Wonderful and Terrible: The Medical System in the US of A

The medical system in the US is wonderful—I got "science fiction" non-invasive treatment over a year ago for blood clots in my lungs, making a full-recovery in days, if not hours.

And the medical system in the US is terrible—I just got another bill for my treatment from over a year ago; apparently, even though I went to an in-network hospital approved by my insurance company, one of the doctors who saw me is "out-of-network."

So the US medical system can apparently "balance bill" me the full amount charged by that doctor. Over a year later (no bill previously sent.) After I've been making monthly payments over the previous year on my in-network high-deductible out-of-pocket bill.

I mean, I'm glad I'm alive. I can't bitch too much. But holy shit we need some reform and we need it now.

Real Insurance Saved Me. Now It's At Risk

I had a medical emergency earlier this year. Without affordable individual insurance, my 50 years of savings would have been wiped out.

Now it's a pre-existing condition, to use a term from a few years ago. Which means if I were to suffer a similar incident again and we move back to junk insurance, I'd have to declare bankruptcy.

Real insurance is the only reason I'm not living paycheck to paycheck, with no financial cushion. It allowed me to leave Wizards of the Coast in 2018 and try something riskier.

As Chuck Wendig says on Twitter, "Vote in November like your life depends on it. Because it just might."

That Time I Didn't Die

2018 continues to be the year I didn't die! Too early to call it? Screw that. I spent last weekend in Tacoma General Hospital's intensive care unit (ICU). I was treated for dual pulmonary embolisms (blood clots in both my lungs that were restricting blood to and from my heart) over the weekend and through until Monday—February 17th to the 19th 2018.

(Torah tells me blood clots in the lungs leading to a heart attack is what killed Carrie Fisher. Wisely, she kept that to herself until the clots were dissolved.)

By the mere fact that you're reading this, you've probably guessed that the treatment was successful. You're right! I got tPA (clot-busting juice) Saturday evening into early Sunday morning dripped into me via IV. But for several hours before and after that, I got heparin, a blood thinner. Sometime around 2 am Sunday morning, the clots were gone.

Styling in my hospital gown. They gave me pants! And groovy socks.

I had to stay in the ER for 36+ hours after the tPA treatment, where someone woke me once an hour to check that I wasn't having a brain bleed, with questions like "Where are you? Do you know why you're here? What's your name?" Luckily, I consistently answered correctly. Though at one point the idea came into my head to start answering everything with "Blurple" because how funny would that be? (Blurple is a term coined by Bear Weiter, MCG's Art Director, to signify a busy status beyond Red.)

During that same period, my average heart rate came down from 80-90 bpm to the 50-60 bpm (or 45 when I'm really relaxed) it normally is. My really scary blood pressure dropped back down to its normal level, which is in the 120s / 80s. Apparently, no lasting damage had been sustained.

Finally, I got to come home Monday afternoon.

After all that clot-dissolving and clot-preventing medication, including the blood-thinner I'm going to remain on for at least 3 months, my blood is unlikely to throw up another clot. The downside is that if I cut myself during this period, it won't stop bleeding. Thus I've been warned. I'm imagining the results like something out of a Monty Python skit.

So, what life-altering wisdom have I taken from this near-death experience? I wish it was as easy as that. It's pretty muddled. Here's where my thoughts mostly are right now.

1) Your loved ones, friends, and family are really the most important thing. I didn't once think "Man, I wish I'd lost that extra 10 pounds," or something similar. Instead, I thought "Wow, I'm sure glad Batgirl's here." Batgirl (Torah) stayed with me the entire time, sleeping in a chair for two days while I had the bed. Imagining how she, my friends, and my family would feel if something happened to me was really the only time I felt sad or scared. (But maybe that wouldn't have been the case if she hadn't been there to keep me company.)

Sometimes Torah got TWO chairs to sleep on

2) It's hard to appreciate how wonderful it is to stand up and not have to catch your breath, to talk longer than 4 or 5 sentences and not have to catch your breath, not to be afraid of going up the stairs and therefore choosing not to, to be able to walk the dog for a block then not pass out on the floor and sleep for 2 hours to regain equanimity... It's all still fresh for me, so whenever I do one of these "minor" things over the last day and a half, I still marvel. It's wonderful.

3) We often hear about the failures of western medicine. And even experience them sometimes when a friend or family member passes, or when a chronic condition manifests. But holy moly, It almost seems like science fiction that in one short weekend's treatment, I'm feeling better than I have in months. I'm amazed, and I hope all of you get to be just as amazed as me, if something should ever go so wrong for you.

4) Yes, it's a cliche, but after my brush with death, I feel like I need to do more to improve the world than what I'm currently doing. Except what that is hasn't come to me with crystal clarity. I give money to several charities. I support several Patreons on an ongoing basis. But I don't really give up my time to volunteer or work on charitable initiatives. Maybe that should change. Not sure what's a fit for me right now, but it's something I'm going to think about.

5) At the very least, I'd like to figure out how to build bridges between people. I was examined, transported, treated, cared for, cleaned up after, and in some other way helped by a bare minimum of fifty different people during my weekend Embolism Tour. Every one of them was smart, dedicated, and caring. And I bet at least half of them disagreed with me on some particular issue or other. Should I let those single points of disagreement define those people to me?

In case you're wondering, the answer is not "Blurple."

Artificial Sweets May* Be Killing You

Some of you remember my vocal arguments against the widespread use of hydrogenated oil in the 90s and beyond ("Artificial Fats Are Killing You") Over the last couple years, I've come to have similar doubts about artificial sweeteners (though I haven't been nearly so vocal for whatever reason--less evidence, probably). But it is one of the reasons I stopped drinking diet soda and energy drinks, just to be on the safe side. More evidence is accumulating that such things may be bad for you.

Consumption of artificial sweeteners, such as aspartame, sucralose and stevia, is widespread and increasing. Emerging data indicate that artificial, or nonnutritive, sweeteners may have negative effects on metabolism, gut bacteria and appetite, although the evidence is conflicting. To better understand whether consuming artificial sweeteners is associated with negative long-term effects on weight and heart disease, researchers from the University of Manitoba's George & Fay Yee Centre for Healthcare Innovation conducted a systematic review of 37 studies that followed over 400 000 people for an average of 10 years. Only 7 of these studies were randomized controlled trials (the gold standard in clinical research), involving 1003 people followed for 6 months on average. The trials did not show a consistent effect of artificial sweeteners on weight loss, and the longer observational studies showed a link between consumption of artificial sweeteners and relatively higher risks of weight gain and obesity, high blood pressure, diabetes, heart disease and other health issues.

https://medicalxpress.com/news/2017-07-artificial-sweeteners-linked-weight-gain.html

L-Carnitine And Atherosclerosis

l-carnitine

The metabolic pathway for atherosclerosis has been discovered. Sorry, regular meat eaters. (And energy drink guzzlers!) 

The old school thinking of "if a little is good for you, then a lot must be better" has been proved wrong by Stanley Hazen, whose research last year established a link between bacteria in your gut, l-carnitine, and heart risk.

Yes, it's well understood that l-carnitine is crucial. It helps produce all your body's energy by transporting fatty acids to your mitochondria. However, humans produce all the l-carnitine they need. Supplementing with it (and eating a diet rich in red meat) does no good, and in fact, does harm.

Your gut bacteria can be "trained" to digest l-carnitine by eating a lot of it. The more you ingest, the more your gut fauna evolves to digest it. A byproduct of this digestion is a substance that promotes plaque build-up in your veins. 

Instead of accelerated energy, you end up with accelerated Atherosclerosis!

Want to hear it straight from the horse's mouth? Then give this a listen! http://www.sciencefriday.com/guests/stanley-hazen.html#page/full-width-list/1

Laughing Rats and its Consequence

I heard a story on NPR (probably the Radiolab program) about a guy doing research on rats.

Apparently, rats vocalize at too high a pitch for humans to hear, but special microphone equipment in a rat cage dials down the pitch enough to allow us to hear the occasional little chirps rats make at this frequency. After ten years of study that went nowhere, the idea came to the researcher to tickle a rat. Suddenly, the chirps came hard and fast and sounded oddly like . . . laughter.

Another rat, same thing. It turns out rats like to be tickled, and they laugh in a way that is eerily like a human baby being tickled. Check out this video:

Anyway, the thought immediately occurred to me that if rats can feel this very simple human joy, it's probably true that most mammals can. Even the ones we regularly slaughter and eat.

Which leads me inexorably to my next thought: I don't think I can morally justify personally eating higher order animals.

So I'm back to being a vegetarian. I'm afraid birds are out too--but I'll still eat eggs, milk (and cheese), and fish. This'll be the third time in my life I've tried to be a vegetarian. Maybe third time'll be the charm? My omnivore genes may power through my moral decision in the end, but I'm ready to give this another go.

From the Vault: 0 Trans Fat?

My old friend Jeff Quick remembered how I used to evangelize the health risks of consuming hydrogenated oils [as reiterated here], and told me he now stayed well clear of it. Well, it's been over a decade since I began that crusade. In the last few years my voice and many others have had a positive effect--I'm not the crazy lone doomsayer any longer. Now, for instance, you'll regularly see packaging claiming the food inside contains "0 Trans Fat."

Thus Jeff's [and Charles's] question: "I see a lot of labels nowadays crowing about 0 grams of transfat, but they still have hydrogenated oils in their ingredients list. What is your opinion on this turn of events?"

I told him my guess was food manufacturers could legally get away with claiming 0 trans fat if the amount contained was under a certain threshold. Well, by pure happenstance, it looks as if I didn't lead him wrong.

According to David L. Katz, M.D, a professor at Yale author of Flavor Point Diet:

"[Under FDA rules, food manufacturers are] required to post just how much of the artery clogger (trans fatty acid) is in the food--unless there's less than .5 grams per serving, in which case they can say 'zero trans fat.' The problem is 'one serving' can be misleadingly small--seven or eight 'free' cookies could sneak in 3 or more grams of trans fat."

There it is--if you see hydrogenated or partially hydrogenated oil in the ingredient list, stay clear.

From The Vault: Artificial Fats Are Killing You

Did you know that artificial fats are in much of the food that you buy? Did you know that this artificial fat, called trans fatty acid, is slowly killing you? [A lot of you probably do. So, next question... Are you doing anything about it?]

Next time you reach for the coffee creamer, the margarine, or even your favorite brand of potato chips, flip over the bag and take a look at the ingredients--if you see hydrogenated or partially hydrogenated oil of any type, you're eating a trans fatty acid.

What is a Trans Fatty Acid?
Imagine an oil as a string of carbon atoms that hang together like bulbs on a string of Christmas lights. Some oils are a bit more complicated, and have hydrogen atoms stuck on them. When the oil is completely filled with hydrogen atoms, the string of carbon is called a Saturated Fat. The way that the hydrogen sticks to the carbon is important. If the saturated fat is naturally occurring, the bond is called "cis." A regular saturated fat could be called a Cis Fatty Acid.

You guessed it, a Trans Fatty Acid is a lot like a regular saturated fat, except for the way that the hydrogen atoms stick to the carbon atoms. Trans fatty acids are made when food companies shoot hydrogen gas through oil. Some of the hydrogen sticks to the carbon, but in a rigid way that makes the food last longer on the shelf . When hydrogen is artificially attached to carbon like this, the bond configuration (the type of connection between the carbon and hydrogen) is called "trans." Saturated fat of this kind is called Trans Fatty Acid.

Why Is It So Bad?
Your body can't tell the difference between a normal cis fatty acid and an artificial trans fatty acid. When you eat a trans fatty acid, your body incorporates it into your cells--your cells actually become hydrogenated! The consequences include increased occurrence of heart disease, sexual dysfunction, weakened immune system, cancer, atherosclerosis, diabetes, and obesity.

What Foods Is It In?
Margarine, non-dairy coffee creamer, some whip creams, "soft-serve" ice creams, many breads, restaurant french fries, restaurant and supermarket fried chicken, restaurant and supermarket fried food of all types (sadly, old-style lard frying was healthier because frying took less time so less oil penetrated the food, and it was cis-fatty acid), most crackers, some "health" foods... the list goes on and on and on. Hydrogenated oil (trans fatty acid) is in more than 70% of processed foods found on store shelves!

What Can I Do?
It's up to you to check out the INGREDIENTS ahead of time for hydrogenated or partially hydrogenated oil! Stop buying foods that contain partially hydrogenated oils. Lately, I’ve noticed that some foods come right out and say ‘No trans fats’ and ‘cold pressed oils’ in bold letters. You can find alternatives without this terrible additive. Here's the golden rule for eating right: Eat whole, unprocessed foods when possible. Try to buy foods that use cold pressed or expeller pressed oil in the ingredients (oils so labeled are unlikely to contain trace organic chemicals). Don't be afraid to consume foods high in natural fat, including animal fats (in moderation). No kidding. Good luck--be healthy!

Century Massage

Some of you may recall I complained a few months back about pulling a muscle in my back.

I've been slowly getting better, with the help of a couple months of physical therapy, which ended in December. I even started getting back on my workout schedule at the end of December.

But the muscle knots reached a plateau of healing, then refused to get any better (as in, go away).

Early this week I finally got off my duff and sought out a massage therapist specialized in sports medicine. The knots ease up with a tennis ball on a wall--maybe someone who knows what they are doing would work even better?

I found Century Massage in Renton. This place isn't about hot stones or scented oils. Its about heavy duty muscle manipulation designed to break up knots. After 30 minutes, I knew I was on to something.

I went again this morning, and the numbness I've been feeling in my pointer finger on my right hand since September has finally dissipated. I have a whole new outlook on the year. Here's to avoiding hurting myself in 2008!

XBOX Stream of Consciousness

My XBOX 360 displayed the three blinking red lights of doom on Dec 25th. Hardware failure.

The silver lining to this sad story of failed holiday bliss is that Microsoft has extended a 3 year warranty for all devices that exhibit this particular failure. So I'm covered. This is the second time a 360 has failed me.

I guess I'll have to do something constructive with the time I had set aside to practice my battle rifle skills in Halo 3. Like, work on a 2nd draft and exercise, maybe. I've been eating too many molasses chips and pieces of peppermint bark. I've fallen off the fitness/good-eating wagon, and now I need to climb back on. The sugar really nails me, but when I get a bite, I can't stop. I know, as soon as I finish off all the goodies in the house, I won't have anything left to tempt me . . .

Yeah, that's good thinking, Bruce! It's when I wrestle with food that I become particularly convinced that consciousness is a synthesis of personality fragments. To ourselves, it feels like we're whole people with a unified mind, but nope. We're a collection of competing ideas and needs, and getting a handle on those rooted in the deepest part of the brain is a battle that is never won.

Say No to Antibacterial Soap

Did you happen to watch CBS's 60 Minutes episode about MRSA? MRSA stands for methyl resistant staph aureus (or, more properly, Methicillin-resistant Staphylococcus aureus). I've known about MRSA, the ominously labeled "community acquired" version (as opposed to the kind that hospital patients fear), for about a year or so, though its been around much longer, especially in the UK. But it's here in the US now, too.

MRSA is fancy way of saying flesh-eating bacteria.

Used to be if you got a staph infection, well, it probably wasn't too serious.

Now however, the staph bacteria living on your skin might be resistant to most antibiotics. And we have only ourselves to blame.

Mainly, it's because as a society we failed to put two and two together.

I mean, we've known the principles of evolution since Darwin, and those principles have proved true in the nearly 150 years since they were advanced.

We also know that bacteria churn through generations like mad; some divide every 15 minutes.

So we should have recognized that applying a selective pressure on organisms that throw off iterative chances to survive antibiotics every 15 minutes would lead to something like MRSA.

Well, some people did, but no one listened to them.

Anyhow, now that such bacteria are out and about everywhere, there is something you can do right now: stop using antibacterial hand soap.

I'm serious. Antibacterial soap doesn't remove bacteria from you hands any more efficiently than regular soap. All you are doing is driving normal, healthy bacteria toward antibiotic resistant status. In truth, all the antibiotic soaps, cleansers, and wipes in your house are doing the same thing.

See, you're covered in bacteria. More than that, you are filled with bacteria. You may not realize it, but you are a human-bacteria hybrid. When you begin to kill off portions of yourself by overusing antibiotic, bad things happen.

Antibiotics were a wondrous cure, but we've overused and abused them, and their effectiveness is fast approaching 0. Don't be part of the problem, be part of the solution. Save the antibiotics for when and where they are actually needed.

Also, if you're a legislator, know a legislator, or feel like bringing up this topic with a legislator, urge a ban on the routine use of antibiotics in farm-bred meat. This practice is probably the single biggest source of antibiotic resistant bacteria. At least one company is already stepping away from this practice: Tyson says it'll stop putting antibiotics in its chicken.