Thursday, September 2, 2004
I drank coffee late this evening...
...in order to make sure that I had the drive to stay up and write the essay forming in my head about dehydration. The coffee doesn't seem to be kicking in tonight, though, and both my mind and body are mush.
I'll probably set up the beginnings of the exercise therapy journal tonight, as that doesn't take an awful lot of mental effort, and then go to bed. I also began researching the Prescott ER doctor's claims about Medicare payments to rural communities on the Medicare website but didn't get very far. It looks as though some of the information for which I'm looking might be available there. It also became apparent that it would take a fresh mind to wade through it since I'm not a provider and need to access areas for which I need specific codes that I'm having trouble finding on the site. The codes that are easy to find aren't the codes I need. Two weeks ago when I ran his claims (that Medicare pays less to providers in rural communities) by MPBIL he carefully considered what I had been told and said, yes, that may very well be true since Medicare bases geographical payment on such aspects of available care in an area as, for instance, number of specialists available, capabilities of local facilities including hospitals, laboratories and surgical centers, etc. He also gave me the name of someone he thought would be able to answer my questions, an activist here in Prescott. Unfortunately I've been unable to locate her. I also haven't had a lot of time to do local research and uncover other activists.
I'm still suspicious of this doctor's plea for sympathy and the support of rural patients in turning Medicare around in regard to capitation levels for rural communities, as, from my point of view, it is the non-alternative medical establishment that has gotten itself into its fixes in large part by succeeding in turning themselves into an exclusive club out of which the patients (without whom they wouldn't exist) are excluded at every level including the first level which is informed treatment. My feeling is that doctors are getting exactly what they deserve and they need to be the primary problem solvers, without soliciting uninformed and questionable lobbying from patients whose ignorance they not only promote but whose attempts at becoming informed they fight tooth and nail.
Speaking of which, I did discover, after looking through the past four years of my medical records on my mother, that the pharmacy we use should have been providing her with the extended release version of glipizide according to the prescription but hasn't been. I think I know how this occurred. I believe that when the original prescription for Glucotrol XL was written (which, at that time, had no generic equivalent) the pharmacy, a national chain whose policy is to attempt to substitute generics "whenever possible", probably called Mom's PCP and asked if straight glipizide could be dispensed. As I've mentioned here before, Mom's PCP has a hard time remembering that her prescriptions are covered by TriCare at a very low rate and even non-generic prescriptions leave barely a scratch in our pocketbook. Without checking with us I think her PCP said something on the order of, "Yeah, go ahead, that's fine," thinking he was doing our financial status a big favor. I'm a little annoyed about this because if she'd been getting the extended release version since 2000, we may never have had the problems that metformin created. In addition, at virtually every appointment we've had since 2000, I've found myself, yet again, having to remind her PCP that Mom is on TriCare and her prescriptions are easily handled financially, but he simply doesn't retain this information. I wish I'd been somewhat more assertive up front with the pharmacies. The truth is, I didn't notice the switch until the last prescription was renewed.
There are so many stupid, ridiculous details a meticulous caregiver must keep up with when negotiating non-alternative medical care on behalf of their Ancient One. I believe it will get worse before it gets better. I also believe it won't get better until the physicians' community finally realizes they need to start acting like service providers rather than demi-gods to whom sacrifices must be made before care is dispensed.
On to another subject (my mind is doing a race in slow-motion, tonight, courtesy of the late coffee and an unexpectedly early mental let down) for my reference. As far as I know my mother's last bowel movement was day before yesterday. I mention this because she didn't think she'd had a bowel movement but when I was tending her in the bathroom the odor told me that she probably had and I was right. It surprised her. She declared that she "hadn't felt" as though she was having a bowel movement. This happened once before, previous to her adventure with the hospital and the skilled nursing facility. Her bowel movements are usually hearty, in part because of her high fiber diet and in part because she tends to hold onto her waste for awhile. Even when she has daily bowel movements her system literally cleans itself out in one fell (pun not intended but appropriate) swoop. I'm curious as to why currently she seems unable to detect that she is having a bowel movement during the event. I suspect that the reason she is evacuating on a less than daily schedule right now is that her liquid consumption is only about one half to two thirds what it used to be, which tends to render iron-rich shit very sticky and hard to move. With all of her other senses improving lately, though, I'm surprised that her ability to sense a movement when it is happening appears to be dropping. Not caring to be aware could be a factor although she hasn't had an accident since she was released from the SNF despite having had several accidents there. My intent is to explore this development further which is why I mention it tonight. It's been on my mind but I haven't had time to ply it with further thought and research. I think I may have noticed a connection between her bowel movements and her blood pressure dropping below 100, but I haven't recorded anything to which I could refer to see if this connection is real or imagined. Oh well. Nothing like thoughts of shit to end a night.
Later...definitely tomorrow (which is actually today), since we won't be going to Mesa until Friday and Friday will have to be a no excuses day so we can get our lot rent paid on time...yes, later.
I'll probably set up the beginnings of the exercise therapy journal tonight, as that doesn't take an awful lot of mental effort, and then go to bed. I also began researching the Prescott ER doctor's claims about Medicare payments to rural communities on the Medicare website but didn't get very far. It looks as though some of the information for which I'm looking might be available there. It also became apparent that it would take a fresh mind to wade through it since I'm not a provider and need to access areas for which I need specific codes that I'm having trouble finding on the site. The codes that are easy to find aren't the codes I need. Two weeks ago when I ran his claims (that Medicare pays less to providers in rural communities) by MPBIL he carefully considered what I had been told and said, yes, that may very well be true since Medicare bases geographical payment on such aspects of available care in an area as, for instance, number of specialists available, capabilities of local facilities including hospitals, laboratories and surgical centers, etc. He also gave me the name of someone he thought would be able to answer my questions, an activist here in Prescott. Unfortunately I've been unable to locate her. I also haven't had a lot of time to do local research and uncover other activists.
I'm still suspicious of this doctor's plea for sympathy and the support of rural patients in turning Medicare around in regard to capitation levels for rural communities, as, from my point of view, it is the non-alternative medical establishment that has gotten itself into its fixes in large part by succeeding in turning themselves into an exclusive club out of which the patients (without whom they wouldn't exist) are excluded at every level including the first level which is informed treatment. My feeling is that doctors are getting exactly what they deserve and they need to be the primary problem solvers, without soliciting uninformed and questionable lobbying from patients whose ignorance they not only promote but whose attempts at becoming informed they fight tooth and nail.
Speaking of which, I did discover, after looking through the past four years of my medical records on my mother, that the pharmacy we use should have been providing her with the extended release version of glipizide according to the prescription but hasn't been. I think I know how this occurred. I believe that when the original prescription for Glucotrol XL was written (which, at that time, had no generic equivalent) the pharmacy, a national chain whose policy is to attempt to substitute generics "whenever possible", probably called Mom's PCP and asked if straight glipizide could be dispensed. As I've mentioned here before, Mom's PCP has a hard time remembering that her prescriptions are covered by TriCare at a very low rate and even non-generic prescriptions leave barely a scratch in our pocketbook. Without checking with us I think her PCP said something on the order of, "Yeah, go ahead, that's fine," thinking he was doing our financial status a big favor. I'm a little annoyed about this because if she'd been getting the extended release version since 2000, we may never have had the problems that metformin created. In addition, at virtually every appointment we've had since 2000, I've found myself, yet again, having to remind her PCP that Mom is on TriCare and her prescriptions are easily handled financially, but he simply doesn't retain this information. I wish I'd been somewhat more assertive up front with the pharmacies. The truth is, I didn't notice the switch until the last prescription was renewed.
There are so many stupid, ridiculous details a meticulous caregiver must keep up with when negotiating non-alternative medical care on behalf of their Ancient One. I believe it will get worse before it gets better. I also believe it won't get better until the physicians' community finally realizes they need to start acting like service providers rather than demi-gods to whom sacrifices must be made before care is dispensed.
On to another subject (my mind is doing a race in slow-motion, tonight, courtesy of the late coffee and an unexpectedly early mental let down) for my reference. As far as I know my mother's last bowel movement was day before yesterday. I mention this because she didn't think she'd had a bowel movement but when I was tending her in the bathroom the odor told me that she probably had and I was right. It surprised her. She declared that she "hadn't felt" as though she was having a bowel movement. This happened once before, previous to her adventure with the hospital and the skilled nursing facility. Her bowel movements are usually hearty, in part because of her high fiber diet and in part because she tends to hold onto her waste for awhile. Even when she has daily bowel movements her system literally cleans itself out in one fell (pun not intended but appropriate) swoop. I'm curious as to why currently she seems unable to detect that she is having a bowel movement during the event. I suspect that the reason she is evacuating on a less than daily schedule right now is that her liquid consumption is only about one half to two thirds what it used to be, which tends to render iron-rich shit very sticky and hard to move. With all of her other senses improving lately, though, I'm surprised that her ability to sense a movement when it is happening appears to be dropping. Not caring to be aware could be a factor although she hasn't had an accident since she was released from the SNF despite having had several accidents there. My intent is to explore this development further which is why I mention it tonight. It's been on my mind but I haven't had time to ply it with further thought and research. I think I may have noticed a connection between her bowel movements and her blood pressure dropping below 100, but I haven't recorded anything to which I could refer to see if this connection is real or imagined. Oh well. Nothing like thoughts of shit to end a night.
Later...definitely tomorrow (which is actually today), since we won't be going to Mesa until Friday and Friday will have to be a no excuses day so we can get our lot rent paid on time...yes, later.
