Dr. Maryellen Strikes Again

I’m trying to keep the medical articles separate from the blog.  But a doc’s gotta do what a doc’s gotta do.  So, for those of you who like to read the medical stuff, I will put links to my medical articles as they are published, and add them to the page on the right.

Today’s article (just published) is about placenta previa.

http://shine.yahoo.com/know-placenta-previa-214600179.html

It is published on Yahoo! Shine.

Who is that Answering your Doctor’s Phone?

There have been situations where my receptionist has stepped out or been sick over the years.  Someone else has been drafted to answer the phone.  Interesting things have happened.  This is my take on what happens if someone else answered the phone.

Office Nurse – This happens in a lot of offices.  Sometimes the message is OK, sometimes you have to call back to make an appointment because the nurse has no idea at all how to work the computer.   She can work all the complicated medical equipment, help with surgery, but never gets appointments in the right slots.

Doctor’s Mother – You might get a message taken, you would probably get some good advice, and you would probably have a nice homey chat.  If the doctor is Jewish, you would get a recipe for chicken soup; Italian, a recipe for lasagna; Cuban, the best black bean recipe……

Doctor’s Father – A quick message and a hang up.  At least if it was my Dad.  He was an engineer.  The message would be very neat and precise.  Miss you Dad.

Doctor’s Husband – if they have been married for a while, he’s probably pretty good at taking messages without getting involved and NOT giving any advice.  My husband actually worked in the office for a while and is great at making appointments, etc.  He is not embarrassed about asking the “girl questions”.  My patients get a little freaked out about it. 

Doctor’s Kids – one of the funniest skits I ever saw on The Cosby Show was when Dr. Huxtable’s oldest son answered the phone (at home).  He asked the person on the other end all the appropriate questions to determine that she was in active labor.  He sent her to the hospital, then told his Dad that Mrs. X was on her way to the hospital.  I LOVED IT.  {My kids won’t answer the office phone.  They might answer my cell if I can’t get to it fast enough.  They only say things like “Hold on for my Mom.”}

Doctor – nobody else is there.  She is not going to admit it is her unless she is really new at this.  She will make up a name and maybe an accent.  That’s how my pseudonym, Maryellen Smith, came about.  I found out early that if people recognized my voice they would expect a free visit. 

One day Maryellen Susan Smith (MESS) was born.  I borrowed her from someone else.  They used to blame her for everything that went wrong at an organization she worked for. 

“Maryellen must have done that.  That’s OK, I can fix it.” 

It works well when I don’t want anyone to know it’s me.  She has “worked” in my office for years now.  She even gets mail on occasion.  I tried to retire her, but the new pseudonym didn’t work out as well.  So she’s back.  In fact, she has even written articles for a web site called associatedcontent.com (now part of yahoo).

I worked in offices in college.  Maryellen does a pretty good job of answering the phone and taking messages.  She does NOT give out any medical advice.  I guess I’ll keep her until I retire. 

Finding the Silver Lining Inside the Cloud

This time of year is time for many of us to do taxes.  It is not my favorite thing to do.  Fortunately, I am somewhat obsessive about keeping track regularly on my computer of expenditures. 

I print out the year from my check book and cash expenditures.  Check.

I print out the year from my office receipts.  Check.

I start looking for all the other paperwork.  Not so check.

This is where I have to depend on other people.  The members of my family who swear that they have given me whatever paper it is that I am currently looking for (the spousal division).  Or look at me with that blank stare that tells me that they have no idea what I am talking about (the high school division). 

I spent 4 days last week looking for a 1099 that my husband swore he had given me.  I cleaned the entire surface of my desk.  That’s the silver lining.  I didn’t find it.  I asked him to look for it at home.  He found it in less than 5 minutes.

Yes, he is still alive.  No, you may not inquire about my blood pressure. 

Top Ten Things Only Women Understand

10.  Cats' facial expressions.
9.  The need for the same style of shoes in different colors.
8.  Why bean sprouts aren't just weeds.
7.  Fat clothes.
6.  Taking a car trip without trying to beat your best time.
5.  The difference between beige, ecru, cream, off-white, and eggshell.
4.  Cutting your hair to make it grow.
3.  Eyelash curlers.
2.  The inaccuracy of every bathroom scale ever made.

AND, the Number One thing only women understand:

1.  OTHER WOMEN

  

*I’ve been working on my taxes.  This is something someone sent me that I saved and thought was cute.  I have a few of these.  Enjoy. 

Another Car Conversation

As any parent knows, some of the best conversations I ever have with my kids are in the car.  They have no place to go.  If I’m quiet, eventually the silence gets to them and they will say something.  It’s a technique most parents eventually find.  If you haven’t used it yet, try it.  You might like it.

I was doing my weekly trip to the big box store with Mr. Impatient.  Friday was not my best day.  It will probably take a whole week of posts to tell you all about it.  Mr. Impatient was being very patient and understanding.  However, he was a bit confused. 

You see, Tall Guy and Year Book Gal have been dating for a year.  It was time for their anniversary.  Tall Guy got all romantic about it.  He bought her flowers and a gift.  He took that to school on the actual day.  She bought him a gift, too.  Then they went out to dinner on Friday.  The actual day was scout night. 

Mr. Impatient likes to go out to eat.  He just assumed he was going along.  Any time someone goes out to dinner, lunch or even breakfast from our house, he thinks he is going along.  If not, at least they need to bring him something back.  I told him he was NOT to expect that.  He was crushed. 

He wasn’t quite sure what an anniversary was, either.  That was another ten minute discussion.  What?  Why?  Why can’t I go?  Why do they have to go by themselves?  Why can’t they bring me something back? 

I was tired before we even got out of the car. 

I told him that, when you’ve been married for a long time, you stop making such a big deal over it.  I was going to say practically forever, but decided I didn’t want to explain that expression. 

Heart Month

Since February is heart month, I thought I would post a few:

Don’t ask why they are arranged the way they are.  I don’t know, either.

Another Website Issue

Another Website Issue

Does anyone know what happened to HealthCare Roundup? 

This is a site that had lots of smaller blogs, including mine, listed on it.  Each day the new posts would be on there.  It’s where I got my “start”.  I also got a lot of info from there.  The last week or so, I get “this site is active but no information is loaded.”

What is going on?

"Estrogen Issues"

10 Ways to Know if You Have "Estrogen Issues"

1. Everyone around you has an attitude problem.
2. You're adding chocolate chips to your cheese omelet.
3. The dryer has shrunk every last pair of your jeans.
4. Your husband is suddenly agreeing to everything you say.
5. You're using your cell phone to dial up every bumper sticker that
says: "How's my driving".
6. Everyone's head looks like an invitation to batting practice.
7. Everyone seems to have just landed here from "outer space."
9. You're sure that everyone is scheming to drive you crazy.
10. The ibuprofen bottle is empty and you bought it yesterday.



 

Worth a Read

My friend who writes at Labor and Deliverance has stated things well.  This post is definitely worth a read:
http://laboranddeliverance.blogspot.com/2012/02/i-really-did-not-want-to-be-politcal.html?showComment=1329773356432#c3915780550301889625
It is a discussion of prenatal testing from the side of a practicing obstetrician. 

Testing is for information.  What an individual patient and her doctor do with that information is between them.  We got the government out of the examination room years ago.  Or did we?

OLE & BESSIE

Ole's car was hit by a truck in an accident.   In court, the trucking company's lawyer was questioning Ole.

'Didn't you say, sir, at the scene of the accident, 'I'm fine?' asked the lawyer.

Ole responded, 'Vell, I'll tell you vat happened.   I had yust loaded my favorite mule, Bessie, into da......'

'I didn't ask for any details', the lawyer interrupted.   'Just answer the question. Did you not say, at the scene of the accident, 'I'm fine?'

Ole said, 'Vell, I had yust got Bessie into da trailer and I vas driving down da road.....'

The lawyer interrupted again and said, 'Judge, I am trying to establish the fact that, at the scene of the accident, this man told the Highway Patrolman on the scene that he was just fine.   Now several weeks after the accident he is trying to sue my client. I believe he is a fraud.   Please tell him to simply answer the question.'

By this time, the Judge was fairly interested in Ole's answer and said to the lawyer, 'I'd like to hear what he has to say about his favorite mule, Bessie'.

Ole thanked the Judge and proceeded.  'Vell, as I vas saying, I had yust loaded Bessie, my favorite mule, into da trailer and vas driving her down da highvay ven dis huge semi-truck and trailer ran da stop sign and smacked my truck right in da side.  I vas trown into one ditch and Bessie vas trown into da other.   I vas hurting real bad and didn't vant to move.   However, I could hear Bessie moaning and groaning. I knew she was in terrible shape yust by her groans.

'Shortly after da accident da Highway Patrolman, he came to da scene. He could hear Bessie moaning and groaning so he vent over to her.  After he looked at her and saw her fatal condition her took out his gun and shot her right 'tween da eyes.

'Den da Patrolman, he came across da road, gun still smoking, looked at me and said, 'How are you feeling?'

'Now vat da hell vould YOU say?'

[I lived in North Dakota for a while.  Ole, Lena and Sven are the characters they tell jokes about.  Not the brightest Norwegians in the bunch, but funny!  Yes, I am part Norwegian, so I can tell them.]

They Never Grow Up

I was running errands with two of my 17 year olds this afternoon.  We stopped at McDonalds to get something to eat.  From the passenger’s seat came a small voice, “Can I have a Star Wars toy, Mom?”

I turned to the speaker and said, “…and two Star Wars toys, please.” 

Then I asked the “child” in the back seat if he wanted one.  “No, Mom.” 

You see, I knew if I came home with one for the kid in the car, the one at home would pout all evening.  Not gonna live with that. 

They never grow up.

Thoughts on Pregnancy

(Thanks to Sandy)

PREGNANCY Q & A & more!

Q: Should I have a baby after 35?
A: No, 35 children is enough.

Q: I'm two months pregnant now. When will my baby move?
A: With any luck, right after he finishes college.

Q: What is the most reliable method to determine a baby's sex?
A: Childbirth.

Q: My wife is five months pregnant and so moody that sometimes she's borderline irrational.
A: So what's your question?

Q: My childbirth instructor says it's not pain I'll feel during labor, but pressure. Is she right?
A: Yes, in the same way that a tornado might be called an air current.

Q: When is the best time to get an epidural?
A: Right after you find out you're pregnant.

Q: Is there any reason I have to be in the delivery room while my wife is in labor?
A: Not unless the word "alimony" means anything to you.

Q: Is there anything I should avoid while recovering from childbirth?
A: Yes, pregnancy.

Q: Do I have to have a baby shower?
A: Not if you change the baby's diaper very quickly.

Q: Our baby was born last week. When will my wife begin to feel and act normal again?
A: When the kids are in college.

People send me stuff by e-mail and face book.  This one is from a friend of mine named Sandy.  She’s retired now, so she has lots of time to send all the good stuff.  Thanks, Sandy.

Prior Authorization of a Medication

Insurance companies are deciding more and more which medicines they want to pay for.  They also set limits on how much of a medication patients may have per month.  If the patient needs anything different than what the insurance company (in their infinite wisdom) has decided is the ideal medication, doctors are supposed to get a “prior authorization”.  This used to be simply signing a form.  Times have changed. 

These are the steps that we have to go through for prior authorization of a medication. 

1.      Pharmacy or insurance company faxes prior authorization request the office

2.      Princess pulls the chart

3.      Princess attaches PA to front of chart and lays it in doctor’s inbox

4.      Dr. Lasermed checks

A.   When was the patient was last seen? (no refills if more than one year for some meds, 6 months for others … by law)

B.   When did the patient last received the medicine?

C.   Is there any reason why this patient should not have the medicine now? Is she overdue for a visit or test? Should she still have some medicine?

D.   I check to see if the medications can be changed to something different.  I review the chart to see what other medications have been used.  I check doses on all medications.  I make a list of the patient’s medical conditions.  Basically I get prepared to speak to the pharmacist.  Of course, some of this may be done while I am waiting on hold for the insurance company.

5.     Either the fax is filled out, or the insurance company is called.

6.     Calling the insurance company may involve several steps.  There is always some sort of menu of choices.  Usually there are several.  The first real person that I talk to is rarely a pharmacist.  Occasionally they can solve the problem.   Usually, I have to get transferred to someone else.

7.     When I finally get to speak to the pharmacist (usually about 15 to 20 minutes into the phone call), I need to have the patient’s name, date of birth, insurance number, Medication name, dose, frequency, condition we are treating…..  The pharmacist will then sometimes tell me WHY the medication is not being approved, or ask if we have tried other medications.  That’s why I go through the chart and make that list.

8.     We may have to change to a different medication.  Medicaid recently changed from Brand N for stomach Acid to any of three other medications.  Since they are about the same, I just changed the medicine, called the pharmacy and notified the patient.  Of course, they changed TO Brand N about two years ago, so we went through this then.

9.     Sometimes I have a form I have to fill out.  I may have to send records.  Once it was a chart that went back 15 years. 

10.   Sometimes I have to write a letter.  I have gotten mean and crotchety in my old age.  I tell the insurance company that they are assuming the risk in changing the medication because I will NOT.  I ask them for a medical license number in my state.  I state my reasons for not approving.  It’s my last effort, but it has worked when I try it. 

11.  I may get approval.  That’s my favorite.  Usually that’s because I’m prepared.  I got approval for one patient the other day until December, 2022.  I think there might have been a typo in there, though. 

12. There are two separate places in the chart where any medication interaction needs to be noted – on the progress notes and on our “medication sheet”. This is a separate part of our chart that has every medication prescribed since the mid 1990s.   It makes it easy to see what medications the patient has been on all that time. 

13.  The chart is returned to Princess, who checks to make sure all of this was done.  If I forget a step, she returns the chart to me.

14.  A bill is generated. 

15. The chart is filed.

After all that, do you understand why doctors hate to hear the expression “I need to have you prior authorize my medication”?

Articles Written with a Different Pseudonym

I have just about finished a new page for this blog.  It has links to all the articles that I have written in the last couple of years as Dr. Maryellen Smith.  There’s even an article explaining the pseudonym.  (http://voices.yahoo.com/10-interesting-things-know-5367813.html?cat=37 )  You can locate the page in the right hand column of the blog under “pages”. 

The most popular article has been “15 Things I Learned During My Triplet Pregnancy” with over 23,000 page views since it was published. 

There are articles that were published on other Yahoo! sites that I am still trying to find links for.  As I find them, I will add them to the page.

There is also a link to the community page which lists all the articles and has summaries of each one. 

Enjoy them.

If you have any suggestions about the page, please let me know.   

What Do Doctors Really Do?

It depends on who you are as to what you think doctors do.  This was posted on a doctor’s web site that I visit regularly.  I particularly like “What my friends think I do” and “What I really do”.  Only my desk is much messier than that. 

Negotiating My Lunch Date

My autistic son, Mr. Impatient, often makes announcements about what he wants to do on certain dates.  He doesn’t ask, he just announces.  This week he announced that he wanted to go out for pizza on Saturday.  He loves to go out on what I call a “lunch date” on Saturday “just me and Mom”.

Another feature of autism is the love of routines.  For the last million years or so, we have had to have pizza on Thursday night.  That’s the night that Three Speed and Tall Guy go to Boy Scouts.  They pick up pizza at the local joint on the way home.  We have trouble right now because MI’s favorite place is closed for renovations.

I explained to MI that grown-ups get tired of eating pizza after a while.  It was the same thing with McDonalds when my boys went through that phase.  I got to the point where I almost got sick when I walked in.  Thank goodness I’m over it now.  But I can’t tolerate the concept of pizza more than once a week.  Some weeks I think once is too much. 

This whole conversation was extremely difficult for my poor son to understand.  How could anyone get too much pizza?  He was very confused.  I vaguely remember that concept from my teenage years back in the stone ages.  The explanation took almost the whole drive to the big box store that we go to every Friday.  That is another routine we have established that I would miss if we didn’t do.

But I wouldn’t miss the pizza.

So I negotiated other restaurants.  The place we went to in this post is one of them:

Mini Melt Down in a Restaurant: http://dr-lasermed.blogspot.com/2012/02/mini-meltdown-in-restaurant.html

I still don’t want to go back to the pizza places. 

Mini Meltdown in a Restaurant

Mr. Impatient likes to go out to lunch on the weekends.  He usually asks to go “Just me and Mom.”  Today, Tall Guy got home from Jazz Fest in time to go with us.  I like to have more than one of my boys, because the conversation is much more interesting.

We went to a local branch of a major national restaurant.  Mr. Impatient knows exactly what he wants.  At every restaurant we go to.  Chicken strips and French fries.  He likes cheese and bacon on the fries if possible.  No sauce except catsup.  No lettuce or parsley.  We call that “no green stuff”.  We are very specific about how we order.  He orders his drink without ice ever since he wasn’t allowed to chew ice with his braces.

The waitress paid attention and wrote down everything.  She was attentive and kept stopping by.  Could it be because I had two attractive young men with me?

When the fries came out, there was a huge scoop of sour cream on the top and a cup of some sort of sauce.  Mr. Impatient said “it’s a mistake?”   The waitress took them back to the kitchen and brought him an order that was correct.  He munched on some of the chips from Tall Guy’s and my appetizer while he was waiting.

When the chicken fingers came out, another waitress brought them.  They were sitting on a bed of lettuce!!  Mr. Impatient was polite and said “it’s a mistake?”  I, however, kind of had a mini melt down at this point. 

This is a major chain restaurant.  They have already screwed up once.  This is number two on the same child’s order.  It’s not like we asked for extras.  We asked for stuff to be left off.  How hard is it not to put lettuce under the chicken?  How hard is it to leave off the sauce?  Someone in the kitchen just didn’t care. 

I did just pull the lettuce off the plate of chicken fingers.  I was in tears by now.  It basically ruined my “dining experience”.  This meal cost about $70.00 for three people excluding tip.  I tip generously if the service is good.  It wasn’t the waitress’ fault that the kitchen messed up.  It was her fault she didn’t notice.   

The manager stopped by to ask how things were.  I let him have it.  I don’t expect to pay for that kind of inattention.  Thank goodness Mr. Impatient has matured (today a whole lot more than his Mom) and didn’t have a fit.  The manager actually agreed with me, and took the price of the items off the meal. 

Inside a Toddler's Brain

This image is courtesy my friend Maureen A. Doolan Boyle

of MOST (Mothers of SuperTwins - an organization for parents of multiple children).  The image comes from ALEX Toys.

Women’s Health Care Coverage

The debate has started again about what services should and should not be covered by health insurance.  Religious organizations feel that they should be able to not cover birth control.  If they don’t believe in it as a religious policy, they should not pay for it as part of their insurance policy.

I thought we had finally finished fighting this battle.  Sigh.  Here we go again.  I have had to deal with insurance companies (and parents sometimes) about this for years.  People – this is not the 1950s. 

1.     The choice of whether or not to have children belongs with the woman who is having the children.  It does not belong with anyone else.  As a physician, I can only assist in this decision. 

2.     The choice of birth control method also belongs with a woman.  Her partner may or may not be involved in this decision.  My job is to educate her and assist in this decision.

3.     Birth control is not always used to prevent pregnancy.  We use birth control pills to control bleeding, keep cycles regular, assist with acne control, aid in controlling cramps, help control endometriosis, and many other things.  We use IUDs, patches and other birth control methods for some of the same issues.  Some of the women using these methods aren’t even sexually active.  If the insurance company decides not to cover “birth control”, they won’t cover the medications for any other reason. 

4.     Many of the “covered lives” (shudder at that term) may not be of the same faith as the organization that they work for.  Should they have to live by the same rules?

It is interesting to me that most of the people who are making these arguments are not the ones who are going to have to raise the babies.  Once the babies are born, they aren’t going to have the responsibility for them forever.  It’s only in the abstract that they talk about “the pregnancy”. 

Let’s give them 5 babies, minimum wage, no welfare, no medical assistance, etc, and see how they do!

My Blog is Read Worldwide

Today, with the addition of Morocco and Slovakia, my blog has now been read by someone in over 40 countries.  If you look at the little sidebar to the right, you can see the list.  It is one of the interesting things that the internet and today’s computer magic, these things can be tracked.

The blog itself is translated into a bunch of languages, including Russian, German, French, Farsi, etc.  That’s probably why it is read in so many different countries.

FYI, the most common countries after the USA are:

Russia

Canada

Sweden

Germany

United Kingdom

Australia

Italy

France

India

Interesting? 

Women’s Health and Politics

I am not only a Techno-dinosaur, but an old fart that grew up in the turbulent 1960s.  There was a lot of upheaval during that time.  We even had an expression “never trust anyone over thirty”.  I have recently heard that out of my own kids.  Maybe it’s an age thing.

We fought for civil rights, women’s rights, and the right not to go to war.  Vietnam was still a hot issue.  Our brothers (but not sisters) were going off to war.  We were burning our draft cards and our bras.  We had sit-ins, rallies, the first Earth Day, demonstrations and all kinds of protests.  “Peace and Love” was a motto for the Hippie generation. 

One of the things that we fought for was women’s right to birth control and control over our own bodies.  The invention of birth control pills in the late 1950s gave women some control over their fertility.  The Supreme Court decision of Roe v. Wade in 1973 made abortion legal, ended generations of illegal, dangerous “back street” abortions.

Planned Parenthood was and is where many women obtain their reproductive health services.  This is especially true for women who are medically underserved (those without insurance and financially strained).  In many areas, PP is a major provider of women’s health care.  It’s where women go to get their pap smears, their birth control, their STD checks and their breast checks.  They get treated for any abnormalities.  Some federal or state programs help with some of these.  Others are funded with donations. 

The Susan G. Komen foundation has helped fund the breast care screening, education and treatment part of this for PP for many years.  Recently they decided to withdraw their funding because PP is “under investigation”.  This investigation is by a congressman who is anti-abortion.  Nothing was found, but he refuses to close the investigation.  SGK states that their move is not political.

Evidently there has been some pressure on SGK by some conservative organizations to stop their support of PP because they were afraid the support money was going to abortion care. 

America realized this.  America spoke.  The internet lit up.  Donations were huge to PP.  In less than 48 hrs, SGK issued an apology and promised to restore funds.  Women won’t be quiet anymore.  Don’t mess with our health care.

Birth Control Pill Recall

This news is all over the web, but I want my readers to have it, too.

Pfizer has recalled multiple lots of their birth control pills Lo/Ovral and Norgestrel 0.3mg, Ethinyl Estradiol 0.03mg. 

I know I don’t prescribe a lot of this.  But, if you are on it you should immediately contact your “health care provider”.  Also use a back up method of birth control. 

Evidently some of these have more “reminder pills” (inactive) in them than they should.  So your chance for getting pregnant is higher.  Since the majority of women who are on birth control pills are using them to prevent pregnancy, this needs to be addressed.  For those of you who are using the pill to control your bleeding, you may have issues with your bleeding.  Again, contact your "provider". 

I have a list of the lot numbers, but I can't get it to post on the blog.  Techno - dinosaur strikes again.