A little bit of fun :)


Ritu said:  Oh yes, another day, another silly quiz! Thus time to find a 5 letter word that describes you…  (Go to her site for the link to the quiz.)

Unfortunately, there were only three choices for each question, and a few times, I wouldn’t have chosen any of them.  Here are my results:

The word that describes you perfectly is:  Smart
You just love learning more about the world around you and whether it’s a new book, a cool documentary or just people-watching at your favorite café, you can’t help but find everything fascinating. Sure, this might mean that you’ve not got a great deal of common sense and people often make fun of your forgetful and clumsy ways, but you hold all the answers – so when they need a quiz team, you’re the first one they call.

I take offense at a 10-question internet test telling me that I don’t have a great deal of common sense.  I have lots and lots of common sense.  Shows you what the internet knows. 🙂

For some, opioids are necessary


Re: “Stopping the epidemic of opioid addiction,” July 15 guest commentary.

Opioids are a valuable tool for treating legitimate pain issues. But the actions of state and federal governments concerning opioid abuse are adversely affecting the ability of people with chronic pain to get the medicine they need.

In conversations with my chronic pain support group and doctors, I’ve learned: some doctors won’t even discuss opioid prescriptions; many doctors have stopped prescribing opioids for any reason; and doctors are very cautious about accepting new patients with chronic pain. The doctors are concerned about being investigated and find it simpler to just avoid the issue. This makes it more difficult for people who properly need opioids to get the help they need. The doctors are caught in the middle. The legitimate patient suffers.

This dilemma must be resolved to allow doctors to practice medicine as they should so those with chronic pain can be treated as they should.

Wayne Buehrer, Littleton

This letter was published in the July 22 edition.


(7/14/2015) Guest Commentary: Stopping the epidemic of opioid addiction
By Sylvia Burwell and John Hickenlooper

On Thursday, we’ll join members of the Colorado Cabinet, the Colorado Consortium for Prescription Drug Abuse Prevention and others to discuss this commitment, share the ways in which we can best tackle this crisis, and discuss specific, targeted and tangible recommendations to curb overdose deaths and reduce the rate of opioid addiction in Colorado and nationwide…

We must begin by ensuring powerful opioid medications are prescribed appropriately. Nationally, we are developing opioid prescribing guidelines and supporting training and tools for providers to make informed prescribing decisions. In Colorado, the Hickenlooper Administration and the Colorado Consortium for Prescription Drug Abuse Prevention have brought together a wide range of partners to help health care providers connect through a Provider and Prescriber Education Workgroup. Colorado now has one of the 10 lowest opioid prescription rates in the nation.

We can do even more with the power of electronic prescription tracking programs. Programs like Colorado’s prescription drug monitoring program allow pharmacists and other health providers to share information and can help identify those at risk for dependence, addiction and overdose. At the federal level, we are increasing investments for these types of programs to expand the scale of their impact…

For those Americans who have fallen into opioid addiction and dependency, we can make the greatest impact by helping them move into recovery. One way we can do this is by expanding access to medication-assisted treatment, which is the use of medication in combination with counseling and behavioral therapies…

“Fallen into opioid addiction and dependency…”?  What is that supposed to mean?  Sounds like they’re talking about fallen angels, full of sin (opioids) and now living in the hell of dependency… because opioids are now considered more harmful than human suffering.

Does anyone ever “fall” into addiction?  Does anyone ever “fall” into cancer, chronic pain, or diabetes?  Or do these conditions come with someone or something pushing people into “falling”?  Where are the DNA police when we need them?  And where’s the attorney who’s going to file a class action lawsuit against surgeons who maim, creating chronic pain patients in their wake?

You’ll notice that “medication” in recovery does not include opioids.  (Because if you’re addicted to them, they’re no longer medicine.)  Or so they want you to believe.  But medications like buprenorphine are not sugar candy.  It’s not a placebo effect.  The same harms that can befall patients taking opioids also occur in those taking medications approved for the treatment of addiction.  But, what the addiction industry calls “harm reduction services,” I call management of a chronic condition.  And the patients that use these medications to manage their addictions usually do a lot better than those who choose abstinence.

When we find strategies and ideas that work, we should share them broadly and quickly. Governor Hickenlooper recently co-chaired the National Governor’s Association Policy Academy for Reducing Prescription Drug Abuse, bringing together state leaders on this issue. And the Consortium serves as a stellar example of how health providers, state leadership and top universities can look at the epidemic in new ways and quickly implement the solutions with the power to make the biggest impact.

Ending the opioid crisis will protect our families, our businesses and our communities. It will save lives. For too many Coloradans, a medicine intended to ease pain results in abuse, addiction and, too often, death. We know that by working together and with our partners at all levels of government and across the country, we can take important steps toward ending the opioid crisis.

Sylvia M. Burwell is secretary of the U.S. Department of Health and Human Services. John Hickenlooper is governor of Colorado. The longer version of this essay is at denverpost.com/opinion.

Lots and lots of anti-drug groups.  The drug war is well-represented here. (A representation that we’re all paying for.)  And so is the drug-war rhetoric.  When you lie to the public about things like the scope of an “epidemic” or “crisis,” it usually backfires on you.  I’m not sure when the government will learn that lesson.

But do you see a group representing pain patients?  Any government announcements about groups working on viable treatments for chronic pain?  Because focusing on drug addiction is so much easier than trying to do something about the real epidemics of chronic pain and suicide.

Now, it’s time for some chocolate (and hopefully, a better internet connection).  Thanks for reading my ramblings. (These ramblings also brought to you by Verizon Sucks.)

‘How Much Is That Going to Cost Me, Doc?’


As a resident, about 50% of my clinic time was spent working with uninsured patients at a safety-net clinic. That was my crash course in health care costs. Most patients were “self pay” (a term I now despise!) for anything I ordered or prescribed.

In training, I also started to become more aware of insured patients’ costs as well. I quickly realized that just having a plastic card in your pocket does not lead to affordable costs or fair prices. I tried my best to help patients avoid surprise medical bills, but it was often an exercise in futility. I often felt helpless in answering my patients’ questions about costs of even basic stuff that was provided by my clinic and hospital system.

Wanting to provide my patients with more transparency, I started a Direct Primary Care practice shortly after finishing residency in 2011. My business plan and pricing structure had a radical mission: Make things affordable and tell patients what stuff costs…

By limiting overhead costs — which is pretty easy when you aren’t dealing with insurance hassles — I could make basic primary care services, including communications, clinic visits, point-of-care tests, and labs and office procedures very affordable if bundled in a simple monthly membership fee ($30 for kids, $50 for adults and $70 for seniors for unlimited amounts of service; with big discount for families).

Many of the patients who joined my practice were uninsured or carrying high-deductible insurance plans — not the “concierge” crowd that many of my colleagues predicted…

Being fully membership fee supported — without a need to profit from any ancillary services — we have been able to provide our patients labs and medications “at cost” of contracted rate. I was initially skeptical we could do that for things beyond basics, but the actual costs of most outpatient services are often astoundingly low compared to what I remembered hearing throughout my training.

With our lab contracts, we found an average of 50%-90% savings versus insurance-based prices and 80%-95% versus “self-pay” prices (if a patient gets billed directly by the lab). In fact, we purchased basic labs (lipid panel, hemoglobin A1c, TSH, metabolic panels, blood counts) so cheaply we decided to provide them at zero cost to our members; along with most point-of-care tests we perform (dipstick UA, EKG, urine pregnancy, rapid Strep)…

Doesn’t include a drug test.  That probably costs extra.

For medications, we used several tools to help patients find the best prices at pharmacies. We eventually realized the value of in-house dispensing of most common generic drugs. We offer patients meds at wholesale price with a very small markup to cover the pill vial, label, and bag. Our medications are usually 50%-90% cheaper than any pharmacy; a huge value and convenience to our patients. A good percentage of our patients save more money on medications each month than they pay in membership fees.

Most “common” or most “popular” generic drugs?  Because either way, that would include opioids, and I think the DEA frowns on doctor’s offices having an in-house pharmacy.  The drug war has created many profit motives for pharmacies, which obviously means corruption and illegal activity will follow. Maybe if you could prove to them that there’s no profit in selling drugs, they would let you carry opioids.

But you never know if you’ll have a problem with the DEA.  If you sell opioids, the DEA could be watching you right now.

Perhaps it’s not surprising that I see no mention of how this practice treats pain.  And I’ve read that the number one reason people see a doctor is because of pain.  If this practice just refers pain patients out to specialists, I’m not sure how much money is being saved by the patient.

How often do you need a specialist?  In my experience, by the time I see a doctor for something, it’s usually time for a specialist.  So, you go to this general practitioner, get tests done, and they send you to a pain specialist.  Who will then do the same tests over again, and add some more, just for good measure (and per the DEA).  Maybe you’ll get referred to yet another specialist, this time in neurology or physical therapy.

Somewhere down the line, you’ll be referred to a shrink.  Does Valium help you sleep?  See the shrink.  Obviously you need to talk to someone or else you’d be able to sleep.  Do opioids help your pain?  See the pain specialist.  Stress giving you a rash?  See the dermatologist.  Allergies bothering you?  See the ENT.

For diagnostic imaging, we have developed a local network of facilities with cash-friendly prices. It may seem unreasonable for patients to pay directly for things like CTs and MRIs, but we have found steep discounts for most things (i.e., $150 for ultrasound, $450 for MRI). We subcontract x-ray technical service with a local orthopedic group for $25-$35 per series and I don’t charge patients for my interpretation — not bad, considering our local hospitals charge $100-$300 for x-rays.

Ironically, even our patients with “good” insurance often spend less out-of-pocket on ancillary services with us by “paying cash.” …

I can understand why “good” is in quotes, but why is “paying cash” in quotes? If you don’t have insurance, you pay cash.  Even with insurance, you pay cash with deductibles and co-pays.  The question should always be, “What kind of service am I getting for my money?”  If I’m paying for a referral, that seems like a waste to me.

Even excellent primary care has its limits, so our patients do need to use their insurance when we can’t provide a needed service. This is still a tricky task for our patients, but thankfully, more organizations are taking up the cause of promoting transparency at all levels. Finding a baseline “fair” price for a given service is becoming easier with online tools. Recently a partnership between MedPage Today and ClearHealthCosts.com has started another transparency project to help tackle the issue…

I think I’ve shown just a few problems of a health care set-up like this.  Basically, you’re paying more money to have the ability to see the doctor whenever you need to.  As many times as you need to, although I’m sure there are some monthly limits.  And not too many evening or weekend visits either.

So, you have to keep paying for your insurance because you’ll still need it, but in addition, you’ll be paying for this service too.  Sounds like a concierge service to me.  A service not covered by insurance, just like some pain specialists.

For the first year of seeing pain specialist Joel Hochman in Houston, I was able to pay with Medicare. Then, he made me sign a form announcing that he was opting out of Medicare. Oh, he gave some good reasons why I now had to “pay cash” for his services.  But soon thereafter, he bought another new car.  And I can’t be sure I’m remembering this correctly, but I think he went to Venezuela for one of his “vacations” during that same year.  He took these vacations two or three (or four) times a year, bringing back photos, artwork, souvenirs, and lots of stories about his travels.

No, the question is not, “How much is that going to cost me, doc?”  The question is, “Which treatments (and services) will I have access to if I see this doctor?”  And how much cash will I have to pay the gatekeepers?

There, I feel better.  Thanks for reading. 🙂

Which is more dangerous?

Which carries more risk?  Taking drugs or mountain biking?


Keeping his cool in a sticky situation, an otherwise healthy, and seriously lucky, 40-year-old man drove himself to the hospital with a tree branch piercing out of the side of his neck after taking a nasty fall from his mountain bike during an off-road excursion.

“With a branch in his neck, he jumped back on the bicycle, rode the bicycle to his car, and then drove the car to the hospital,” which was about 20 miles from the accident, Lev Deriy, MD, of the University of New Mexico Health Sciences Center, in Albuquerque…

A stick lodged that far inside a person’s neck could have easily caused vascular, airway, nerve, and cervical spine injuries, the authors wrote, but this patient miraculously came out with nothing more than a small flesh wound. And kudos to the patient for not yanking the stick out on his own…

At the hospital, the surgeons removed the stick, explored for vascular and airway injuries, irrigated the wound and stitched it up. The patient’s postop was uneventful, and he “will definitely mountain bike again,” Deriy added.

And why not? After this, he should be used to staying calm when the stakes are high.

Senators Press CMS on Efforts Against Provider Fraud


Sen. Elizabeth Warren (D-Mass.) pressed Agrawal on another topic: providers who stayed in the program despite repeated transgressions. “Instead of kicking big-time bad actors out of Medicare, the government settles with a fine and the company enters into a corporate integrity agreement,” she said.

Warren cited the case of Tenet Health, a $5.8 billion corporation with 81 hospitals and several hundred outpatient centers. “In 1994, [Tenet] paid a $379 million fine for illegal kickbacks to doctors, and signed a corporate integrity agreement. Then in 2006, Tenet got caught fraudulently billing Medicare and paying illegal kickbacks to doctors, and paid a $900 million fine.”

“In 2012, Tenet admitted breaking the law again, and paid a $42 million fine. Just a year later, they got a $4 million slap on wrist for misconduct,” she continued. “So if a big company can commit major fraud and be fined and promise to be good, and move on, I’m not sure there’s an incentive not to break the law. When is it that you say, ‘Enough is enough’?”

Agrawal responded that settlements are not handled by his office but by the Justice Department and the Health and Human Services Office of Inspector General (OIG)…

Texas Congressman Releases Own Data on VA Wait Times


At a hearing in June, O’Rourke likened the crisis in El Paso to a “five alarm fire” and linked the lack of access to mental health care to a higher suicide risk…

Robert McDonald, Secretary of the Department of Veterans Affairs, told a House Committee the average wait time for veterans seeking appointments with a mental health provider is 3 days, the wait for a primary care visit is 4 days and the average wait time for visiting a specialist is 5 days. “I defy you to find another medical system in the country that has that,” McDonald said.

O’Rourke said official VA reports for veterans in his district show appointment waiting times averaging 17 days, but a poll his office conducted shows dramatically longer waits.

Last summer, around the same time the VA scandal over wait times was discovered in Phoenix, O’Rourke’s office, the 16th Congressional District in Texas, conducted an online survey to measure veterans’ access to healthcare and the quality of that care. Results then showed veterans waited over 2 months for both primary care appointments and visits with mental health providers.

The survey was repeated this year and O’Rourke’s office released those results last week…

Nearly half of the veterans surveyed said that care at the El Paso VA Health Care System was “more or less the same” as last year, while about 33% said service had “greatly” or “somewhat improved.”  El Paso ranks 141st out of 141 mental health systems in the VA’s own statistics…

Other findings from the survey included:  34% of respondents were not able to gain access to a mental health provider “at all.” …

At the hearing, O’Rourke also mentioned a pilot program that he hopes will correct some of the current problems veterans have in accessing care. Currently, a third of VA care in El Paso happens outside of the VA’s centers. But what he continuously hears from veterans is that those who ultimately access mental health care at the VA are “bounced” back and forth between the community and the VA’s own clinics. Having to repeat their problems to multiple providers over long stretches only exacerbates their trauma…

O’Rourke said his district currently has fewer mental health providers now than it did at the end of 2014. If the VA is serious about preventing veteran suicides, he said, “It’s time to pony up.” ...

Smile, Halloween Is Here!

I’m having trouble with my internet connection again, so I’m forced to entertain myself.  (Today’s self-entertainment is brought to you by Verizon Sucks, a frequent theme on my blog.) And today, I’m lost in random thoughts about Walgreens, America’s legal drug dealer…


Walgreens caters to our addictions, whether we need vitamins, other-the-counter medications, sugar/salt, alcohol, make-up, caffeine, cigarettes, or those requiring a doctor’s approval. (CVS is the same; just without the cigarettes, but with the nicotine patch.)

When I required drugs which needed a doctor’s approval, I had health insurance to help me find the care I was seeking. While it’s true that medical services offered on a cash-only basis can sometimes be suspect, there are plenty of doctors who no longer take any insurance — and not because there’s something shady about them. But there’s also plenty of scammers pretending to be doctors — and more often than not, they’re cash-only businesses. I would think most doctors practice above board, but even with the fountain of information on the internet, you won’t know if a doctor is right for you until you see her face-to-face. Unfortunately, you have to pay for that privilege, at least in the U.S.  But I guess patients everywhere would complain about their lack of access to the doctors they would choose to see.

I’m not sure I can say the same for pharmacies which only accept cash, but that’s only because I lack experience with that issue. I’ve used various pharmacies over the years, but the majority of that time, I was a monthly customer (with an insurance card) at the Walgreens pharmacy counter.

Now I just visit pharmacy counters to pick up my Claritin-D, which I have to do every 10 days, because… the drug war. At least I don’t have to pay a doctor to get treatment and relief for my allergies, but I know many people do.

The Walgreens pharmacy counter lost a good customer when I stopped taking prescription medications. But the loss of one customer is nothing to Walgreens. It’s not even a drop in the bucket. Maybe I’m more like a speck of dirt… just one customer out of millions.

But fear not for Walgreens, because the store also carries Russell Stover’s chocolates, one of my addictions. Not the kind of candy you can get every day, but all of my holiday favorites. The season goes like this: Halloween, Thanksgiving, Christmas, Valentine’s Day, and Easter. Then there’s a HUGE amount of time when there is no holiday candy whatsoever, and you have to wait for Halloween again.

And my first sign of Halloween candy at Walgreens happened this week!  (See featured photo.)

I know, it’s exciting!  (Try to control yourself.)  I have little money for luxuries, although this chocolate is more of a necessity. I’ll (try to) follow the same rules I use every season: you’re allowed any product that has dark chocolate; do your best to stay away from the nuts, they just get stuck in your teeth and make your jaw hurt; not too much caramel, it’s bad for your jaw too; and you’re allowed to try any new flavor, even if it’s covered in milk chocolate, has a lot of caramel, and maybe even a nut or two.

It just occurred to me that I may like making rules because I like to break them. 🙂

Can you smell the chocolate?


Living in the past leaves you unprepared to deal with the future


Do you spend a lot of time reminiscing about the past? If the answer is yes, that’s okay. Thinking fondly about the past and looking back at the way things used to be isn’t a bad thing until it is.

There is a difference between thinking about the past and living in it. Sometimes we live in the past because it’s familiar — we know what happened; there are no surprises. Think about why you watch your reruns of your favorite old sitcoms over and over again.

This is what happens when we live in the past. We choose to live there because it’s familiar. We know everything that happened. When the past was really good, you can live there because just thinking back on it gives you a feeling of comfort and happiness.

I spent eight years in the Army and am proud to have served my country. I have a friend who also served and although he has been separated from the military for many, many years, he still lives there. Every story he tells is about his days in the military; every situation or scenario that is currently happening is compared to the “good old days” being in the service.

Think of the middle-aged guy you know that always talks about his days as a high school football player; the mom with three kids that talks incessantly about her days as a college gymnast; the retired executive that relives over and over again her days as the head of a Fortune 500 company…

If you find that you are clinging to a specific period from your past because you don’t feel there is anything in the present or future that could possibly better, and if thinking about the past in that way actually makes you sad, you may be stuck in the past.

Why is this a problem?

Living in the past is a problem because it robs you of the opportunity to enjoy the present. Not enjoying the present? If you aren’t happy where you are, living in the past won’t help! Living in the past allows you to avoid dealing with issues in the present…

While some people live in the past because they don’t want to deal with the present, others live in the past for fear of what may come in the future. Just like watching that favorite old sitcom you’ve seen 100 times, looking back on your life doesn’t bring any surprises. Even if some of the past isn’t good, it is, at least, predictable.

The future is fraught with uncertainty: What will happen to us, to our family, to our career? And one of the scariest things to contemplate about the future is, what if the best days are behind us?

What if nothing in the future will ever feel as good as what has happened in the past? …

If you are fearful of the future, there are a few things you can do to help you move to a healthier and more optimistic place…


Negative events of the past can make it hard to live in the present. Troubling memories can make it hard to sleep or get through the day. There will come a point at which you must let go of the past or it will define your future. And yet, we always carry our pasts with us in the ways we think, talk, and perceive the world. Managing this can feel like a tightrope walk without an end in sight. By taking things step-by-step and keeping your mind open, you can come to accept your past as part of yourself…


Choosing to live in the past or the future not only robs you of enjoyment today, it robs you of truly living. The only important moment is the present moment. With that goal in mind, consider this list of ten tips below to start living your life in the present…