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COPD Flareups and Dependencies

Well last week was certainly one for the books. My Computer crashed and I had to rebuild it out of parts, which are getting thin on the ground as this is an old machine running XP. As part of my treatment regime I walk and lay around my house with a cannula pumping oxygen into my lungs at a rate of 2 liters per minute. I am getting good moving around and not getting the hose tangled up. Hell, I am just getting to the point where I wake up with the cannula still in place.

Therein creeps up the first dependency. Going places without that oxy shortens the time available to do things outside the house. Having to pump up with the magic drugs to get ready for road trips which are much shorter in time and distance is a drag. I feel okay at rest, but as soon as I move around breathing becomes problematic. Being clean and sober for 28 years does not minimize the whole cycle of dependency. Intellectually I know that this is different than being a drunk and a dope fiend, but emotionally it grinds on my brain.

Last Saturday morning I had a flareup, which is an inability to breathe despite my regular regime of meds. Basically a flareup is your lungs tighten up to the point where you literally are panting like a dog and cannot catch your breath. (Humidity is a big factor in COPD, as you feel that you are breathing in cotton balls) Ended making my first and hopefully my last 911 call. The Firemen were stellar in getting me stabilized for transport. Went to a New ER for treatment. 7 hours later I came home, still breathing slow, but regular.

Sunday I woke up to find my dog Walnut died,(she had been with me for 13 years) so I ended up in the ER again, but my regular one.(yeah I know how weird that sounds, just like the sitcom Cheers ‘where everybody knows your name)A friend came and drove me there. I used to drive myself, and hope I can continue to do that in the future.

The ER regime includes a dose of Magnesium sulfate, which works to relax the smooth muscles, aka your lungs. Also are steroids which help in getting the lungs to relax and work. This is usually good for a couple of days of really good breathing so I can get stuff done around the house. Depending on the results of blood tests, sometimes a course of antibiotics are added.

One of the standard diagnostic tools are x-rays of the lungs. X-Ray imaging is electronic now. No more developing of film and waiting to dry before looking at images on a light box. The shot becomes an image file that can be viewed immediately.

(Tech Tip: COPD has a tendency to lengthen the lungs, so tell the x-ray tech to use ‘portrait; over ‘landscape’ will help capture the lungs in one image vs 2.)

Part of my new lifestyle includes the ‘good’ parking next to shops, and being one of those folks riding around the grocery store in the motorized carts. Which is good news. The not so good news is that my limits on activity become shorter over time.

Early in my internet life when I was actively building websites, dreaming of sitting in front of the keyboard in my bathrobe and making money was the plan. That didn’t last very long, as anybody who is still active can tell you. Well now I am retired in front of the keyboard in my bathrobe.

Bur hey, I am still on the green side of things:)

The COPD Lifestyle

A little over a year ago, my daughter drug my ass down to the local ER. I have been having what I thought was just a little problem breathing from years of smoking, plaster dust, drywall, solvents, taping dust, and other contaminants that I have been around over the years of remodeling.

Well it turns out that what I have is a as one ER doc put it, “a Crazy Sick case of COPD.
Chronic Obstructive Pulmonary Disease

COPD is a major cause of disability, and it’s the third leading cause of death in the United States. Currently, millions of people are diagnosed with COPD. Many more people may have the disease and not even know it.

COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.

Most of the time, COPD is diagnosed in middle-aged or older adults. The disease isn’t passed from person to person—you can’t catch it from someone else.

COPD has no cure yet, and doctors don’t know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.
Source National Institute of Health

Basic activities are about all I have left these days. Going for groceries for example requires many drugs, forethought and way more time than I ever thought you could spend in a store.

I have a cabinet full of drugs, to keep me breathing and my heart going.

This is the new me.
cannula
The cannula is connected to an Oxygen Concentrator.
oxyconcentrator
This machine scrubs nitrogen out of the air and delivers it to me attached to a 50′ cord allowing me to walk around my house and do things. It is amazing how much better you can think and do things when you are actually getting enough oxygen in your system.

For treatments we have this machine the Nebulizer.

nebulizer
the “neb works with a mask to pump albuterol suspension into your lungs to get whats left of your lungs to accept oxygen. This I use every four hours.
I have other drugs that are once a day, twice a day, and the semi-familiar ‘rescue inhaler’. I also have a portable oxygen tank like the girl on Bates Motel, but I don’t go out long that much anymore.
More time for the web.


If ever there was a good excuse to quit smoking this ranks close to the top.

Woman Loses Health Insurance Due to Facebook | e-Patients.net

Woman Loses Health Insurance Due to Facebook | e-Patients.net.

Insurance and Health Care seem to be in conflict.  You can bet that your insurance company is not the only one that uses Facebook to make your life miserable.

Health Care Rationing and Death Derivatives

We need a Public Health Care Plan. Available to all, Covers everything. Full Stop.
The folks who want to scream Socialism only need to read this sentence, “Public Schooling gave you the ability to read this.” Available to all, covers everybody.
That private for profit Insurance Companies are offering to take anyone regardless of condition is bullshit. Let me count the ways they will slide. Claim Denials, Rescission, Cost. There has never been an insurance scheme that has resulted in lower costs. No Fault Insurance states are the poster child of this. Every time private insurance companies get to sell policies under mandates, the price goes up.

Health Care Rationing
According to the California Nurses Association/National Nurses Organizing Committee
California’s Real Death Panels: Insurers Deny 21% of Claims PacifiCare’s Denials 40%, Cigna’s 33% in First Half of 2009

Death Derivatives
The NYT has a story on the latest wrinkle on investing.

Wall Street Pursues Profit in Bundles of Life Insurance
“After the mortgage business imploded last year, Wall Street investment banks began searching for another big idea to make money. They think they may have found one.”

“The bankers plan to buy “life settlements,” life insurance policies that ill and elderly people sell for cash — $400,000 for a $1 million policy, say, depending on the life expectancy of the insured person. Then they plan to “securitize” these policies, in Wall Street jargon, by packaging hundreds or thousands together into bonds. They will then resell those bonds to investors, like big pension funds, who will receive the payouts when people with the insurance die.”

“The earlier the policyholder dies, the bigger the return — though if people live longer than expected, investors could get poor returns or even lose money.”
Link

This is the next credit-default swap, and or collateralized debt obligation, backed by your illness. You know how well those worked out.

Health Care killed his father

Here is an interesting look at health care.
How American Health Care Killed My Father Some of the villains are surprising.

Rescission Math

Rescission is the retroactive cancellation of individual health insurance policies.  This is used by the health insurance industry to keep their medical loss ratio low and avoid paying for expensive or chronic health problems. Which is what you bought insurance for, but who knew.

Unconscionable Math is a posting at Taunter Media that shows your chances of being cancelled if you get sick or need expensive care is a whole lot higher than the health insurance industry is telling you. Highly Recommended.

Medical Loss Ratio

Health Insurance has always been presented as a method of sharing risk across large groups so that when catastrophe strikes you are covered. The theory is that premiums create a large pool of money that is used to cover you in the case of need. Conversely your premium is used to help someone else. This of course breaks down as soon as somebody can find a way to get folks who might actually need to use their policy denied benefits. The insurance industry uses rescission, purging, and the latest game, the Medical Loss Ratio.

Medical Loss Ratio is a term that has nothing to do with providing health care, but everything to do with profitability of for profit insurance companies.

Here is a quote from Wendell Potter, who until recently was the Chief PR guy at Cigna, during an interview with Bill Moyer.

WENDELL POTTER: Well, there’s a measure of profitability that investors look to, and it’s called a medical loss ratio. And it’s unique to the health insurance industry. And by medical loss ratio, I mean that it’s a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry’s been dominated by, or become dominated by for-profit insurance companies. Back in the early ’90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

Here is the Interview Video.
Here is the transcript.

After watching this, you may have a different view on health insurance.

Medical Bills and Bankruptcy

Headlines around the web[1] are reporting that a recent study(Feb. 2005) by Harvard University[2] noted that medical bills accounted for 62% of bankruptcies.

This curious tidbit is not new, nor other problems with Insurance based Health care. From The National Coalition on Health Care [3] comes these nuggets:

Health care spending is 4.3 times the amount spent on national defense.

The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,700 in 2008. Workers contributed nearly $3,400, or 12 percent more than they did in 2007.2 The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).

According to a recent report, the United States has $480 billion in excess spending each year in comparison to Western European nations that have universal health insurance coverage. The costs are mainly associated with excess administrative costs and poorer quality of care.

Politicians are staging themselves around Health Care. This is political posturing. Everyone of these folks that is saying Health Care, really mean Health Coverage because they all have a large insurance company stick rammed up their ass. The only efficencies that are currently in the insurace industry is how fast they can deny your claim, exclude treatment and therefore payment, or use recission on your ass to just not pay at all.

The insurance industry should be the absolute the last group invited into any discussion about health care. When 62% of bankruptcies are related to medical bills, and 78% of them had health insurance, maybe you might want to think about why universal health care is a better idea.

[1] Google Search ‘Harvard University bankruptcies medical expenses’
[2] Harvard University Bankruptcy Paper – Final Manuscript (PDF)
[3] National Coalition on Health Care Health Insurance Costs

Health Records and the folks who bill

Online health records are getting a lot of publicity, but very little significant traction. In one of the more public tests e-patient Dave recounts his experience in uploading to Google Health. And here is the spin behind that experience.

A couple of issues stand out for me. One is the insurance billing code nonsense. Every Insurance company has Not Invented Here Syndrome. So every time you are exposed to a hospital experience, a small army of billers has to drag down the particular manual to be able to submit a claim in hopes of getting paid. That this adminitrivia is such a large part of overhead is part of what is driving health care costs through the roof.

Part of the current adminstration’s plan should be to create codes for all procedures and require insurance companies to use them or not have a hope in hell of getting a dime. The VA has such a system that seems to work.

Hospitals need to change. They are currently being run like hotels. You get charged for everything in the place, regardless of use. They look at occupancy rates, and add extras, to make their ‘nut’. The design is lunatic. If you have ever needed blood work, x-rays, and MRI’s you find yourself riding elevators and stacking up mileage as they move your around like grocery stores putting the milk bread and eggs at the back of the store. This helps them keep you there longer to get an extra day of occupancy out of your insurance company. Fixing the problems is not the preferred outcome, as the longer they can keep you, the more they can charge.

Out Patient Aftercare is heresy of the blackest sort, because of the billing scenario above. Insurance companies are not working to reduce hospital stays either as this article in the NYT shows.

They are not paying for health, they are paying for procedures. Seriously fucked up.