The Fall of, well, Me.

Just three months ago and some weeks, I fell down. There was no ice to slip on, the sidewalk was dry. I didn't trip over a crack or stumble over a pothole. The days of wearing elephant leg pants have long since passed, and I did not fall off my platform shoes. I just fell. And kind of rolled. And managed to get back up again. Then I stiffly kept walking back to where I was going and didn't think much of it.

My left leg gave me a reminder the next day

. Bruises such as I have never experienced before showed up. Even on my arms, which I don’t remember being much involved in this falling down thing at all, had very colorful bruises on them. Wow, I thought. Maybe I ought to get this checked out.

By the time I did, my left leg was not only very colorful, it was very swollen. I had to wear my too big rubber shoes to work, which I do not feel is proper. The PA took a look at me, and then sent me for an X-ray.

The results? Nothing broken or fractured in any way.

That was in November.

1: Bruises
If you are human it is very likely you have had bruises in your life. Some are very painful, like a bruise on your bone. Those take a long time to feel better! Some are mild, like accidentally bumping into the corner of a counter.

Did you know there are different words for bruises? Contusion, hematoma, owie…It is defined as an unopen injury under the skin, characterized by pain, swelling, and discoloration.

Why did I have Xrays to check for a break? Bruises are a symptoms. They could mean a sprain, a strain, or  a break. The amount of swelling was a symptom, too.

It took a month or two for the bruising to fade. It went all the way down to my toes! I was impressed! When it finally faded, I didn't expect any more trouble. But trouble came in the form of swelling  on my left knee, redness, heat and pain. I finally went to a doctor to have another look see, and he told me I had to go get an ultrasound to check for blood clots.

I have had ultrasounds before, and they really were no big deal. But the ultrasound to rule out deep vein thrombosis was painful! The tech checked my good leg first, to have a guideline or baseline to judge the bad leg by. In order to prove there were no clots, she had to press down pretty hard on the veins. The femoral vein, at the top of the leg and near the pubic bone, hurts like absolute heck when someone is pressing down a device to prove there is no blockage! It has to be done. Blood clots are nothing to take lightly.

I didn't have any clots.

what happened next is the big golf-ball sized lump on my left knee burst open over night. It was messy and ugly and gross. The doctor I had seen had also started me on antibiotics, thank goodness, because my knee was badly infected! So I went in to see another PA (physician's assistant) and she had me get another X-ray to verify if the bone was infected (a terrifying thought!) and also who recommended me to see an orthopedic specialist.

The stuff pouring out of my knee was reddish orange and thick. Very scary stuff.

Exudite, or wound drainage.

There are three main kinds of exudite: Serous exudite is clear and water, and it is what usually comes out from blisters or burns. Sanguineous exudite is from an open wound and it is kind of another way to say you are bleeding from a cut or other kind of open wound. Then there is purulant exudite. Yep, Pus. Nasty, stinky, thick stuff which can range in color from greens to yellows to really to gross to talk about. My exudite was a combination of the last two, purosanguineaus exudite, which meant that I had an infected wound.

So, the orthopedic specialist took a look at my knee and kind of looked like he was expecting really bad things. He drew up samples of the stuff to send to the lab and find out just what kind of infection he was dealing with. Then he drained my knee and packed it.

Oh, holy cow. It was like going to the dentist, having a stubborn tooth pulled, and then having the dentist pack the stuffing into the empty socket. It hurt!

Two days later I heard that I had a staph infection. Glad it wasn't worse! How did I get an infection any way?  I have a bad habit. I cannot leave sores alone. It is one of the ways I show a low self image or nerves. If nothing else motivated me to stop doing that, this sure as heck did!

The next appointment with the orthopedic specialist his face showed something akin to awe at how much better my knee was looking. He suggested surgery to take out the remaining fluid underneath but we both felt that the skin tissue wasn't strong enough to hold stitches. Also, I had just started a new job and really cannot afford more time off than I have already had! He ordered another round of antibiotics and I will be going in for another evaluation soon to see if it looks like it will heal without surgery.

What have I learned?

Listen to my body. Pain is a symptom, swelling and redness, all of these are signs not to be ignored.

Stop picking sores!!! I am embarassed to admit that I do this. It is a bad habit, one that I am making great strides in stopping especially after all of this happened!

I live a blessed life.

The Power of Music

“The rhythm of life is a powerful beat, puts a tingle in your fingers and a tingle in your feel, a rhythm on the inside, a rhythm on the street: The rhythm of life is a powerful beat”

Sweet Charity, Rhythm of Life.

Yesterday, our community bid good-bye to a man who had a huge impact on many lives, a teacher, a musician, a minister in many ways. Robert Fisher has closed the keyboard for the last time here, in this place, anyway. In the photo displays put up to celebrate his life, I found a photo with me in it. I saw a really skinny young man with a huge bassoon at the Interlochen Bowl, I believe. I saw brothers together over the years. The rumpled hair and broad smile over the years. The spark in the eyes, mischief and pure joy of life.

The influence of music is universal. Music is spoken worldwide but with different dialects. It can create, unite, divide, soothe or cause fear. It is a language that is mathematical and factual as well as being emotive and fantastic.

I have been so privileged in my life to have such wonderful and extensive exposure to music, theory, and the power of song. I may joke about inappropriate songs to sing at work, but the plain truth is music is so powerful and so deeply absorbed. It can be healing, soothing. 

Please enjoy some of the music that Mr Fisher had introduced to us choir kids over the years, and think about music that has meaning in your lives.  

Peace Peace with Silent Night

Rhythm of Life

Movin' On

Creation: A Rock Cantata

Drugs of Abuse, the next part

Recently our local county sheriff was interviewed and communicated this idea: That while heroin is a growing problem for our area, prescription drug abuse was a greater and more harmful problem. http://www.upnorthlive.com/news/story.aspx?id=905806#.VE9zv_nF9yw

More harmful than heroin. 

Most prescription drugs that are abused are opioids. That is, they come from the same family as heroin. Prescription drugs are easier to find without the seedy drug dealer, right in your own home or a friend's home or someone's purse or...well, the possibilities are endless.

Washington, D.C. October 7, 2013 - Michigan has the 18th highest drug overdose mortality rate in the United States, with 13.9 per 100,000 people suffering drug overdose fatalities, according to a new report, Prescription Drug Abuse: Strategies to Stop the Epidemic.

The number of drug overdose deaths - a majority of which are from prescription drugs - in Michigan tripled since 1999 when the rate was 4.6 per 100,000. Nationally, rates have doubled in 29 states since 1999, quadrupled in four of these states and tripled in 10 more. (http://www.healthyamericans.org/, 2014)

At a seminar for continuing education that I attended last year, a state police officer described how people, not just kids, were grabbing prescription drugs from their grandparents or sick relatives and taking them to parties where they would put all of the pills into a container. Then they would reach in and take pot luck whatever pill they happened to grab. It could be a mix of blood pressure medication, thyroid meds, pain killers, water pills; it didn’t matter. This is a new and scary kind of Russian roulette.

Someone described to me how a family member was so addicted to pain killers that they would take topical pain patches and open them up and lick the medication from them. People crush painkillers and inhale or inject them. There are new forms of certain prescription drugs that are crush proof to try to stop this practice and make the drug less desirable.

And then there is the money question. In the light of the economy and the uncertainty involved with being able to receive medical care, people are taking advantage of selling their prescription drugs, whose cost in the first place is hard for these same patients to manage.

NEW YORK (CNNMoney) -- Prescription drug abuse, now the fastest-growing drug problem in the country, has created a ballooning street market for highly-addictive pain relief, anxiety and depression drugs. Given the money involved, it's no wonder.

Here's a sampling of the street prices for a single tablet of some commonly trafficked drugs, compared to their retail prices:

-Oxycontin: $50 to $80 on the street, vs. $6 when sold legally

--Oxycodone: $12 to $40 on the street, vs. $6 retail

--Hydrocodone: $5 to $20 vs. $1.50

--Percocet: $10 to $15 vs. $6

--Vicodin: $5 to $25 vs. $1.50 (CNN, 2011)

These are per pill prices, not per quantity. Most people I know are strapped for money. This is pretty temping. Big bucks for hardly any effort. 

So, what can we do about it?

Do not share, sell, or give away prescription drugs. There are so many reasons not to, but let’s see if saving a person’s life is a value you can work with.

Turn in out-dated and unused prescription drugs to your police department. I know Benzie Police Department has a locked container to drop drugs in for safe disposal. Some pharmacies have yellow jugs for disposal of old drugs.

(http://www.munsonhealthcare.org/News/Default.aspx?sid=1&nid=340, 

http://www.michigan.gov/msp/0,4643,7-123-1579---,00.html)

Do not flush your old prescriptions down the toilet, particularly if you have city water. What goes around comes around, and traces of prescription drugs are showing up in city water supplies as well as non-prescription drugs.

Don’t assume someone will not steal your drugs. 

.

For your information: There are a lot of people contesting which drugs are controlled substances. As of October 2014, this is the current standing:

Definition of Controlled Substance Schedules

Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules.  An updated and complete list of the schedules is published annually in Title 21 Code of Federal Regulations (C.F.R.) §§ 1308.11 through 1308.15.  Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused.  Some examples of the drugs in each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").

Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone (Dilaudid®), methadone eperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).  Other Schedule II narcotics include: morphine, opium, and codeine.

Examples of Schedule II stimulants include: amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®).

Other Schedule II substances include: amobarbital, glutethimide, and pentobarbital.

Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.

Examples of Schedule III narcotics include: combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin®), products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and buprenorphine (Suboxone®).

Examples of Schedule III non-narcotics include: benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such as Depo®-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and ezogabine. (US Department of Justice Drug Enforcement Administration, 2014)

Inappropriate Songs to Sing at Your Workplace, again

I made the mistake of telling my friend at work that I despise, detest, and totally hate "McArthur Park" and now she keeps singing it to me. I get her back by singing Beatles songs, particularly "I am the walrus". So there!

Today, songs from childhood days were playing in my mind. Songs about duckies. You know, quack quack? Remember the one little duck with the feathers on his back? And this lead to the song about the little black bug swimming in the water.

Thinking back to childhood, a whole cornucopia of music comes to mind. I was real lucky and blessed to have a variety of music growing up, everything from Hank Williams Sr to Peter and the Wolf. Burl Ives and the Kingston Trio filled my repertoire up with songs like Ann Boleyn and The Fox, and my favorite Mangwane Mpulele.

So much music, so little time.

But music seasons the day. I use music like a frightened person whistles in the dark. It brings back good times and reminds me of better days. Hope it does the same for you.

Going to the Doctor

The world sure has changed.

When I was a child, there was one doctor you saw for everything that ailed you. Dr Kamp delivered me, treated me for everything from chicken pox to taking a BB pellet out of my ear to cleaning up a cut on my knee that I got from kneeling on a piece of broken whiskey bottle in an old village dump behind my grandparents.

Well, ok, Mom had a bone doctor. Dr Clark was as much a part of our lives as Dr Kamp was. We saw Dr Sarya for our orthodontist, Dr Ross for our dentist. My grandmothers both went to Dr Willoughby. But, we didn't have an ear, nose, and throat specialist, or a dermatologist. Dad did go to an open heart surgery pioneer when he had his bypass surgery, and that was over in Milwuakee. That guy gave us thirteen extra years with Dad, and I am very grateful for that. That in mind, there is certainly a need for specialists.

I used to think that a doctor's work day was more similar to a workday you or I am familiar with, with the earnings based on production or care given. I had no idea what being a doctor really meant. To this day, I don't have a clear understanding, but I am getting a pretty good picture. It really made me angry at what I perceived to be the doctor's wage for visit. So much money for ten to fifiteen minutes of his or her time!

What I didn't realize is how much work a doctor is actually doing.

1. Today's doctors need to do a lot more paperwork than ever before. Due to insurance changes, HIPAA, legal requirements, new medications and changes in how medications can be prescribed, there is a whopping lot a doctor has to do on paper or on computer. If he or she doesn't create the paperwork, they need to find if paperwork has been completed historically, such as medication agreements. Doctor's also have to do prior authorizations, or at least have their nurses do them. Some insurance requirements make providing care a nightmare with the burden of proof of the patient's needs resting on his primary care physician.

2. Due to the internet, patients come in with information that may or may not be correct and healthy for them. The doctor is constantly challenged by a patient's "education". Add in pharmaceutical advertisements on TV and in magazines, and popular opinion, and this can be a pretty good mine field for a doctor to maneuver through in order to provide correct and healthy treatment for the patient.

3. A doctor is constantly interrupted. He spends time listening to the patient during the appointment and has to chart this visit. But there are prescription refills to address, appointment requests, calls from other doctors or health care providers to discuss other patient cases, and more. And always it seems that just after a patient finishes his appointment, he remembers that he forgot two or three important things he needed to ask the doctor about.

4. Patients do not follow orders.  There are people who actually get huge kicks out of not following doctors orders and  how daring that is. Then they come back, complaining about the same symptoms and blame the physician for not taking care of them. I am just as guilty of non-compliance: I am overweight, and have been told by years by my physician that I need to address this. I am still overweight and getting more health issues as time goes by. It is within my power to gain health, but it is so much easier to ask the doctor for a simple remedy. Self discipline is just too hard..

5. Some patients are just lonely or needy. Seeing the doctor may be their only social event. They spend a lot of time talking with the doctor, asking to talk to their doctor, demanding to get appointments for this or that, and being traumatized when the doctor can't see them.  These folks take a lot of the doctor's time as well as the office staff's time. This is just a fact.

6. Doctors have feelings too. A doctor can't stop taking his or her appointment's for the day when they hear a friend or family member has passed away or other bad news. Sometimes, patients will take out their bad day on the office staff and the doctor. A doctor can't take this personally: Sick people are not at their best. Frightened people may lash out too, when lab reports or diagnostic imaging gives bad news.

7. Doctors have had a lot of schooling, and are continually learning. They have a lot to remember. I went to school for four years to become a medical assistant. I took some classes twice because I didn't get it the first time around, and I didn't want to risk other's health because I didn't understand what I was learning. This wasn't all that long ago, and I have already forgotten terminology and techniques. I am in an administrative position, and glad of it. I  had a two-year program that took me four years. How long does it take to become a doctor? And how long does it take to pay off those student loans?

How can a patient help his PCP have a more productive visit?

Seek care when you need it. Understand what is an emergency and what is not an emergency. If your situation is not clear, call and talk with a nurse about your symptoms. Listen to your doctor. Take medications as directed. Don't save antibiotics for later. Understand that your PCP sees many people. Be involved with your care and aware of your symptoms. Have an annual wellness exam. Don't take your bad day out on your doctor and his staff. Do make sure your insurance and address and phone number are up to date in your chart. Specify where you want prescriptions to be sent.  When you call your doctor's office, please identify yourself and please state what you are calling about clearly. Don't expect your doctor to address fifty issues in a ten minute time span. Don't bring family members in to your appointment to be seen for a problem they are having. They need their own appointment.

My mom used to bring all of us kids in to see Dr Kamp when one was sick. It made sense as a mom, but was really hard of Dr Kamp. He finally told her she couldn't do that anymore. Sometimes we just don't think. It is hard to remember that you are just one of many patients, particularly when you are really sick. You are important! So are the other patients.

Drug Abuse, step one:

When you think of drug abusers, what comes to mind?

Now, think again about drug abusers, and substitute the image you visualized with a grandmother, a teacher, a minister, college student, or even yourself.

I used to think that marijuana was THE gateway drug. Now I think it is pain relievers, starting with harmless little old aspirin. We have been taught for years to take a pill and the pain will go away. So convenient! Now that I am in my fifties, I am noticing that there is a lot more pain and a lot less time so it’s a Tylenol here and an Aleve there. If I don’t take too many and have a variety, that is better, right?

This is me normally as a teen. Honest!

So, plain old over the counter pain killers are commonly abused.

These are the gateway drugs, if you ask me. It was in high school that I first heard of a way to get high with aspirin. Just take it with a Coke, on an empty stomach is best. This was when aspirin was still ok for kids to take. Reyes Syndrome was not a new notion in those days, and in truth a school mate had died from Reye's Syndrome. But it was not a firm theology to avoid aspirin yet then.

The other issue with aspirin, Tylenol, ibuprofen and similar drugs is that we do not think of them as being drugs, not really. A drug is something like Tylenol three or Percocet. But anything that is medication consists of drugs, a fact to keep in mind. Also, too much of any of these meds is bad for your body. Do you really want to have issues with bleeding ulcers or liver damage?

Do not exceed the prescribed dosage on any medication. This is not a good idea.

It is also a very good idea to check your other medications for interactions. I was prescribed a medication for restless legs. I got a headache, and thought nothing of taking an aspirin for it. Big mistake! On that particular medication just about any and all other medications interacts badly! I stopped that medication pronto. It was too scary. Read those drug inserts, folks, they can save you a lot of grief!

The thing is, our brains are tricky manipulative little buggers who figure out that if one pill helps the pain, another would help more.  Like Pavlov’s dog, an ache or pain is the bell that calls for a reward of pain relieving bliss. Instead of physical activity such as stretching or walking we baby the pain with pills. Instead of quiet rest with a cold compress on the eyes, we keep reading or working on the computer or driving. We of this current culture, with all its gizmos and doo-dads and time-consuming things, do not know how to rest.

Read the label and the package insert for safe use of medications

This is all basic stuff. What do I mean by drug abuse?

Taking more than the prescription reads, or more than is suggested on the package of over the counter medications, is drug abuse. You have a doctor written prescription for pain medication. You only use it when you need it, it is to help you. But if you take more than the doctor has prescribed, that counts as drug abuse. That means your prescription will run out sooner than it is written for and you will be shocked by the fact that the doctor will not do an early refill for you.

Say your sister has a migraine medication. You get a migraine. She gives you one of her pills. This is illegal. It is also unsafe. Say your sister is a heavy person and you are thin. The dosage is designed for her, and you may actually receive an overdose. Never take a drug that has not been prescribed for you.  You wouldn’t borrow someone’s prescription glasses would you? Prescriptions are not one size fits all.

Taking or using medications in a way other than they were prescribed is drug abuse. For instance, crushing an extended release pill is not how it is prescribed. It is designed for the medication to be released over time. When a pill like this is crushed, the medication is felt all at once. Don’t cut pills that are not designed to be cut. Don’t open capsules. If swallowing pills is difficult for you, tell your doctor or pharmacist. There may be an alternative method for that medication.

I am working hard on developing good habits with medications. This includes reading the insert that comes with prescribed medications and sticking to the suggested dose on the packages. Before I became a medical assistant, I was pretty ignorant about these things. If you cannot read or understand the inserts, ask your pharmacist. They can also tell you about possible interactions with other medications you may be taking.  There are also drug books that are easier to read for people without medical degrees, and websites that help.

Inappropriate Songs to Sing at the Workplace, Second Verse

“Great big gobs of greasy grimy gopher guts…”(lyrics)

I almost sang that out loud at work. My brain radio throws up some crazy music without warning and fully prepared for me to be singing out loud with. The other day had Gilbert and Sullivan ( The Nightmare Song) running rampant in my brain. On yet another day, I had Salt and Peppa’s “Let’s Talk About Sex” in my mind. (Salt N Peppa)

 

Which cues this next thought: I remember the first time I saw a little kid of about three or four singing George Michaels “I Want Your Sex” and dancing to it, just like she knew what she was singing. I was kind of shocked by this!The problem is, the song is fun and has a good beat. It gets wedged in your head. (I will bet you are singing it right now!) Mind you, there are worse songs, lyrically, on those Kids Bop collections.( 8 Worst Kidz Bop Songs)

(Good gravy. Just because I said the song had a good beat, I now have the theme to American Bandstand playing in my head. Thanks, Barry Manilow.) (American Bandstand Theme)

Beyonce’s “Put a Ring on It” is another one that kids seem to really jam to. There are babies in videos online just jamming down to this song, which is kind of fun. Even the spoofs are worth watching for a good belly laugh.(single ladies baby dancing)

But to hear the song is to watch the video for me, and I just can’t get my head around all that dancing in high heels with bathing suits on. Not just cause I am jealous of those women who both can wear high heels and look awesome in one piece suits, either.

Work doesn’t help either. Sometimes hold music is pretty drowsy stuff. Today I heard a song about chickens. Yep, chickens. Done to a swinging 40’s beat. I was amazed to be able to complete the call coherently, it took me so by surprise.(The Chicken Song)

My husband, bless his heart (and I mean that in a truly southern way), can burst out with C.W. McCall songs and be able to sing every single word; intonation, innuendo, and all. I am not just talking about “Convoy” and “Wolf Creek Pass” either. And he does sing every word.(CJ 5)

The other day at work when the radio was quiet, he broke out loudly and proudly with “Jeremiah Was a Bullfrog.” The people all around him fell over in awe.  Or was that ow? One thing we both learned in choir is how to project, and that boy can out project a Broadway singer. (Joy to the World)

The problem is, music gets in to the brain and it stays there. It is hard to not hear music, especially if it is an annoying song that you never want to hear again, ever. Like, oh, “McArthur Park.” I so very much hate that song. Why is the cake so traumatically important? Who cares about the cake? Non-the-less, in my brain radio, that despicable song lives on. (Very Dreadful Song)

Great. Now I have the theme to Dispicable Me in my mind. Wait, I like that song! (Dispicable Me)