field lately makes me sick to my stomach....

and then drug companies running commercials on TV with their powers of suggestion convincing folks they have these symptoms or that, and to run down to the doctor and ask for this medicine by name ...

Chin up Dan! Go whack a varmint and you'll feel better. If that fails, there's always sour mash!

I'll kick in an opinion here... We have waaaay too much lawyered medicine. Around here the general opinion is that most doctors do the maximum testing to show that they did 'everything possible to save the patient' to a jury...cause a horrifically high percentage get sued.

Sure, there are some who take advantage of it too, but I'll venture that most are practicing defensive medicine, not medicine in the best intrests of the patient. There is a differnece..

All is not lost though. Before you or your end up in the same boat, communicate your wishes WIDELY (no he said-she said if 10+ people know your plans) for urgent or life prolonging care. YOU CAN SAY NO TO ANY TREATMENT! Get a medical directive signed for you and everyone you may have to make decisions over in the future.

My 2cents worth, YMMV. FWIW, I'm an organ donor and a 'no extreme measures to prolong life' guy, and my parents, brother, and wife are well aware of the fact! Now you all know too, just in case!

My condolances to you Dan,,,,When it rains ,,it pours,,Just like morton salt,,My grandparents on both sides went down like dominoes.That's pretty screwed up though.I can relate to some of the rest of the gangs posts,,,,But not into beating horses,,Your friend ,,Clay

quote:

Originally posted by claybuster:
But not into beating horses,,Your friend ,,Clay

clay, I would never beat a horse. But taking a WHACK AT A QUACK, that is something else.

Hog Killer

Potkb!!!I'm with ya HK

And btw,,the 100 mph rundown on the side effects of said drug commercials,,are you really going to feel better?,,or robbing peter to pay paul,,and the doctor,and the phamacist,the drug companies,,and whoever else has thier dirty little hands in the mix?? As like big brother?Mebby the "crazy" lady in w.v. was'nt so crazy,,her toe bothered her so she drank a copious amount of vodka and shot it off with her .410 ,,Clay,,, http://www.smirnoffshotgunning.com

Digital Dan,

I understand your position. They say death comes in threes. In my case it looks like the next round will be my mom and my exes two brothers. (my kids uncles)

Some say I'm a cold harted bastard but my attitude is "Gods will be done."
It will be my turn one day and my attitude will not change.

Sometimes we can avoid taxes....

Swamp, you aren't cold hearted, you are just a realist. derf

quote:

They killed her. But the hospital got to bill an invoice. And that is what they are all about.

quote:

As to that doctor, perhaps an optirectomy from the cape gun would make the wife feel a bit better since a lawsuit cannot bring back a lost parent. derf

quote:

In the case of your mother-in-law, I'm very sorry. I'm just naturally suspicious of any doctor and any lab tests they recommend. The whole medical field lately makes me sick to my stomach....

quote:

clay, I would never beat a horse. But taking a WHACK AT A QUACK, that is something else.

Hog Killer

quote:

Potkb!!!I'm with ya HK

quote:

And btw,,the 100 mph rundown on the side effects of said drug commercials,,are you really going to feel better?,,or robbing peter to pay paul,,and the doctor,and the phamacist,the drug companies,,and whoever else has thier dirty little hands in the mix?? As like big brother?Mebby the "crazy" lady in w.v. was'nt so crazy,,her toe bothered her so she drank a copious amount of vodka and shot it off with her .410 ,,Clay,,, http://www.smirnoffshotgunning.com

Well gang,

It's 01:15 am and I just got home from making some Saturday house calls here in rural Idaho. Today was a 150 mile round trip. I did get dinner/supper out of the deal, and even made enough to cover gas and wear on the truck (1991 model with 235,000 miles).

I have never had a lawsuit, but my insurance has tripled in the last five years. I can't deliver babies anymore because it would bump my insurance by $85,000.00 a year.

I built this clinic with my own hands because that was the only way it was going to happen. It opened five years ago next month. We have not turned a profit yet. We are hoping to finally break even in 2006. I have drawn exactly $1,600.00 in salary in 2005, ytd. I go into town and work a shift here and there to supplement.

I make exactly $5.40 profit (above basic operating costs) on an average patient visit for my folks on medicare. In January reimbursement will be cut 6%. Next January it will be cut again by a further 15%. My costs rise about 20% per year. In two years I will lose $10.00 for every straight medicare patient that I see. How do I continue to see these patients and still pay my staff a living wage? Or even keep the doors open? Those questions keep me up nights.

I qualify for Patient Assistance Programs for some of the medicines that I take myself.

If y'all hate doctors so much; eat lots of raw or steamed veggies, don't drink, don't smoke, stay at ideal body weight, swim or bicycle 5 days a week, and use good lifting technique when moving heavy stuff. That will eliminate about 50% of your need to see a doctor. Oh yeah, wear your seat belt.

Before you lump all doctors into the same bucket, come on out and follow me around for a week. I'll even pay you my salary. If you still want to "Whack a Quack", come on out anyway. Armed struggle is always diverting.


John Charlie Noak, MD
Owyhee Medical Clinic
Homedale, Idaho

PS I'm very sorry for your loss Dan. I don't know why the perforation happened. That is every patient's and every surgeon's nightmare. I recommend colonoscopies for some of my patients. In the last fifteen years six "saves" have resulted. I recomend colonoscopies for the same reason that I do rectal exams, pap & pelvic exams and put some patients through the annual humiliation of a "total body check" for skin cancers. If my dad had gotten a colonoscopy in a more timely fashion he would still be alive.

Dr John,

You sound like the kind of doctor I want!! Do you make house calls to Maryland??....I'll cover dinner then we can arm wrestle over your bill!!

IMHO, it's the lawyers we need to WHACK, not the doctors...yeah..there are some bad docs out there too, but the doctors my family have are afraid to do anything for fear of a law suit. It's a damn shame ya can't even help deliver a baby!! It used to be that the system policed it's self to a great extent, then we got lawyers and liberal judges involved and suddenly, we have way more problems than we had before and we don't have good medical care either...although Hillary is going to fix all that!!

Dan,

Sorry for your loss and hopefully, it will be the last for awhile...I've been to 3 funerals since September myself.

Well Doc, in my case ... what possible reason would a doctor have to order additional bone tests and blood work in that scenario.

Patient is 76 years old.

Diagnosed with metastatic cancer 5 years prior (and already gone through 2+ years of chemo)
Building up abdominal fluid that has to be drained off periodically
Unconcious
Constant morphine drip
98% renal failure
total gastric failure
hemmoraging blood

Then as she's laying there, he orders more labwork done.

quote:

As much as I tried to persuade my grandfather to just let her go, he wouldn't. And the hospital kept pumping new blood into her, sometimes 4 or 5 pints a week, just to keep her going.

In the same or a similar scenario I would also have done my best to convince her husband to allow comfort measures only, and to let her move to the next life with as little agony as possible. I have faced the same issues in the past, and have almost always been able to persuade the family to follow the humane course. When the family says "do everything possible, and keep doing it", well that is what I have to do. I don't like it, but I have to do it.

As for your particular case, the blood work was likely to check ammonia, protein and liver enzyme levels to see what, if anything could be done to help bring her to a conscious level of functioning. He or she was also likely checking the prothrombin time to see if some vitamin K would help slow the blood loss. I don't think I would have done a bone marrow aspiration in those circumstances, but the doctor may have been looking to see if there was enough functioning normal blast cells to respond to Epogen (erythropoieten), so she could make her own red blood cells.

The bottom line in our society is that as a doctor I am obligated to honor the patient's (or in this case, the husband's) wishes.

Let's go back up the time line a bit (In the Navy this is referred to as "walking the cat back".). What was the primary tumor type? Lung cancer? Breast cancer? Colon cancer? Did grandma smoke? Did she get her mammograms? did she eat a lot of fresh veggies and not so much fatty and/or processed meats?

My adopted dad loved barbequed and smoked meats (both are carcinogenic). He did eat salads every day, but didn't go to his doctor for preventative check-ups. He had been having blood in his stool for a while, but didn't get seen for that (I found out later).

After his first surgery, when the cancer re-metastasized, I told him that the response to chemo in primary colon cancers was very low. He decided to try chemo, and went through three more years of incredible suffering. Twice I nipped likely fatal pneumonias in the bud. Was that the right thing to do? I didn't think so for a long time. Mom finally told me to get over it; dad had wanted to stay around as long as possible. Do I miss him every day? Yeah. Do I wish I had forced him at gun point to do his annual check-ups? You bet.

Are a proportion of doctors cold hearted technicians and/or money grubbers with dead souls? Sure. Do hematology/oncology doctors get burn out by watching so many of their patients die very painful, long and un-dignified deaths? Every day.

Do I tell my end stage patients that they can't smoke or eat salt water taffy? No. I do as much work as I can on the front end to hopefully prevent end stage diseases. I wish every one was reasonably fit, led an active life and had a rapid decline at the end to die of natural causes. That is my hope and goal.

I can't change what happened to your grandma. I can only hope that you do the things that you have control over so you don't ever have to go through the same thing.

lawndart.

Lowrider 49,

When I do a stint teaching at the military medical school in Bethesda I'll buy you dinner and show you around the place.

I am able to practice medicine the right way because I don't own anything (other than some rifles, shhhh), and don't have kids or a wife to feed.

Take care,

lawndart

Finding myself thanking you fellas for your thoughts on the subject more than I care to of late, but it is part of life I suppose. I don't recall thanking you for the laughs though, and I am truly thankful for those.

Charley, good luck on your clinic, and your words remind me of ol' Dr. Crow up in Dover, Tn. First dentist I ever visited...had a belt drive drill and no novicane. He did have some good suckers for kids after the fact. Then there was Doc Dunham in Frostproof, Fl., a fella I saw more than once in my youth, and who probably deserved the trust I felt in him more than most.

Thing that's happening down here IMO is that we're getting a LOT of foreign born doctors in the state, in part due to designation by somebody somewhere, to the idea that there is a shortage of health professionals in some areas. They are to be avoided like the plague based on my past experiences, especially those from India. That and large corporate conglomerates. When you get into the hospital environments you are somewhat at the mercy of fate as to who winds up attending to your needs...in the case of my M-in-L there was a potpourri of nationalities, Chinese(two surgeries), Russian(Cardiology) and the previously mentioned Indian nationals. Part of a corporate entity known as Florida Hospitals, a no-joke money making machine...I think that is all they do. My wife spent nearly all of the two weeks between surgery and death at the bedside and tells me that over 25 different physicians attended. So I hope you will pardon my cynical attitude in this case. I do wonder how a doctor could perforate a bowel and not know it...they are using something akin to a bore scope after all. Simply stopped the procedure and discharged her from the surgical clinic where it was performed. My wife drove her into a fire station on the way home when a pneumothorax condition developed, ie. gas migrating from abdomen to throat between skin and muscle.

In any case I think it boils down to the fact that the ol' gal trusted doctors across the board, and it led to her undoing. My wife and I have living wills, we have walked away from recommended treatment in recent times with no ill effects. The question I ask myself in such circumstance is "What are they thinking?" It is what I ask about the treatment my Mother-In -Law received. What were the odds that cancer in the lower GI tract would kill her before something else, and what were the risks attendant to the recommended procedure given her state of health? I saw that before the fact but the decision was not mine.

Before my retirement a couple of years back I watched a fleet of over 25 corporate jets fly thru my sector enroute from Orlando to Birmingham, all with the suffix 'HS' on their callsign. My inquirey to one of the pilots led to the revelation that all the aircraft were owned by Health South. 5 or 6 different kinds of jets ranging from the vaunted Gulfsteam 5 down to the more mundane Hawker and Lear Jets. I've no doubt how they afford such trappings at this point, question is though, how long will it be tolerated? The medical profession was something to be revered and trusted in my younger years, but I think that has been voided as time has passed. I feel a lot of sympathy for the youth of today, it's not going to get any better.

Well, I'm off for a bit, services and such. Be back around the coming weekend, chat with you all then. BTW, Clay, I've been having a fungus problem with my left big toe, you recall what choke and load that lady used with the .410?

Dan

Lawndart...one honest question. Other than the aforementioned healthy lifestyle choices, what do you recommend that we mere mortals with minimal or no medical knowledge do to protect ourselves against the medical corporate thinking?

I respectfully submit that you are the exception and that the megacorp hospital is the coming norm (if it isn't already) and the only real good reason I can see for it is risk exposure control...i.e. fending off the injury lawyers by pooling resources.

What's the common guy to do!?!?!?

UN-

Dan, the only thing that I can say is that hopefully you are outliving as many of your enemies as you are friends!

quote:

Originally posted by DigitalDan:
BTW, Clay, I've been having a fungus problem with my left big toe, you recall what choke and load that lady used with the .410?

Dan

Dan, may I suggest, full choke with #8s. Of course at that range choke does not matter much. But the load of 8s should do a nice even job.

Hog Killer

PS: I hope Lawndart does not turn me in for giving a prescription with out being an MD.

Lawndart,

I've been to Bethesda too many times....mostly to watch students take bodies apart in the basement. I do beleive the cafeteria makes some of the best bean soup around....Navy always could make good bean soup with lots of ham!!

I teach in Metro Station in Bethesda a couple times a month. I'd be honored to have dinner some evening. Let me know when you get back this way and I'll try to schedule something. I don't go to the dark (West) side of the Bay unless I must.

quote:

Lawndart...one honest question. Other than the aforementioned healthy lifestyle choices, what do you recommend that we mere mortals with minimal or no medical knowledge do to protect ourselves against the medical corporate thinking?

I respectfully submit that you are the exception and that the megacorp hospital is the coming norm (if it isn't already) and the only real good reason I can see for it is risk exposure control...i.e. fending off the injury lawyers by pooling resources.

What's the common guy to do!?!?!?

You are right about the corporate mentality taking over. In reality, medicine is now more of an occupation than a calling, or a vocation as us Jesuit trained kids said 40 years ago.

I am a bit of a throwback. I realize I am closer to dying than to being born. I have the free will to conduct myself in any way that I choose. It just appeals to me very much to do medicine in the way that I know to be correct. If I never can afford a 21 day safari to Tanzania, so be it. Every day I get to do what I knew I was going to do when I was five years old.

Back to the question:

1. Read. I go to the internet several times a day for information. It is cheaper, and more up to date than a shelf full of $275.00 books (which I also have). Avoid sites that are selling something. Even the sites geared toward doctors are pretty understandable.

2. Find an advocate. That is what your family doctor is supposed to do, but many don't these days. An independent guy like me can get more done because no one owns me. The specialists know that if they are nasty to one of my patients I will stop referring to them for a full year.

3. Don't try and save a nickel on your health insurance. The cheapest deals have restricted lists of doctors you can see. Those doctors are not payed much by those plans so there is incentive to run people through too fast so as to pay the overhead and make a dent in the $200,000 in school loans they have out.

4. Don't go to places that say: "The Sinus Center", or "The Shoulder Center", or "We Be Migraines and Shit". Those places make their money on procedures. You can bet you will be imaged, tested, cut, plucked and f****d without a kiss. Those places take an assembly line approach to things.

5. Avoid fancy offices. It is just like all those pretty lights in Las Vegas. Who pays for the marble and chrome? Yep, you do.

6. Don't tolerate abuse. Don't yell back at the doctor. Just write it down and pay someone $50.00 - $100.00 to write a letter for you. One copy to the doctor, one to the hospital he works at and one to the board of medicine if he was particularly outrageous. Just simply state that you expect the simple courtesy and decency that any adult human in this country should give to another adult human. On the other hand, be realistic. When it is time for neurosurgery, you want the best. Many really good surgeons are socially awkward. They don't hold their first job out of training until they are 34 - 35 years old.

7. Take a (not overly emotional) family member with you. They will remember stuff that you didn't hear.

8. Save money on your medicines. There are legal ways to obtain medicine from Canada and Mexico. A little research on the net could save you big bucks. Again, don't try and chisel down the last nickel. If a medicine is very expensive (and some of them are insanely expensive these days), ask if there is a comparable generic available? There may not be, but often there is. Prozac used to cost $2.50 a day. Now it is $.12. There are newer (and somewhat better) antidepressants available, but Prozac still works for a lot of people. You get the drift.

8. Don't try and be a doctor. It is usually wives and sometimes moms who do this, but I have a patient's son who is a total squirrel bait doing this right now. If you try and play doctor you will invariably screw things up completely. If you don't trust what the doctor is telling you, invest in a second opinion, or find a doctor that you do trust. If you don't think any doctor is worthy of trust, go take a look in the mirror.

9. There is nothing magic about a place just because it says Mayo Clinic, The Cleveland Clinic or Harvard on the sign out front. The Mayo clinic is a great place to get an executive physical.

10. An interested and intelligent primary care doctor will often take better care of you than some fancy specialist. All the medical knowledge out there is available in articles, books and on the web. I use specialists for their greater experience in handling certain conditions. Part of the price for the specialist to get my referral is my demand that he or she teach me something, so I can take care of it myself in the future. This goes back to having an advocate.

11. Try and avoid "doc in the box" types of quick care clinics. They generally charge more than your family doctor. They make their money on volume (they have a corporate infrastructure to support, don't ya know).

12. Digital Dan made a very good point about, "trust but verify".

13. Herbal preparations are no more "natural" than Prozac, but they are a lot more unpredictable.

14. All the insurance agents I know have health plans with high deductibles ($3,500 - $5,000), but very good coverage after the deductible is met. Insurance is for catastrophe. No insurance agent that I have cared for blinked at all about paying for a few office visits for something minor.

15. If you are up against a wall, and still aren't sure, feel free to shoot me a PM. I cannot legally, and will not ethically give a consult over the internet, but I can often point you toward some resources. I still have some of my patients from Illinois come out to Boise to see me now and then. I'm no medical genius, but my rates are reasonable (shit, I better put this on the classified board), and Boise is a lot more pleasant than Rochester, Minnesota
.

I will close by saying that I don't really care to hang out with most doctors myself. There are some very fine and dedicated physicians out there though, and it is worth the work to ferret them out.

Bottom line:

Find a good primary care doctor. Have him or her eyeball you from time to time. If something doesn't feel right with your body or your head, see your doctor sooner, rather than later. It is so much easier to deal with stuff up front than on the back end. People consider open heart surgery for bypass grafting a heroic success. I consider it a dismal failure.

I did not mean to hijack this thread. I took some comments personally (which was appropriate). My skin is usually pretty thick, but it was late, and I was tired.

I am very sorry for what Dan's mother in law went through. Don't hate doctors or lawyers (well, not all of them). Just do your best to navigate this interesting world we live in.

lawndart

Edited for spelling.

quote:

Before my retirement a couple of years back I watched a fleet of over 25 corporate jets fly thru my sector enroute from Orlando to Birmingham, all with the suffix 'HS' on their callsign. My inquirey to one of the pilots led to the revelation that all the aircraft were owned by Health South. 5 or 6 different kinds of jets ranging from the vaunted Gulfsteam 5 down to the more mundane Hawker and Lear Jets. I've no doubt how they afford such trappings at this point, question is though, how long will it be tolerated? The medical profession was something to be revered and trusted in my younger years, but I think that has been voided as time has passed. I feel a lot of sympathy for the youth of today, it's not going to get any better.

Health South was owned and run by a bunch of bean counter executive types. Many of them are being sentenced to a small room in the big house as you read this.

JCN

quote:

Thing that's happening down here IMO is that we're getting a LOT of foreign born doctors in the state, in part due to designation by somebody somewhere, to the idea that there is a shortage of health professionals in some areas. They are to be avoided like the plague based on my past experiences, especially those from India. That and large corporate conglomerates. When you get into the hospital environments you are somewhat at the mercy of fate as to who winds up attending to your needs...in the case of my M-in-L there was a potpourri of nationalities, Chinese(two surgeries), Russian(Cardiology) and the previously mentioned Indian nationals. Part of a corporate entity known as Florida Hospitals, a no-joke money making machine...I think that is all they do. My wife spent nearly all of the two weeks between surgery and death at the bedside and tells me that over 25 different physicians attended. So I hope you will pardon my cynical attitude in this case. I do wonder how a doctor could perforate a bowel and not know it...they are using something akin to a bore scope after all. Simply stopped the procedure and discharged her from the surgical clinic where it was performed. My wife drove her into a fire station on the way home when a pneumothorax condition developed, ie. gas migrating from abdomen to throat between skin and muscle.

I wish I could say that I have never heard of this scenario before, but I can't.

JCN

Dan, that sucks. That's not the first time I've heard of a scumbag doc (vs. good doc) making a mistake and then concealing it.

Medicine is now big business BECAUSE of "good" medical insurance. Not only that, but businesses (and our gov't) are being crippled because of the health care they've committed to. I'm a large deductible man, myself. AND it costs three times as much to pay cash to the doc, because the big mafia-like HMOs and the even more mafia-like Medicare types don't pay their share.

As far as the drug commercials are concerned; If you think drugs are too expensive, fine: Sulfa is still cheap. Buying drugs from Canada just cuts down on the chances of better drugs from America in the future. Profits are motivation for better drugs.

On the other hand, we have "doctors" prescribing cholesterol reducing drugs to patients with healthy lifestyles for cholesterol levels of 189.

I make an adjustment to the bill for cash customers. I don't believe in cost shifting.

Profits are one thing; I believe in healthy profits to stimulate new research. Profiteering is another issue altogether. Allow me an example:
Provigil is a wonderful medicine. It is the first effective medicne for ADHD that is not a Class II stimulant. It helps the fatigue of people with Multiple Sclerosis and Chronic Fatigue as well. It is safe as water, and very effective.

Its price recently doubled to $7.50 per tablet!

Large drug manufacturers typically spend 15% - 20% of their budgets on research and development. They spend 30% - 40% on advertising and marketing.

Medicare is definitely a government sponsored mafia like organization. 50% of their budget is sucked up into "admistrative costs". They keep cutting reimbursement to doctors in the face of rising costs, while at the same time increasing reimbursement to hospitals. Guess who has the better lobbyists?

These issues is very complicated; there is blame enough for every body involved in this mess.

Over time I believe we will find that the main lifesaving effect of "statin" type cholesterol lowering drugs is that they function in an anti-inflamatory role inside the blood vessels. The reducion in mortality is much greater than can be explained just by lowering the cholesterol levels in the blood. I personally keep my total cholesterol level down to 165 mg/dL. I discuss the pro's and con's with my patients, but don't get insistent until their levels are above 220 mg/dL. Several of the "statins" will go generic in the next three years. That will be huge.

lawndart

Dan,,I prefer#6 shot in my .410,,#4 even better. I tryed to load some #4's a couple of times,,I'd love to know how they do it at the factory,,nothing but trouble through the mec,,probably the reason they're so expensive. Any ways,,be carefull there Dan,,You don't want to be having to change your handle to Digitless Dan!!!!!Peace and roadkill grease!!!!Clay,,,,,,,, http://www.rollyourown.com

Personally, I exercise a lot, and I've never had less than 220-230, and really don't care. I do a lot more dangerous things than have high cholesterol and from what I read, I don't see anything more than a correlational link. Plus, my life experience tells me that when everyone gets heated up about something, like they currently are about high cholesterol THEY ARE WRONG!

Hey 120MM!!!you oughta see the egg salad sammywitch I made for tomorrows lunch,it's a whopper of a sammywitch,,I put in a sliver of lettuice to make it "healthy",,Clay,,,,,,,,,,,,,, http://www.newworldgassupply.com

lawndart--several years ago I was in an Army school where one of our tasks was to "evaluate" our US systems (health, manufacturing, etc) and I wrote a paper on the health piece of it and the cost increases. My conclusion was that there were three primary reasons: High tech medicine (everyone wants the latest assuming it is the best/right thing for them w/o regard for their doctor's inputs) Defensive medicine - you know about this based on your insurance premiums, and Economic medicine - corporate involvement with for-profit motivation.

That was 15 years ago, and I'm not so sure much has changed. Patients still insist on the latest/best/specialist referrals (or most expensive and most advertised) whether medicines or procedures, we produce more and more lawyers each year, and corporate profits continue to grow.

And, you point out very well that we are our own worst enemies in terms of lifestyle, diet, etc.

Do we ever learn?

Cholesterol levels are mainly a function of age, and especially of who we picked to have for parents. Only 15% of our circulating cholesterol is from our diet, the rest is built by our body, mainly while we sleep.

I agree about misuse of the high tech stuff, especially imaging studies. I try to mainly order an MRI to map out the situation for the surgeon. An orthopedic surgery group that I refer to often is comfortable enough with me now that if I say (and put it in writing), "I've been seeing old Sven here for a long time, and his right knee is trashed; I believe he needs a replacement."; they will proceed with just x-rays. That seems so different these days that it is hard to remember that knee replacements were done before the MRI machines came into wide use.

Insurance companies don't like to rely on a doctor's judgement. They want a test or imaging study before they approve much of anything.

Insurance companies also tend to be dime smart and dollar dumb. I shattered my L5 disc in 1991, but continued to fly F-16s for years afterward. Now it looks like a dried and cracked piece of mud. Every few years another piece migrates backward to pinch some nerve roots, I get really crabby from the pain, and go get the piece pulled out. What I need is a disc replacement, but the insurance company wants me to get a fusion, because it is cheaper. But, I will go back to the Army for a few tours in 2007 or so, will go back through Jump School Refresher Course (I hope I am the oldest f****r to ever go through), train, run, hump a ruck, haul patients off of helicopters, etc. etc. I will also be very active in the civilian world. If I get a fusion it will transfer the flexion and extension forces from where they should be to higher in the spine, so a few years down the road the L4 disc will blow, and on and on. I will keep my civilian health insurance, and will have any work down the road done by guys I know. Instead of paying for the right operation once, the insurance company would prefer to pay for the wrong operation three times. Duh.

My favorite scam is "Laser This, and Laser That". Laser knives are great in certain applications, especially when you need to make large cuts in very vascular tissue. They are also wonderful for certain eye lesions. My patients see the advertisements on the bill boards in Boise and ask about it. I tell them that lasers are great for leveling field with D-9 Cats, but that I would prefer to send them to a doctor who will use one only if it is appropriate.

Fancy medicines. I am absolutely and completely grateful for many of the new medicines that are now, or soon will be, available. They do truly miraculous things. The treatments for such things as ulcers, heart disease, high blood pressure, diabetes, multiple sclerosis, rheumatoid arthritis, mental diseases and other conditions are easily a hundred times better than when I was a kid. There is no reason to throw the baby out with the bathwater though. I have a very lovely and very sharp 80ish female patient. She has been on Phenobarbital for her seizure disorder for, I believe, 42 years! I get nasty grams from the drug oversight comittee at the insurance company about changing to a more modern medicine. It turns out that she might get drowsy and fall; that was quite a revealation to me. Gosh, you learn something new every day. I have the letter already in the computer. I just put a new date on it every six months. "Dear insurance company, she has done extremely well on this medicine for over four decades, and I hope it helps her for another decade or two."

Defensive medicine is a tough issue. My approach is to try and do the right thing, and document well. I don't give my patients pages of legal boilerplate to sign to cover my ass. It doesn't do anything but alienate people. If I screw up, I could be screwed. I just do my best to not screw up, but I do sometimes. When that happens I do worry about my hide, that is only human. So far, I have worried more about how my patient will do. I fess up instantly, and call in the cavalry if I need to. I haven't needed to since 1992, but I won't hesitate if I need to in the future.

I see a lot of doctors who won't prescribe any medicne off label, and who won't take any case that isn't right up the middle. I am much more cautious when I have a patient with an unrealistic view of things (unfortunately many of those folks don't take medicnes that would truly add many years of high quality existence to their lives because they have a phobia about getting a 1:40,000 minor and reversible side effect, while their underlying condition has a 1:5 chance of killing them in th enext decade).

Sooooo, dustoffer (Slicks or Crash Hawks?) I endorse your conclusions with no suggestions for changes.

Here is another thought about lifestyles:

1. Life is much more stressful than in years past.

A. The noise levels we experience today are much higher than when we were kids. Ditto light pollution.

B. Most people are leveraged to the point that they are two paychecks away from picking up cans on the interstate. That eats on you every day.

C. Why do people own televisions? The Saturday morning hook and bullet shows are ok, the news shows are total bullshit, I am told that the prime time shows are just simply devoid..., The Learning Channel and Discovery are pretty watered down. The History channel is ok.

That stress, in all its forms adds up. It makes us sick. We self medicate for it with alcohol and tobacco and food. That doesn't help. We die younger, and have a harder time of it our last twenty years because of it.

So, what about your back Mr. lawndart? I will gladly take a loan against my retirement savings and pop for the disc replacement out of my own funds, if necessary. Can I afford it? With my goals for the next tweny years, I can't afford to not do it. When you need something serious taken care of, find a talented doctor and have it done right.

Sorry to ramble on.

lawndart

quote:

Well, I'm off for a bit, services and such. Be back around the coming weekend, chat with you all then. BTW, Clay, I've been having a fungus problem with my left big toe, you recall what choke and load that lady used with the .410?

Dan

Hey Dan,
We can get rid of the fungus completely, finally, safely and comfortably. Shoot me a PM when you get back.

Lawndart
You are a rare brick,man!
I reckon you are genuine and one of the few to count on in a spot and trust from what I have seen in your posts over the last year or so I have lurked and posted. Plus you have a shared outlook on the feline population.
A guy I would be glad to share a worthy drink by the fire some night and reflect on the good nature of hunters through the flames.
I obviously haven't met you but make a goal to do so. Either I will lob on the doorstep [with a little warning] or you are welcome here in Australia should you visit.
Dan - your contribution is enormous also. I emphasise with your situation as I have had a friend undergo a similar procedure here last month and just survive with many months and extra operations now to face.
Keep well and have a great 2006 guys!!
APB

Hey lawndart, I'm an R6 man, myself. The "scotty dog" broke it's neck breaking horses when I was 17. It impinges on the sciatic nerve, and has done so since that time. When I get X-rays, the doc always offers to cripple me to to take care of the pain, and I always tell him to f*ck himself. After all, that's what they invented Scotch for.

I've just about lived in hospital rooms and emergency rooms. I'm technically crippled, with only 10% use of my left leg, but I'm still in the Army, and pass the PT test in the 260-270 range without any alternate events.

quote:

that's what they invented Scotch for.

hear hear!

quote:

Either I will lob on the doorstep [with a little warning] or you are welcome here in Australia should you visit.

Any time, any time.

quote:

When I get X-rays, the doc always offers to cripple me to to take care of the pain, and I always tell him to f*ck himself. After all, that's what they invented Scotch for.

That area of surgery is actually getting better.


I saw my new neuro cutter today. Good guy, and smart to boot. We will trim it up again. he wants to wait until 2007 or 2008 before thinking about an artificial disc. There are two new ones coming out, and he will have more experience with them by then. On my last two surgeries I was out of the hospital within 90 minutes of waking up in recovery, and back at work the next day. Too back bad I can't use Acraglass Gel or Marine-Tex to hold the disc fragments in place.

I hope the funeral went ok for Dan. It sounds like the scope operator needs his license suspended.

LD

quote:

Originally posted by lawndart:
It sounds like the scope operator needs his license suspended.

LD

How about getting tried for man slaughter, and then prison. Just to set an example for the rest. If he had hit her with is car, he wouild face a day on court. But a medical mistake, gets a pass, that ain't right.

Hog Killer

About time they are held to the same standards as eveyone else.

Being human,

Every doctor has made mistakes in the course of his/her career. Some of the more egregious occurrences are resulting in criminal convictions these days.

If you guys really hate and distrust doctors as much as it sounds like, just don't ever go see one. Use the money for a hunting trip or three.

If any of you would like to come out to Idaho and follow me around for a week of clinic, minor surgeries, house calls and phone calls at 03:00, I have an extra bedroom.

lawndart

LD, I for one have great respect for what you guys do...heck with what I watched my wife put her OB through these last 4 years (2 late night birthed kids via 2 complicated pregnancies) I could never complain if they were just a bit cranky.

My beef is that every time we get a decent doctor they bail out, either quitting delivering babies or leaving the city for less litigous areas of the country. Some really fine doctors too! I don't blame them TOO much (the quitters ) but damn it, WTF can we do about it? Now the only thing we get are the 'University of Tijuana' or 'Bombay Tech' types. Don't get me started there...

Have you ever thought about moving to the coast and doing some fishing? Corpus is a really nice area and we need a new family doctor! No snow either, so you don't have to worry about falling on that bad back of yours.