Healthy Living?

Recently, my niece sent me a link to a post in the New York Times about a gentleman who had been diagnosed with incurable cancer back in 1979.  Instead of undergoing expensive chemo treatments, he decided to return to the island in Greece where he had been born and die among his family there.  But, in spite of expectations, the gentleman not only did not die, but his cancer went into remission.  Thirty-three years later,  he is  still alive.  What could possibly have made this be the outcome?

According to the author, Dan Buettner, longevity on the island of Ikaria, where this gentleman’s family originated,  is higher than other parts of Greece and other parts of the world. Buettner has been part of a group that has been looking at different parts of the world to determine what makes the inhabitants of some areas more likely to live longer.  These areas have been dubbed the “Blue Zones” and the island of Ikaria is one such place.

So what was so special about this island?  The answer is surprising and not so surprising:

Ikaria, an island of 99 square miles and home to almost 10,000 Greek nationals, lies about 30 miles off the western coast of Turkey. Its jagged ridge of scrub-covered mountains rises steeply out of the Aegean Sea.

The air and the sea are factors.  But so is diet.  The population on Ikarea eat things like olives, garbanzo beans, lentils, potatoes, garden products from their back yard, as well as wild greens.  They make their own sourdough bread. They drink wine in moderation, eat meat in moderation,.  Honey is a regular part of their diet as is goat’s milk and goat product.  And they all drink a tea from the herbs on the island which includes wild mint, Artemisia, and rosemary. Plus coffee.  Very little sugar, no processed foods.

But probably the most interesting factor is how they spend their days.  Clocks and watches are just not a part of their lifestyle.  People get up when they want to.  They do their work, whether it is gardening or helping someone build a home.  Then the village takes a long nap in the afternoon.  In the evening, they stay up late, chatting or doing other relaxed recreational activities with friends.  No one on the island is particularly interested in money or the making of it.  Their exercise consists of walking up and down the steep roads of the mountain like island.

Accoding to Buettner, there are about a dozen factors that lead to the longevity factor:

Enough rest; unprocessed fresh foods; walking up and down the hills; time plays no role in people’s lives; you live in a community that will look out for you and for who you will look out; because everyone knows everyone’s business, less likely to be a victim of crime; at day’s end, you and your neighbor’s will share a medicinal cup of tea; you will also share a glass or two of wine with those same neighbors;  and your spiritual as well as social sense of belonging will be nourished by going to church every Sunday.

I count about a half dozen:

Good food, good friends, enough rest, socialization, spiritual nourishment, and exercise.

Although I have all of that, except rest, I also have ridiculous demands on my time.   Hm.  Maybe time to think about moving onto a small island 30 miles to the West of Turkey!

© Yvonne Behrens, M.Ed  2012



Antibiotics:  A regular part of our lives.  We get a tooth pulled, we are given antibiotics.  We have surgery, we are given antibiotics.  We have a stomach ailment, we are given antibiotics.  We have a cough, we are given antibiotics.  We have diarrhea, we are given antibiotics.  We have vague feelings of not feeling well, we are given antibiotics.  We have a viral something, we are given antibiotics.  Antibiotics have become as common in our lives as getting a yearly check up.

And yet, ……

Often, there are side effects that can be very harmful to our systems.  Often, the antibiotic prescribed is too potent for the particular ailment.

In an article written by Jane E. Brody for the New York Times, we learn in great detail some of the terrible repercussions of poorly prescribed use of antibiotics.  Ms. Brody cites that fluoroquinolone is the ingredient that causes innumerable unwanted side effects. :

Part of the problem is that fluoroquinolones are often inappropriately prescribed. Instead of being reserved for use against serious, perhaps life-threatening bacterial infections like hospital-acquired pneumonia, these antibiotics are frequently prescribed for sinusitis, bronchitis, earaches and other ailments that may resolve on their own or can be treated with less potent drugs or nondrug remedies — or are caused by viruses, which are not susceptible to antibiotics.

In an interview, Mahyar Etminan, a pharmacological epidemiologist at the University of British Columbia, said the drugs were overused “by lazy doctors who are trying to kill a fly with an automatic weapon.”

I don’t know about lazy or not.  If in fact lazy is the reason, we have a major problem in our medical system.  But we might be talking about ignorance, not laziness.  If that is the case, we have an even greater problem in our medical system.

Ms. Brody continues:

Adverse reactions to fluoroquinolones may occur almost anywhere in the body. In addition to occasional unwanted effects on the musculoskeletal, visual and renal systems, the drugs in rare cases can seriously injure the central nervous system (causing “brain fog,” depression, hallucinations and psychotic reactions), the heart, liver, skin (painful, disfiguring rashes and phototoxicity), the gastrointestinal system (nausea and diarrhea), hearing and blood sugar metabolism.

The rising use of these potent drugs has also been blamed for increases in two very serious, hard-to-treat infections: antibiotic-resistant Staphylococcus aureus (known as MRSA) and severe diarrhea caused by Clostridium difficile. One study found that fluoroquinolones were responsible for 55 percent of C. difficile infections at one hospital in Quebec.

A friend of mine, who had been on antibiotics, became a welcoming environment to the C. difficile.  My mother-in-law developed severe diarrhea while she was living in an assisted living facility.  No one could figure out why.  She had just gotten off a regiment of antibiotics, but, of course, no one suspected that as being the cause since antibiotics are beneficial, right?  Luckily for us, my friend had learned that her problem was being caused by C. difficile and she apparently had a brilliant doctor who suggested that Pepto Bismol would take care of the problem, which it did.  We gave my mother-in-law Pepto Bismol and lo and behold, her diarrhea, which had been going on for months, stopped!

Unfortunately, there are no studies out there to solidify the direct link between the fluoroquinolones and the C. difficile.

Fluoroquinolones carry a “black box” warning mandated by the Food and Drug Administration that tells doctors of the link to tendinitis and tendon rupture and, more recently, about the drugs’ ability to block neuromuscular activity. But consumers don’t see these highlighted alerts, and patients are rarely informed of the risks by prescribing doctors.

Until antibiotics are more closely scrutinized, I always check the “allergic to” box.  I think I am safer and will probably remain healthier that way.


© Yvonne Behrens, M.Ed  2012

The Dangers of Fluoride

Last week, I received a notice on my Facebook page that shared that a Harvard study on fluoride found it to cause brain damage.  I immediately thought: “hm.  Rise in alzheimber’s/dementia.  Hm.  Fluoride added to water, when? and to toothpastes, when?  Probably some correlation there.”

Since then I have read about the study in my online newspaper and from Jesse Cannone of “Lose the Backpain”  According to Jesse’s article, there are only two benefits to having fluoride introduced: It has been found to decrease decay tendencies of teeth.  But, wait, if one does it too much

Excessive exposure to fluoride actually damages the teeth, discolors them and causes them to rot from the inside out.

Yikes!  That sounds a lot worse than getting a cavity or two.

The second benefit is that it is cheap.  If it is put in water (which has become the norm in cities around the United States).  According to Jesse’s article:

It costs about $.50 per person to fluoridate water.According to the Center for Disease Control and Prevention, it also saves approximately $38 in dental costs per person. “An individual can have a lifetime of fluoridated water for less than the cost of one dental filling,” explains the American Dental Association (ADA).

Okay.  So it is cheaper to drink lots of fluoride water than it is to get a filling put in.  However, the study done at Harvard’s School of Public Health found that fluoride caused brain damage.  The study done of Chinese children who were regularly exposed to fluoride in their water found that their IQs were effected adversely.  Yikes again!

There is a saying that I think about often:  Penny wise, pound foolish.  Seems to me that this is a classic case of this saying.

However, this is not the end of the story.  According to a Harvard study (Maybe the same one) a higher incidence of osteosarcoma (bone cancer) occurs in populations that drink water in which fluoride has been added.

And so Yikes a third time!

Can this really be for real?  Many years ago, a mystic friend of mine shared a story about a fellow who lived above the hills of a village.  One day, he went down to the village to get supplies and found that the villagers had all gone mad.  With a little detective work, he learned that their wells had been poisoned with some item that was causing this madness.  He went back up to his place in the hills.  For months, he avoided the water.  But eventually he felt so lonely and isolated that he went back down the hill and drank of the well.

Check out the ingredients in your mouthwashes and toothpastes.

Although fluoride in the water is cheaper than a filling, I think a filling is probably cheaper than chemo or replacing all your teeth.

© Yvonne Behrens  2012


Let’s Hear It for Caregivers!

Rosalyn Carter once opined,  “There are only four kinds of people in the world – those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers.”  With this compassionate outlook on life, the former First Lady started the Rosalynn Carter Institute for Caregiving (RCI) in 1987.

Statistics claim that there are more than 65 million family caregivers to dependent elders  in the United States.  Again, according to statistics,  in-home care giving saves our country an estimated $450 billion/year.  It has also been well documented that caregivers have shorter lifespans than non-caregivers do.   Caregiver “burnout” is very real as are compassion fatigue and post-traumatic stress.

Having been a caregiver for various family members over a span of 17 years, I know.  But my circumstances did not even touch a friend of mine who was taking care of her ailing 87 year old mother, her down-syndromed sister, her Asperger son and was working 3/4 time as a principal of a small parochial school. When she started to feel physical symptoms, she ignored them.  She did not have time to think about herself.  When she finally went to the doctor for a check up, she was diagnosed with Stage IV Ovarian Cancer.  And yes, major intervention at a crisis level had to occur.

And yet, caregivers are probably one of the more under-served population in our country.  In part, this is because when one is in caregiving modality, it is difficult to see beyond the immediate needs of one’s charge(s).  Also, if the person you are caring for is a spouse or parent, it is hard to imagine anyone else doing the job.  As one’s charge(s) become(s) more and more dependent on the one person, it becomes difficult to imagine someone else being able to step in and do the job correctly.  There is also the sense of guilt that comes with handing your “loved one” over to a “stranger.”

Yet, According to Leisa Easom, PhD, RN, Executive Director of RCI:

We are facing a caregiving crisis in the United States. Our aging population, increased longevity and the growing burden of chronic illnesses escalate the need for caregivers. Caregivers need support and community programs to help them remain healthy and maintain caring for another.

The mission of RCI is to provide “….caregivers with effective supports and making investments that promote caregiver health, skills and resilience. … to provide greater recognition and support for professional and family caregivers.”  Thus, a great resource to turn to.  But we also have to develop this kind of resource at our local levels.

A few ways that this might be able to be done:

  • Educating caregivers and the public about the situation and needs of caregivers is of foremost importance;
  • Coming up with a way to provide effective support to caregivers that target their specific needs and circumstances;
  • advocating for tax and public policy changes so that caregivers receive some financial support.

Ms. Easom further recommends that:

Creating a National Quality Caregiving Task Force would increase the efficiency and speed the development of this proposed [support] system.  It would minimize conflicts and duplication of efforts and assure accountability for outcomes.

We certainly need to think seriously about how to support and manage this growing demographic.

© Yvonne Behrens 2012




BCBS – Emphasis on the BS

In my last and fourth entry about my woes and “fight” with the insurance company, Anthem Blue Cross Blue Shield, I cautiously opined that maybe, just maybe, I had won the fight because I was given a level 1 with a reasonable premium.  I should have known better.

Turns out that they have set me up as being on probation, sort of.  That is to say, for 12 months, I am not covered for any pre-existing conditions.  So I asked the Customer Service person if they had a specific pre-existing condition outlined in my policy.  “No,” she replied.  So I asked, “Then how do I know or how do they know what might be a pre-existing condition?”  “By looking through your medical records,” she informed me.  “Since the time of my birth?” I asked, incredulously.  “Pretty much,” she replied.  “Does that mean that if I had a wart on my finger when I was 12 years old and I develop a wart tomorrow, they won’t cover removal on the basis of the pre-existing clause?”  “That’s right.”  “What if I was six weeks pregnant when I applied.  Does that mean they would not cover the costs of the birth?”  “That’s right.  Here is a scenario that might help you understand.  If you go to the doctors and he finds that you have kidney stones, the insurance company would not pay for their removal because those kidney stones were forming before the doctor found them, thus a pre-existing condition. But if you should walk out your front door and fall down the steps and break your hip, they would cover that.”  “By that logic, then,  what if I go to the doctor next month and he/she finds evidence of the C word in me. Would that be considered a pre-existing condition?” “Absolutely.  The insurance company’s argument would be that the cancer had developed before the doctor had found it.”

How did I get on this probationary period?  It all came about because although I have been using Anthem Blue Cross Blue Shield since 1997, more than 63 days had passed between the time I began my objections for the cost of the premium on my previous insurance coverage and the present coverage, thus, erasing all previous  records and causing my status to become one of a new client.

WOW!  So I am once again throwing my money out of the window and I have absolutely no positioning power to fight this injustice.

I believe this is a thumbing of the nose towards President Obama’s Affordable Health Care Act, (derogatorily termed “Obama Care” by his opponents — although some day that title will become an honorific, I have no doubt), specifically the clause in which a person seeking insurance will not be penalized for having a pre-existing condition, which, unfortunately, does not become law until 2014.  But the fact of the matter is that by utilizing “pre-existing condition” without definition, the insurance companies are basically avoiding their responsibility for covering any new client.  This clause might well also discourage people from signing on for insurance.  And the people in Congress who have put up such a fight against the Affordable Health Care Act bask in the comfort of their excellent insurance plans paid for by our tax dollars!

Well, I am grateful for this customer service person’s forthrightness and I am just kicking myself for not having thought to ask her if there were any questions I should be asking her that I had not.

I have become aware, over the past two weeks, that the danger of our society being torn apart does not just come from the major amounts of negative propaganda from the opponents, nor the major amounts of money fueling these ads and these opponents, but the choice on the part of the media to not cover what is going on.  It is truly frightening to be aware of just how poorly informed we are, and I include myself, because in spite of the fact that I plan to vote for President Obama, a part of me actually has been affected by the negative campaign that has dogged him throughout his presidency and I have not actively acknowledged/recognized just how much his Administration has been doing to try and make things better in this country.

© Yvonne Behrens 2012


Anthem BCBS: Finale

And in the final iteration of this long tale of woe regarding a peon “David” facing down the “Goliath” insurance company,…..

I received a package in the mail last week.  The contract was the one I had chosen and it was provided to me at level 1!  I think that means I won!  I don’t want to gloat too much since “they” are still much larger than I am and since this may just appear that I have won, although I did go through the policy carefully and it did seem to provide the insurance I thought I had chosen.

I also received my first bill which was more than the premium I was told I would be charged.  I called to find out and was told that they had started my coverage back in July, so the charge reflected six weeks of coverage.  I told them that I had only just received the package.  How could I be charged for six weeks?  The very helpful person on the other end suggested  that all I had to do was send a fax informing the [entity] at the telephone number provided when I would wish the coverage to start and the date would be changed.  Wow.  Okay.  So as of August 15, I am once again covered by insurance.  Phew!

By the way, I also want to thank President Obama for pushing the health care initiative through.  I do not know whether I would have had the same outcome if this were not part of our present landscape.

Anthem Blue Cross Blue Shield

When I was a kid, Blue Cross Blue Shield was considered an insurance company that looked out for its clients.   Seems the times they have changed.  We are now entering chapter 3 of my ongoing battle with this once reputable company.

The latest iteration: I received a call from the “underwriting” department of Anthem Blue Cross Blue Shield.  Oh, first, let me back up. I received a letter from them telling me that my application was missing page 5 and that I needed to send in the first premium payment before they would process my application.  I looked at the copy of the application they had sent back.  Their xerox copy included the filled out page 5 I had originally sent them.  Also they had not informed me what the amount of the premium payment was supposed to be.  As it was, I was not able to get back to them immediately because life got busy and phone calls with Anthem always seem to take at least an hour.  So a week went by before I was able to call them.  When I did, I was informed that they had dropped the application because too much time had gone by (it turned out that on the letter they had sent, they had asked me to reply by July 4.  It was July 12 When I actually called them).

In spite of this, they did transfer me to a young man who proceeded to tell me all the options that were available….well, two of the options that were available.  I chose option 2 and was transferred to the, I guess it was, underwriting department.  It was at that point that I realized that there might be more than those two options available.  I asked if I could be transferred back to the young man.  Sure enough there were about eight options.  So I went over all the options with him and ended up choosing a different option.  They then offered to fill the application out over the phone.  It looked like maybe, just maybe I would have insurance again, and this particular nightmare would be over.

I was transferred to someone who, with thick foreign accent, started to read me the application form.  Now maybe I should have just said, “Listen, I am having a hard time understanding you.  Maybe you should just e-mail me the application.”  But it seemed we were so close to resolution that I went ahead with the “What?  I am sorry.  I did not understand you.  Could you repeat that?” ensuing conversation in the hopes that this would speed up the process.

But, nay, twere not to be.  On Friday, I received a call from a “Liz” from underwriting.  “I have a few questions about some doctors visits from last Fall.”  So I called her at the number that she left.  But, as seems to be their wont, I ended up speaking to somebody else who would pass the information to Liz.   This representative started to ask me questions about my visits to the chiropractor.  The way she was asking them, I realized they were wanting to have my answers allow them to keep me at the level 2 status.  So I explained to the lady I was speaking with that I considered my visits to the chiropractor as preventative:  I get a twinge.  I go to the chiropractor.  He takes care of the twinge.  I avoid back surgery or knee surgery or years on prescription drugs.  Also, I reminded her, that she could note that I have cost Anthem Blue Cross Blue Shield absolutely nothing other than the paper which they use to send their premium bills to me.  This woman seemed to hear me and told me that she would pass the information on to Liz.  Ten minutes later, the phone rings and I am told that Liz is on the line.

Liz informs me that I visited the chiropractor four times between August 22 -September 2 of last year.  Why and what for?  “I don’t remember.”  “You don’t remember or you are afraid to tell me why?” she replies.  “I am not afraid to tell you why.  I truly don’t remember.  I go to the chiropractor for preventative means.  So my visits tend to be inconsequential.”  “four times in one month is not inconsequential.”  “Listen.  I am a very healthy person.  So I go to the chiropractor occasionally.  So what?  I don’t cost you anything.  Why in the world would you insist on keeping me at a level 2?”  What did Liz reply to this?  “Well, you might need a knee replacement some day.”  (I wish I had thought to reply, “and the sun might not come up tomorrow,” but I didn’t.)  “Why are you wanting to punish me for being healthy?  This makes absolutely no sense!  And anyway, are you even legally allowed to refer back to something from last year at this point?”  What did Liz reply to this?  “That law will not go into effect until 2014.”  [So in other words, I can abuse you and take advantage of the circumstances to gut you for more money.]

By this time, I was rather annoyed at their tactics.  I emphatically stated, “I really cannot deal with you and this.  I am a perfectly healthy person.  I certainly am not a level 2 person.”

“Oh.” Liz replied,  “So are you telling me that you would be willing to insure yourself and put money aside should a catastrophe occur?”

“You are incredible.  I have no idea what is going on here, but I will not accept being categorized as a level 2 because I go to a chiropractor.”

“According to (and she named some governmental organization) a chiropractor is not preventative.”

I replied, “Yeah, and I am sure Anthem paid someone good money to have them define it that way, too.”  “We do not do that!” she replied.  “Oh please.  I am sure you have lobbyist down there.  All big corporations do.  And if you were more interested in serving your clients than in keeping profit margins up, we would not be having this conversation.”  “Do you want to cancel your policy?  Do you?  Do you?” she yelled back.

I was astounded.  Most companies live by the rule that the client is always right.  No?  But these insurance companies are so big and so arrogant, that one of their employees can harass me and feel that they have every right to speak to me the way this woman did.

I replied, “I don’t know about cancelling, but I sure do not want to speak with you anymore.”  We have been reading about bullying in school and there has been a public outcry against this.  What about the bullying by a huge conglomerate to a peon like me who just feels that they are giving me an unfair shake.

My husband, last year, when I started this battle with Anthem Blue Cross Blue Shield, advised, “This is not a battle you can win.  Just pay the premium and try not to get upset by it.”  But I feel it is the principle of the thing.  I just do not think it is right for a conglomerate to rule my life in this way and rule the health care providers in the way they do.

Below is a list of some of the other areas and names that are actually Anthem Blue Cross Blue Shield:

Anthem Blue Cross and Blue Shield provides access to networks of licensed dentists for insurance carriers, health maintenance organizations, employers, labor unions, trusts, third-party administrators, affiliated and nonaffiliated companies, or other groups of individuals which extend dental care benefits to employees, dependents, members, enrollees and participants eligible to receive such dental care benefits under the terms of the Plans.
Below is a list of some of their affiliated companies and other payors* (“affiliates”) to assist you in identifying members that may access treatment under one of these affiliates.
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield in Connecticut
  • Anthem Blue Cross and Blue Shield in Maine
  • Anthem Blue Cross and Blue Shield in Ohio
  • Anthem Blue Cross and Blue Shield in Missouri
  • Anthem Blue Cross and Blue Shield in Wisconsin
  • Anthem Blue Cross Life and Health
  • Blue Cross Blue Shield in Georgia
  • Blue Cross of Idaho
  • Empire Blue Cross
  • Empire Blue Cross Blue Shield
  • UniCare
  • Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross Blue Shield Association. ® ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Serving residents and businesses in Indiana, Kentucky, Missouri (excluding 30 counties in the Kansas City area), Ohio, Wisconsin, Colorado, Nevada, Connecticut, Maine, New Hampshire and Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

In other words, they are huge.  And, they are bullies, just like all huge entities become when they can get away with it.

I just found out that they called the chiropractor and asked for all the records over the past year.  Apparently, my chiropractor has to send them all the records and I apparently have given the go ahead (clearly, they would not bother to insure me if I did not, right?)  Disgusting tactics, nevertheless.  Even if I win this I have no doubt that they will somehow punish me since they are in a position to.  I will keep you posted.

© Yvonne Behrens

“The Choice to Die or Live Life as a Ghost”

Michael Wolff of the New York Magazine wrote an article called “A Life Worth Ending.”   His topic?  The approach that our modern society takes towards aging and death.   His focus?  His personal journey dealing with the healthcare system and his mother.

His ability, through his choice of words, to bring the topic front and center is as rich as the questions he poses in the topic he explores.  For example, read how he describes aging in our affluent society, in which death has become the ultimate frontier to tame and subjugate:

Age is one of the great modern adventures, a technological marvel—we’re given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: [emphasis added] By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.  ……

This is not anomalous; this is the norm.

Mr. Wolff writes of the irony that:

The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.

Seventy percent of those older than 80 have a chronic disability, according to one study; 53 percent in this group have at least one severe disability; and 36 percent have moderate to severe cognitive impairments; you definitely don’t want to know what’s considered to be a moderate impairment.

Phew!  What have we done?  How did we go from acknowledging that death is a part of life and there is no way around it to believing that if we only do……then we will live longer and, hey, don’t we want to do that?  Sure, we all clutch at the idea of dying.  It is inherent to our nature.   Moving into an unknown is scary and death is the biggest unknown.  But does that warrant doing everything, at any cost to avoid it?  It really does seem that by doing everything to avoid it, we actually have created a nightmarish extension that includes all sorts of physical and mental break downs and more and more frequent visits to the hospital.

In Mr. Wolff’s case, his mother started to decline physically and mentally sometime in her ’80’s.  As Mr. Wolff found out:

There is a precept here, which no doctor quite spells out: Once it has begun, it has begun; decline follows decline; incident precedes incident. Here’s the medical language: “A decrement in capacity occurs.”

The system has been created that encourages families to follow one course of action after another to delay the eventuality that this “decrement in capacity” will ultimately lead.  And so we are creating a citizenry of individuals who have no quality of life but live on because the natural breakdown of body and/or mind is delayed with round the clock attention (at unbelievable costs).  Pharmaceuticals intervene to prevent the stroke or the heart attack or the pneumonia that might otherwise allow a person who has entered into a state of decremental capacity to leave this world with some dignity.

I lived this with my mother-in-law, a brilliant, vivacious human being who at the age of 93 started to develop memory loss.

Focusing back on Mr. Wolff’s reflections:

From a young and healthy perspective, we tend to look at dementia as merely ­Alzheimer’s—a cancerlike bullet, an unfortunate genetic fate, which, with luck, we’ll avoid. In fact, Alzheimer’s is just one form—not, as it happens, my mother’s—of the ­ever-more-encompassing conditions of cognitive collapse that are the partners and the price of longevity.

There are now more than 5 million demented Americans. By 2050, upward of 15 million of us will have lost our minds.
Speaking of price: This year, the costs of dementia care will be $200 billion. By 2050, $1 trillion.

That is the thing that you begin to terrifyingly appreciate: Dementia is not absence; it is not a nonstate; it actually could be a condition of more rather than less feeling, one that, with its lack of clarity and logic, must be a kind of constant nightmare.

As Mr. Wolff and his family chose to do, so did my husband and I: We put my mother-in-law in a very homey like assisted living facility just before her 95th birthday.  The first year was actually quite good.  The local owners very much wanted to create a home-like environment.  But then they decided to expand which adversely affected their original home.  And like Mr. Wolff, we also learned:

That assistance in an assisted-living facility, even as you increase it and pay more for it, is really not much more than kind words and attendance, opened doors, a bit of laundry, and your medications delivered to you. If there is a need for real assistance of almost any kind that involves any sort of calibration of concern, of dealing with the real complications and existential issues of aging people, then 911 is invariably called. This is quite a brilliant business model: All responsibility and liability is posthaste shifted to public emergency services and the health-care system.

The rate of hospitalization for all other age groups is declining or holding steady, but for people over 65 it’s skyrocketed. The elderly use 50 percent of all hospital days, according to one study. Emergency rooms, …. the land of the elderly, and their first step into the hospital system—where, as Medscape matter-of-factly explains, the “inability to recognize normal aging changes … raises the chances of iatrogenic illness.” Iatrogenic illnesses being the ones caused by hospitals or doctors.

In Minkie’s case, she developed pneumonia while in the assisted living facility.  In the old days, before immediate intervention and antibiotics, she probably would have died peacefully and the horror of her memory loss would not have plagued us for another six years.  But in our modern society, off to the hospital she went, tubes and catheter inserted (I was told this was done automatically because nurses did not have time to take elderly patients to the bathroom every time they needed to go.  Of course, the consequences of stretching the muscles by inserting a catheter — itself a painful procedure — is never addressed by those who do it and the family is not given a choice).

And so we found that for any real care, this was no longer the place to keep our parent.  We were lucky.  We had a friend who was a CNA.  She had just lost her father and had the extra space in her house.  She asked us if we would feel comfortable having Minkie move in.  We said yes.  She lived right down the street from us and so we became the modern model of an extended family.  She and her housemates and my husband and me.  Five people with our friend and us doing most of the care, but all being able to continue with our daily responsibilities without too much taxation on any one person.   Also, at this stage, Minkie was no longer moving on her own, which made her care much more manageable and less dangerous.

Back to Mr. Wolf’s story.  His mother had been living for years, unaffected by a potentially detrimental heart situation.  At some point, she had expressed shortness of breath at the assisted living facility in which she resided and they sent her off to the hospital.  Her cardiologist decided she should have surgery:

…. now that she was showing symptoms that might suddenly kill her, why not operate and reach for another few good years? What’s to lose? That was the sudden reasoning and scenario.

My siblings and I must take the blame here. It did not once occur to us to say: “You want to do major heart surgery on an 84-year-old woman showing progressive signs of dementia? What are you, nuts?”

This is not quite true: My brother expressed doubts, but since he was off in Maui, and therefore unable to appreciate the reality of, well, the reality of being near, we discounted his view. And my mother protested. Her wishes have always been properly expressed, volubly and in writing: She urgently did not want to end up where she ultimately has ended up. She had enough sense left to resist—sitting in the hospital writing panicky, beseeching, ­Herzog-like notes, to anyone who might listen—but of course who listens to a woman who scribbles such notes?

The truth is you’re so relieved that someone else has a plan, and that the professionals with the plan seem matter-of-fact and unconcerned, that you disregard even obvious fallacies of logic: [in this case] that the choice is between life as it was before the operation and death, instead of between life after the operation and death. (emphasis added).

So often, I find that people, myself included, although much less so than the average, walk into their territory (the healthcare industry’s territory) and listen to them spout something that may make no sense, but they are the experts, right?  We nod our heads, and walk out with the decision made.  When my husband had heart surgery, the cardiologist suggested that he start taking Lipitor.  I objected, citing all the side effects.  My husband pointed out that he did not have a history of high cholesterol.  The doctor replied with, “Yes, but you had heart surgery.”  His nurse practitioner added in helpful tones: “Lipitor prevents death.”  (You can imagine how I responded to that statement!).  My husband ended up taking the Lipitor.

As for Mr. Wolff and his story, when they confronted the medical team about the fact that their parent had deteriorated so badly and asked why they had not been better informed of this possible outcome:

Here’s what the surgeon said, defending himself, in perfect Catch-22-ese, against the recriminations that followed the stark and dramatic postoperative decline in my mother’s “quality-of-life baseline”: “I visited your mom before the procedure and fully informed her of the risks of such a surgery to someone showing signs of dementia.”

Six weeks and something like $250,000 in hospital bills later (paid by Medicare—or, that is, by you), she was returned, a shadow being, to 86th Street and her assisted-living apartment.

At the publication of his article, his mother was still alive, still living her shadow existence with occasional moments of clarity.  I doubt that this will ever change.  It certainly did not with my mother-in-law.

Would we have done things differently?  Maybe.  I don’t know.  Would Minkie have chosen to stay alive in a half state?  I don’t think so.  But by the time she ended up in her half state, she was no longer the same person.  We have made advancements in our medical care.  But hand in hand with the advancements has developed this  fallacy that lives should be saved no matter the cost.  And so, I end with Mr. Wolff’s conclusions:

I do not know how death panels ever got such a bad name. Perhaps they should have been called deliverance panels. What I would not do for a fair-minded body to whom I might plead for my mother’s end.

The alternative is nuts: to look forward to paying trillions and to bankrupting the nation as well as our souls as we endure the suffering of our parents and our inability to help them get where they’re going. The single greatest pressure on health care is the disproportionate resources devoted to the elderly, to not just the old, but to the old old, and yet no one says what all old children of old parents know: This is not just wrongheaded but steals the life from everyone involved.

…. My bet is that, even in America, even as screwed up as our health care is, we baby-boomers watching our parents’ long and agonizing deaths won’t do this to ourselves. We will surely, we must surely, find a better, cheaper, quicker, kinder way out.

© Yvonne Behrens 2012







A Picture Is Worth A Thousand Words

Direct to Consumer Rx Marketing

Direct to Consumer Rx Marketing (Photo credit: Mike Licht,

We tend to shake our heads, exclaim in horror,  or laugh when we see those advertisements on television that encourage viewers to try a new drug by first toting how they will change one’s life and then warning about the potential side effects.  You know the ones: Are you depressed? Are you suffering from erectile dysfunction?  Are you unable to go outside because of allergies? Do you have trouble falling asleep at night?

We shake our heads over the fact that television allows this sort of rubbish advertising, exclaim in horror at the  audacity of the drug companies in “pushing” their wares in so blatant a fashion, or laugh at the absurdity of the potential side effects.  We wonder who in their right mind would put anything like that into their body, anyway?

Furthermore, we may wonder why, if these drug manufacturers have to state all the horrible side effects that these drugs may cause, they even bother to advertise.  But in fact, it turns out many people actually respond to these advertisements.  According to an article posted in “Visual Thesaurus”

A report by the Kaiser Family Foundation found that consumers are very responsive to the intent of this kind of advertising, and that a significant number do in fact act as prompted by the concluding suggestion in many of the commercials: “Ask your doctor if ______________ is right for you.” The report says that “nearly a third of adults say they have talked to their doctor about a drug they saw advertised, and 44% of those who talked to their doctor received a prescription for the medication they asked about. [added emphasis]  This means that 13% of Americans have received a specific prescription in response to seeing a drug ad.” The study concluded that for the period examined, each additional dollar that the pharmaceutical industry spent on direct-to-consumer advertising yielded $4.20 in additional pharmaceutical sales in that year.

The article demonstrates how advertisers subordinate the language warning viewers of the potentially dangerous side effects with pictures that actually counter the words that are being said.  We know the adage that a picture is worth a thousand words, and so the way these advertisements are presented cause our visual cues to the brain to override any aural cues.   I suppose another term that could be used is that viewers are being brainwashed into believing the purity of the drug.

The author of the article continues:

The legislation that results in this peculiar experience being available to US television viewers is broadly the Federal Food, Drug and Cosmetic Act, and more narrowly, Title 21 of Federal Regulations and a Guidance for Industry issued by the FDA and the Department of Health and Human Services in 1999. All of these documents spell out in great detail the prohibitions on various practices that a profit-seeking corporation might be tempted to engage in, but guidance about the exposition of major risks posed by these drugs is not very specific: it must be presented “either the audio or audio and visual parts of the presentation.”  ….drug manufacturers seem to have chosen the course that will showcase the benefits of their products visually, while a simultaneous audible portion presents the cautions.

Ultimately, this visual/aural dissonance goes miles to obscure the message of the dangers of these drugs.  Personally, I find the whole business of marketing, particularly pharmaceuticals, unconscionable.  And yet, because these products are presented within the vague wording of the law, the pharmaceuticals are allowed to “get away with it.”

© Yvonne Behrens  2012

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Insurance Companies: Got you ….. (cont.)

Jim Dubel demonstrating adjustment protocals

Jim Dubel demonstrating adjustment protocals (Photo credit: Wikipedia)

In my previous entry, I spoke about the big “fight” I am having with my insurance company.

I called my chiropractor who responded with: “I don’t think my letter is going to change your level because the insurance companies look at any chiropractic adjustment as a treatment.”  “Yes, Bob, I know.  But if you write them a letter letting them know that I have not had a repeat of my situation in 2006, then they will know that my visits to you are not associated with that back issue.”  “But the insurance companies will ask to see all my records of all your visits.”  “Okay.  That should prove the point that I was visiting you was for other things?”  “I don’t know if I can say that.”

At this point, I am recognizing that my chiropractor is accepting the insurance companies’ definition of what he does.  “Bob.  I go to you if I feel a twinge in order to avoid that twinge becoming something bigger.  That, in my book, is preventative.”  “Yes.  But it is not the way the insurance companies see it and believe me, our association has been trying to get the insurance companies to see it that way.  But they won’t and so I don’t think my letter is going to help.”  “What is your philosophical position on what you do?”  Silence.  Then,  “Well, let me look at your records.  Now my records only go back three years.”  “That’s fine.  I only need to show that the problem has not re-occurred over the last two years.”  I guess he felt comfortable with what the records showed, because I received the letter a few days later.

Then I went to my primary care doctor.  We talked about how the insurance companies require the doctors to record everything.  So if my doctor writes a prescription, whether I ever fill it or not,  the insurance company gets a copy.  And, of course, we know, that for most doctors, one can never leave a doctor’s visit without a prescription for something in hand.  In this case, the records strengthened my position.

I have since re-filed the application, with correct boxes marked and letters confirming that I am fine.  Now I await to hear what level they will place me.  As soon as I do, I will post.  If they do not move me back down to a level 1, though, I am not sure what I will do.

© Yvonne Behrens  2012

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