On Dying

I’ve had this thought swirling around in my head today. It’s the anniversary of my mother’s death. She died forty years ago today. It was a great loss in my life.

I’m a senior citizen now and people in my age bracket frequently think and talk about death.

What I’ve decided for me is, “The process of death will be a great ordeal, but the state of being dead will be a piece of cake.”

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Canceled Eye Surgery

I had eye surgery scheduled for this coming Monday, which will be August 20.

On July 26 I went to Dr. Dean Dornic in Smithfield, NC and his technician ran multiple tests on my eyes. They were exhausting tests, and I was glad when they were over. The first time the technician picked up a bottle of eye drops I mentioned that I’d had trouble with eye drops before. He assured me that I’d be fine and squirted, squirted, squirted eye drops in my eyes off and on throughout the exam.

I spent about five minutes with Dr. Dornic, after being in his office exam rooms for over two hours. He determined which eye we would do first and explained the two lens I could choose from. He said there was a better lens, but my insurance would not cover it.

I came home and my oldest, who had gone to the appointment with me, left for work.

That evening, the later it got, the worse my eyes swoll up. I was sure they would reach a certain point and then stop swelling. I was wrong. By the time I realized they were almost swollen shut, I was confused and knew I could not drive to the ER and didn’t know what to do. Eventually I quit breathing. Because I do have asthma, I had an inhaler and used it . . . it didn’t help much, so I got the other type of inhaler I have and used it. Still not much air . . . I noticed my CPAP machine on my night stand and put the mask up to my mouth/nose and turned it on. Oh, Sweet Jesus! I could finally get some air in! I stayed up all night with my swollen eyes and trouble breathing.

The next morning I called my primary care doctor to say I’d had an allergic reaction to eye drops the day before, and could he see me? His receptionist told me to come right in. The doctor insisted he had to do an EKG, which infuriated me, because couldn’t he see . . . it was my EYES, not my heart? He said I was short of breath and he had to do an EKG. He also examined my eyes.

After the EKG, my primary care doctor said my heart was fine, and to go get this prescription for eye ointment filled. When I got the ointment and used it, my eyes finally quit burning and stinging. If someone had been with me the night before, I would have gone to the ER. I was confused and agitated and not breathing well and somehow didn’t think to call the rescue squad.  I knew I couldn’t see well enough to drive in the dark.

My eye doctor finally called me back on Monday (the eye exam was on Thursday). He said I shouldn’t have had a reaction like that. He said I’d had four different types of eye drops during the exam four days ago. He guessed it was the eye drop with the dye in it that caused my reaction and he just wouldn’t use that kind of drop for the surgery. He said to tell the pre-surgery folks not to use the Red Top eye drops on me. When I asked couldn’t HE tell them? He said it would be in his notes, but they might not notice.

He had prescribed three different eye drops to use two days prior to and several days after the surgery. I googled all three. The first two seemed fine. The last one was an NSAID and I called the doctor to try to discuss that with him, since I am allergic to aspirin, which is also an NSAID. The doctor was too busy to talk to me and I had to tell the receptionist, who told the nurses, who told the doctor, who sent a message via the nurses to the receptionist to me. It took four days to get his reply. He said the drops I was concerned about did not contain aspirin or penicillin and to just use them and come on in for the surgery.

I also have low blood platelets and had sent him (his office?) an email through their website with that concern. That message never got answered, and I didn’t feel like playing “Pass the Secret” again.  https://icebreakerideas.com/telephone-game/

I talked with the Pharmacist about that third eye drop as it’s an NSAID and I have asthma and an aspirin allergy. According to the internet, asthmatics can have a fatal reaction to that kind of drug, even the eye drops, if asthmatics are also allergic to aspirin. The pharmacist said there was no substitute for that eye drop (what I had wanted to ask the surgeon) and I probably shouldn’t use it. I cannot have cataract surgery without that type of eye drop.

So I have decided not to have cataract surgery on Monday,  August 20. Suddenly I am inundated with calls from the medical folks who want to be sure I am registered and ready to be there on Monday for my surgery.

Uh, talk to my dog and when she gives me the message, I’ll call you back.

Medical Errors are the THIRD LEADING CAUSE OF DEATH IN THE US.

https://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us

 

 

 

 

 

 

 

 

First Do No Harm (Part Two)

When I got to my primary care doctor’s office, I went to the sliding glass and the receptionist glanced up, opened the glass and I gave her my name. She checked off my name on the clipboard beside her and told me what my co-pay was. Then she told me to have a seat and someone would soon be with me.

My eyes continued to burn and hurt. I had looked in the mirror and they were still very swollen. I could not get comfortable in the chair in the waiting room. I squirmed. I closed my eyes. Once in awhile I’d glance at the TV that was on, but it hurt to look at it, so I’d go back to closing my eyes and waiting.

Finally I was called back. The nurse asked why I was there and I told her my eyes were having an allergic reaction, I thought, to eye drops I got in the eye doctor’s office the day before. Could anybody please do anything to make them quit burning and hurting? She said the doctor would check them. We went in the examing room and she took my temperature, my blood pressure and checked my breathing. She went to the other side of the bed I was on and checked my blood pressure and my breathing again. She said the doctor would be in shortly.

I tried looking around the room. I finally leaned back and closed my burning eyes. I heard the doctor knock on the door and he came in cheerful and smiling. I told him my eyes were killing me. He listened to my heart and my lungs and told the nurse to do an EKG. I was furious! I told him my heart was fine! It was my EYES! My eyes were killing me! He had looked at them, but said nothing. He smiled again and said I was presenting short of breath and that meant he had to do an EKG. Let’s just do that first, and he left the room. The two nurses came in and hooked me up to the machine. I was so upset I said many inappropriate things. They seemed to find my comments amusing, but I’m often told when I’m upset and complaining, it’s funny the way I word things. Nothing was funny to me that morning! After they finished the EKG, I said, “Let me guess, it’s FINE!” They said the doctor would discuss it with me.

The doctor came back in. He said my EKG was ok. He had a prescription in his hand. He said take this to the pharmacy and use this eye ointment in my eyes. I said that was the whole problem! Something had been put in my eyes and they were burning, hurting! I needed help. He smiled and patiently explained to me how to put the ointment in my eyes when I got the prescription filled. He said he thought that would make me feel better. Get the ointment and try it. So I did.

The relief when I put that ointment in my eyes was instantaneous. My eyes still hurt and burned, but not as bad. I could tolerate this pain. The directions said to use the ointment 3 times a day, and I did. I was amazed at how much it helped.

On Monday morning, I called the eye doctor to discuss the allergic reaction I’d had to his eye drops. He was not available. He was in surgery. He’d be done after 3:00 pm and she’d give him my message. I asked would he call me after 3:00? She repeated she would give him my message.

That evening, around 7:00 pm the eye doctor called. He said it was very unusual for anyone to have a reaction like that to eye drops. He said I didn’t need the ointment when I told him what my primary care doctor had prescribed. “You don’t need that,” he said. I told him the ointment had made my eyes feel much better, and I was glad to get it. He said it probably did soothe my eyes. I asked what was the name of the eye drops that had been used in my eyes? He said I’d actually had four different drops and he named them. I wrote down the names phonetically. He said one had dye in it. I told him when I get a CT SCAN, they won’t use dye in me because I’m allergic to aspirin. He said then it was probably the eye drop with the dye in it that had caused the reaction and when I got to the pre-surgery preparation for my eye surgery to tell them not to use the RED TOP Drops in my eyes. Use the others, but not those. I asked couldn’t HE tell them. He said it would be in his notes, but they might not notice, so to be sure to tell them myself.

I had prescriptions from him (the eye doctor) for drops to use at home two days before and days (weeks?) after the cataract surgery. I decided to look them up online. The first two seemed fine but the third one, Ilevro, was an NSAID. I have a severe reaction to aspirin and I know it’s also an NSAID. I called the doctor’s office to see if he could substitute something else for that eye drop? The receptionist told me the doctor was “in patient care” and could not talk to me right then. She said to tell her what I wanted and she’d tell him and then call me to let me know what he said. I told her and waited for a call back. The next afternoon I called and the girl said she had given the message to the nurses to give to the doctor, but no one had gotten back to her.   She said the nurses would not be in until after 2:00 on Monday and to call back then.

I had errands to run Monday morning and that afternoon before I called her back. the girl from the eye doctor’s office called and left the following message: “The Ilevro drops that he prescribed do not contain any aspirin or penicillin. It is ok for you to take because it does not contain any aspirin or penicillin. ”

I knew the drops didn’t contain aspirin or penicillin. What I wanted to discuss was the class of drugs Ilevro was in, which was NSAIDS. Aspirin is in that same class and NSAIDS can also cause bleeding problems and I have low platelets as I put on my form, as well as an aspirin allergy, a penicillin allergy, and asthma.

I decided the doctor was not going to talk to me so I could explain my concerns, so I called the pharmacist to discuss the Ilevro drops. The pharmacist said I would have to have anti-inflammatory eye drops before and after the cataract surgery or my eyes would swell. Well, they had already swelled from whatever eye drops he had his technician use on me in his office. The drops I’d had a reaction to in his office had made me stop breathing. I was very concerned about eye drops. According to what I’d found, those eye drops were NSAIDS. The pharmacist said all the anti-inflammatory drops were NSAIDS and in a way, it was good that my doctor had done many surgeries because he had a lot of experience, but because he did many surgeries, he didn’t have time to talk to patients.

Later that night I googled Ilevro online. I found this:  (I also have asthma and had put it on the health form at the eye doctor’s office.

Ilevro (nepafenac ophthalmic) Disease Interactions

There is 1 disease interaction with Ilevro (nepafenac ophthalmic):

Major

Nsaids (Includes Ilevro) ↔ Asthma

Severe Potential Hazard, High plausibility

Applies to: Asthma

Approximately 10% of patients with asthma may have aspirin-sensitive asthma, characterized by nasal polyposis, pansinusitis, eosinophilia, and precipitation of asthma and rhinitis attacks after ingestion of aspirin. The use of aspirin in these patients has been associated with severe bronchospasm and fatal anaphylactoid reactions. Since cross-sensitivity has been noted between aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), therapy with any NSAID should be avoided in asthmatic patients with a history of aspirin or other NSAID sensitivity, and administered cautiously in all patients with preexisting asthma. Prior to initiating therapy with NSAIDs, patients should be questioned about previous allergic-type reactions to these agents. Salicylate salts, salsalate, salicylamide, and acetaminophen may be appropriate alternatives in patients with a history of NSAID-induced bronchospasm, since cross-sensitivity to these agents appears to be low. However, cross-sensitivity has been demonstrated occasionally with high dosages of these agents (e.g., acetaminophen >= 1000 mg), thus it may be appropriate to initiate therapy with low dosages and increase gradually. There is some evidence suggesting that COX-2 inhibitors may be safely used in patients with aspirin-sensitive asthma, although the labeling for these products contraindicate such use. If necessary, aspirin desensitization may also be attempted in some patients under medical surveillance.

References

  1. “Product Information. Naprosyn (naproxen).” Syntex Laboratories Inc, Palo Alto, CA.
  2. Stevenson DD, Simon RA “Lack of cross-reactivity between rofecoxib and aspirin in aspirin-sensitive patients with asthma.” J Allerg Clin Immunol 108 (2001): 47-51
  3. Stevenson DD, Hougham AJ, Schrank PJ, Goldlust MB, Wilson RR “Salsalate cross-sensitivity in aspirin-sensitive patients with asthma.” J Allergy Clin Immunol 86 (1990): 749-58

View all 38 references

First Do No Harm – (Part One)

I thought “First Do No Harm” was part of the Hippocratic Oath all doctors took. I will put a reference below for anyone who wants to pursue this information.

I have cataracts. I’ve had them for years. My previous eye doctor said they were not growing as quickly as he’d expected, which meant I could postpone the cataract surgery I would eventually need.

When I had my eyes checked last year, the new doctor said I would need Cataract surgery within one to two years. So I began to check out cataract doctors. Always, when I’d ask someone who was the best cataract doctor/surgeon in the area, I’d was told the same name.

So I went to see this doctor after waiting twice for an appointment. The first time, I had an appointment on May 31, which would give me plenty of time to recover from both surgeries . . . they do one eye at a time . . . and get back to work in the school system when school began. My oldest had gotten May 31 off so she could go with me to the consult appointment. I found out on May 30 that my appointment had been canceled suddenly because the eye doctor’s son was getting married May 31, and the eye doctor wanted to go to the wedding. (Isn’t that the kind of event you plan/). The earliest next appointment they had was July 26. I explained how I needed the surgery – both of the surgeries – done over the summer. The receptionist repeated that was the earliest appointment she had. She repeated it until I fnally took it. I took an 8:15 am appointment so my oldest could go with me, but still get to work that day.

I was disappointed when I first walked into the eye doctor’s office. Both receptionists were on the phone and appeared to be too busy to help me. I sat down. My oldest got on her cellphone and went into oblivion. I watched the receptionists and listened to their side of the phone conversations. It seemed others had canceled appointments for the day and they were seeking people to come in early to fill those now vacant appointments. This went on continuously. The receptionists did not put the phone receiver down (they were using landlines) between calls, but quickly plunged down the button and made another call. I got up and walked to the counter again. They continued to ignore me. There were other patients sitting in the waiting area and I wondered how they had checked in? Finally I said loudly, “I HAVE AN APPOINTMENT.”  The receptionists continued to ignore me and speak to whomever they were trying to convince to come in today for an earlier appointment. I repeated myself a little more loudly, “I HAVE AN APPOINTMENT!” One of the receptionists glanced at me, pointed to a clipboard on the end of the counter and with the mouthpiece of the phone receiver covered, she said, “Sign in on the clipboard”. I walked over to it and put my name on the next line. I went and sat with my oldest again.

“I thought I was supposed to be filling out health forms,” I said to her as she texted happily away.  “What?” she asked. So I repeated myself again. “Probably,” she said with her eyes on her cellphone screen. Why was she here with me, I wondered. 

I got up and walked back up to the counter. The two chatty Cathys were still at it asking if the people they had called would like to come in today since there had been a cancellation?

“Don’t I need to fill out some forms?” I asked the receptionist I was closest to. She happened to be ending one call and beginning another She glanced at me with an annoyed look.

“What?” she asked.

“Don’t I need to fill out some forms?” I repeated.

“Are you a new patient?” she asked.

I said yes and she pointed a finger at a stack of clipboards. She told me to take one of them.

I picked up the top one and looked around for a pen. I glanced at the receptionists, aka Chatty Cathys, and said loudly, “DO YOU HAVE A PEN?” The one who was clearly annoyed with me waved her hand towards a cup with flowers in it. “There,” she said. I picked up one of the flowers and a pen was attached to it. I went and sat down.

As I filled out the form, I mentiond various questions on it to my oldest. “It says ‘bleeding problems’, that’s my low platelet count, right?”

“I don’t know, probably” was the answer I got.

I checked yes to bleeding problems and put out beside it “low platelets”. I checked yes to asthma and also put down my two allergies. I checked yes to several conditions. Then I took the clipboard and forms back up to the receptionist. I had gotten out my insurance card because I knew she’d need it and when she awkwardly took the clipboard because she still had one hand on the phone receiver and one hand holding a pen, I shoved the insurance card with the clipboard. She frowned at that, but somehow managed to clip the insurance card with the forms.

I went and sat back down. My oldest continued to text and I sat and waited. If I had driven myself, I would have just left at that point. I asked my oldest if she wanted to leave? She kept her eyes on her cellphone screen and asked “why?”

A young man opened the waiting room door and called my name. “That’s us,” I told my texting child and we got up and followed him. He took me in a small room to do some tests. When he used eye drops in my eyes, I mentioned that I’d had a problem with eye drops before. “You’ll be fine,” he said. He didn’t ask what kind of eye drops or what symptoms I’d had. After he put the drops in, he had me put my chin in a chin holder and read some letters. He flashed terribly bright lights in my eyes. They were so bright they hurt. I complained and he continued to reassure me that he had to do these tests and please just hold still. He would put drops in my eyes,  flash lights at them, and repeat until I was exhausted. Then he led me to a tiny room. There were three chairs on either side of the room, but the room itself was so tiny my knees were almost touching the person’s knees across from me. When a doctor came to get her, she insisted she had to see the main doctor . . . the one I’d been told was so good, so he said certainly, and disappeared. Then he came back and told her the main doctor could see her now. I mentioned to my oldest that my appointment would probably be delayed because of that.

We waited. Then we were finally led in to an exam room and waited some more. My oldest said she hoped he’d hurry up because she would be late for work, if he didn’t.

Finally the doctor came in. He looked briefly in each eye. He asked me which eye I thought was the worst. I said the right one. He frowned and said his technician said it was the left one. He flipped quickly through some papers and said it was the left one that was the worst with my glasses, but the right one was worst without my glasses. Which one would I like to get done first? I said the right one. He went through a spiel about lens and the surgery and asked if I had any questions. He told me to go back up front to schedule the surgery date.

The first date they had for surgery was August 20. It looked like I’d be having surgery and recovering all of September, if I had both eyes done. I asked couldn’t they do it sooner and the woman repeated that was the first date available. Then she scheduled the recheck appointment. I had read online that cataract surgery patients get rechecked the very next day. I mentioned this to her and she said as long as it was within a week. That was what mattered. So I took the recheck appointment for 4:00 pm on the Monday following Monday, August 20.

The eye doctor had said, when I told him those drops and bright flashes really bothered me,  he’d said to be sure to get some sunglasses from his girls up front before I went outside. I was so ready to get out of there that I forgot until I walked out into the sunlight. I turned right back around and went back in and asked for some of those disposable dark film glasses to use. My eyes were really bothering me at that point.

My oldest drove me home, but didn’t have time to come inside. She drove off as I went into the house. As the afternoon went on, my eyes bothered me more and more. By 8:00 that evening, the whites of my eyes were very bloodshot and they were swelling. Around 11:00 pm I took a picture of my swollen eyes and wished my doctor’s office was open. I tried to lie down, but my eyes burned so bad I could not sleep. I kept getting up and checking them. I wished I had someone to drive me to the ER. I don’t drive at night when my eyes are fine; I knew I couldn’t drive the way they were swelling up. It looked like they were going to swell shut. I kept laying down and around 4:30/5:00 am, I completely quick breathing. I jumped up because I have sleep apnea and have quit breathing before, but this time I couldn’t get myself started back. I used my rescue inhaler. I used my flovent inhaler. I finally used my CPAP mask to blow air down my throat. Oh, blessed Jesus! I could finally breathe! I took an allergy pill. I wished I could drive to the ER. For some reason calling the Rescue Squad did not occur to me. I was shaking all over and confused and agitated. When my primary doctor’s office opened, I called and they told me to come in. He is half a mile from me. My eye doctor was in his Cary Office on Friday, if he was in at all, and I always get lost in Cary. I was going to the closest doctor I knew who could probably help.

First, do no harm. As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm” (or “primum non nocere,” the Latin translation from the original Greek.)Oct 14, 2015

Second Thoughts About Giving

I’ve been down on my luck several times in my life. At other times, I was doing well and gave freely from what I had.

I tried to be careful when I gave money. At first I wasn’t. If a cause seemed sympathetic enough, I donated. Later I read about high percentages of donations going to salaries and “operating costs” of various charities and how just a few cents from every dollar actually got to the people I donated to help.

I’ve also been on the receiving end of “help” and some of the very charities I donated to refused to help me when I requested it. I met all their criteria. I don’t know why they didn’t help me.

I find myself in that situation now. I am facing surgery later this month. I had an extra large utility bill for the past month that must be paid by next Tuesday. I looked at all the places that will help people with such expenses. So far – after contacting the places several days ago, only one has gotten back to me. They took my name and phone number and said someone would call me back, but possibly not soon enough to help me. They didn’t do anything, they said, but answer the phone and forward callers’ names and phone numbers to the people who did manage the fund. They said not to expect much because funds were limited . . . and they weren’t sure I’d be called in time to even help me before the cut off date.

Hmmmm . . . I encountered similar places just plain out ignoring my requests last month when I checked around to see what food pantries offer in my area. No calls were returned and no one ever answered the phone. Just a recording to leave your name and phone number.

I believe I have figured out an even better way to screen places if I ever get in the position to donate again, and I will. I’m sure I will.

I will call any place that collects donations and ask for help first to see what kind of obstacles I face. Whoever is managing the money or the food is certainly not in a hurry to help anyone at the places I’ve approached.

Perhaps before you part with your hard earned dollars, you should call and try to get help from the places that say they help others to see if they really do. That will be my plan before I donate any money to anyone.

One of my sons criticizes my donations to Goodwill. According to him, I’m helping someone get rich off items I give away.  Well, the way I see it, I give someone items and they price them so low that anyone who needs what I’ve donated is probably able to afford what I’ve given. That’s all I try to do when I donate – help people in need.

One of the times I did need help was when my sons went to a private school on full scholarships, but needed dress code items.  Belts, even in Walmart were $10 each and I needed three. Goodwill supplied those three for a dollar or two each. Instead of trying to find $30, I needed less than $10. So I will continue to donate to Goodwill, even though I’ve faced criticism for doing so.

The other places? Before I turn loose of any money, I’ll call and see how hard it is to get help. If you collect the donated money to help others, you should be helping others and not figuring out ways to keep anyone from actually getting the money you’re sitting on.

 

Make a New Religion

I find this strange. If gays want to marry, let them start their own religion. Why make others change their religions to accomodate what is against the Bible, which is the basis of the Episcopal Religion?

https://www.lgbtqnation.com/2018/07/episcopals-will-allow-sex-weddings-churches-without-exception/

Genesis 19

Leviticus 18 & 20

Romans 1:18-32

1 Corinthians 6:9-10

1 Timothy 1:8-10

I have no problem with people doing what they want to do; I do have a problem with them insisting others change their beliefs and actions to accomodate them.

I liken it to asking a Muslim to eat bacon during their religious ceremonies. Isn’t that against the book which is the basis for that relgion? The Quran?

Goodwill Industries

I both shop and donate to Goodwill Industries. My son has often criticized me for doing both. He asked if I realized that I am giving products to someone who will sell them for 100% profit? He says Goodwill makes a lot of money off poor people who shop there, and they do it with free (to them) merchandise.

I was in Goodwill with a friend this past week. The price signs were gone and I wondered why. They used to hang over whatever section I was looking in. “How do you know what things cost, if the price signs are gone?” I asked my friend. She said the prices are now posted behind the cash register. So I went to the cash register and put on my glasses so I could read the signs posted behind it. Everything had gone up. How could that be? Why? My son’s words echoed in my head about how Goodwill makes the ones in charge rich while exploiting the poor who shop there and the employees who work there. Suddenly I saw nothing in that store I wanted.

I wandered around just to see what was available that day. Did you know if you pick up something from one of the sections, where they put the price on those items in hand written black marker . . . if the price isn’t on the item, you cannot buy it? There is no price check. You have to let the cashier just put it behind the counter to be sent, so she says, back to be priced. How did it make it out to the floor with no price on it to begin with? Is that something an employee wants for themselves and they didn’t price it so they can get it later?

It didn’t matter which of the other sections I was in, if it wasn’t the section where the price was written on the item, I had to go to the cash register to see what it costs now.

I think my son was right. I just don’t know how much money the CEO or other high ranking Goodwill higher ups want to make from goods they get for free and sell to many who shop there because they cannot afford to shop elsewhere.

Then there are also those who shop there looking for the unusual or unique. However, if the price isn’t on the item, they still can’t buy it. And no, they won’t price it while you wait.