Satellite Question

[pdub]

We have a high deductible bc I freelance and BUD works for a small company.
After that, we're covered, but it's gonna easily clear out that deductible and with only a month left of it 'being useful'.
And all over something I was strongly pushing against everyone down the line escalating.

[TDub]

I had terrific insurance when I was younger and never needed it. Now as a self employed person my insurance is expensive and it's crappy insurance.

[Shirley]

We have a high deductible bc I freelance and BUD works for a small company.
After that, we're covered, but it's gonna easily clear out that deductible and with only a month left of it 'being useful'.
And all over something I was strongly pushing against everyone down the line escalating.

pdub, I'm very sorry you had a procedure it turns out you didn't need and are left with the bill to pay. That certainly sucks. Unfortunately, in medicine, certainty is a luxury you can’t afford.

If an ER doctor sends everyone with chest pain like yours home that they’re not certain is due to an evolving heart attack, there’s going to be some needless morbidity and mortality as a result.

One day almost 30 years ago as I was walking into the hospital I ran into a neurologist who was a friend and former classmate at KUMed, as he was leaving:

Jeff: “My last 4 spinal taps have all been positive. You know what that means?”

Me: “There’s a lot of meningitis going around?”

Jeff: “Yeah, but it also means I’m not doing enough spinal taps.”

That might sound odd, but it’s also true. Just as “time is heart muscle” when it comes to removing a blockage in a coronary artery, time is also morbidity, i.e., damage, when it comes to diagnosing meningitis and treating it before the infection becomes so severe that the impact on the brain becomes irreversible, or even fatal. You absolutely have to have a high index of suspicion and perform some spinal taps that turn out to have been unnecessary, or you’re going miss some early cases that result in needless morbidity or mortality, as much as you would rather not perform and the patient would rather not go thru the procedure. And while it’s embarrassing to put a person, often a baby, thru a spinal tap only to discover they didn’t need to have it done, the penalty for failing to do so is potentially so catastrophic, that you have to. You absolutely have to, because delaying the diagnosis until you’re certain it’s meningitis, (or a blocked coronary artery), is a luxury you can’t afford.

And while you can’t spend your career as a physician feeling like the legal sword of Damocles is hanging over your head, delayed diagnosis is the most common reason physicians are sued for malpractice. (I lied, you spend nearly every hour of every day feeling like the legal sword of Damocles is hanging over your head…)


Speaking of “delayed diagnosis”, (in the case below on the part of the patient,) here’s an interesting case by an ER physician who regularly posts cases on Twitter. The picture is of a chest x-ray of a young patient he saw, and the link to the video explaining it, which I’d encourage everyone to click on and watch, is embedded in the narrative above the picture.

Sam Ghali, M.D.
@EM_RESUS
Here’s a video I made breaking down this important case of a young man in his early 20’s who presented to the ER with cough for 1 month



Take home message: Certainty is a luxury you can’t afford.

[pdub]

I just think, considering the first doctor ( not a cardiologist ) suspected I had pulled a muscle and was having stress on my whole system from a nasty viral infection AND the second cardiologist suspected I had pulled a muscle and was having stress on my whole system from a nasty viral infection AND I suspected I had pulled a muscle and was having stress on my whole system from a nasty viral infection, that patients who go through the trouble/process of overreaction should be protected if they are hesitant about the entire ordeal.

This is with the caveat that I think lawyers, in general, aren't helpful, or rather, the way our laws aren't accessible to the average joe ( and have grown so overbearing and complicated that common sense is left long dead on the side of the road ), is conducive to frivolous and expensive lawsuits. It's not ideal that our doctors have to work largely with that threat on their shoulder rather than acting simply in the best interest of their patients. And with health costs the way they are, unfortunately, that best interest can mean making a 99% call while risking that 1% ( i.e. risking that someone who is young, no health problems, no heart history problems, not a smoker, has signs of a viral infection with a violent cough, tests just barely barely show elevated troponin levels, an erratic EKG can be related to stress on the body from a viral infection might actual be suffering a heart attack ).

[Shirley]

That's not unreasonable, whatsoever.

It's part of the "art" of medicine to be able to tell the difference between intervening and taking a wait and see attitude. Unfortunately, that's often not easy.

As an aside, I was much, much, much less inclined to intervene and instead let time nature take its course, than nearly all the physicians I knew.

[pdub]

As an aside, I was much, much, much less inclined to intervene and instead let time nature take its course, than nearly all the physicians I knew.

Wish you had been on the other line talking to the Doctor who believed what I initially believed.

[DCHawk1]

I had terrific insurance when I was younger and never needed it. Now as a self employed person my insurance is expensive and it's crappy insurance.

So...I know this is an unpopular opinion 'round these parts, but the "A"CA is partly responsible for that.

Before the ACA (as the owner of two businesses but the only "employee" in my state), I bought family insurance on the open market. I had heart surgery in 2009 (and am still eternally grateful to Shirley for the reassurance he provided beforehand) and am, therefore, considered a "high-risk" insuree. I bought a normal family policy for Creamcheese and the kids and a high-risk-pool policy for myself. (38 states had high-risk pools available for people with preexisting conditions before ACA, narrative to the contrary). I paid about $500/month for all of them and about $750/month for myself, $1250 total. Not great, but not bad.

After ACA became law, its preexisting-condition provision ("community pricing") did NOT lower costs for people like me. Instead, it forced underwriters to treat EVERYONE as potentially high-risk. As a result, individual/family rates skyrocketed. Keeping the same coverage would have cost us around $4000/month (an increase of $2750/month, for those of you scoring at home).

Needless to say, we balked at that price. Creamcheese gave up her career as a mom and went back to working for other people, so we could have insurance that didn't cost us almost $50,000/year.

I'm not saying that our old system was great. But the ACA was a sop to the insurance companies and little more. Bipartisan Corporatism is the name of our political game.

Also, for the record, in 2008 John McCain proposed beginning the process of undoing the stupid war-era relic policy that tied health insurance to employment. He was roundly pilloried for doing by EVERYONE. Our health care system is indeed fucked up. The original sin in fucking it up, though, was the war-era policy of wage controls, which made health insurance a fringe benefit that employers could use to lure the best workers.

[TDub]

I had terrific insurance when I was younger and never needed it. Now as a self employed person my insurance is expensive and it's crappy insurance.

So...I know this is an unpopular opinion 'round these parts, but the "A"CA is partly responsible for that.

Before the ACA (as the owner of two businesses but the only "employee" in my state), I bought family insurance on the open market. I had heart surgery in 2009 (and am still eternally grateful to Shirley for the reassurance he provided beforehand) and am, therefore, considered a "high-risk" insuree. I bought a normal family policy for Creamcheese and the kids and a high-risk-pool policy for myself. (38 states had high-risk pools available for people with preexisting conditions before ACA, narrative to the contrary). I paid about $500/month for all of them and about $750/month for myself, $1250 total. Not great, but not bad.

After ACA became law, its preexisting-condition provision ("community pricing") did NOT lower costs for people like me. Instead, it forced underwriters to treat EVERYONE as potentially high-risk. As a result, individual/family rates skyrocketed. Keeping the same coverage would have cost us around $4000/month (an increase of $2750/month, for those of you scoring at home).

Needless to say, we balked at that price. Creamcheese gave up her career as a mom and went back to working for other people, so we could have insurance that didn't cost us almost $50,000/year.

I'm not saying that our old system was great. But the ACA was a sop to the insurance companies and little more. Bipartisan Corporatism is the name of our political game.

Also, for the record, in 2008 John McCain proposed beginning the process of undoing the stupid war-era relic policy that tied health insurance to employment. He was roundly pilloried for doing by EVERYONE. Our health care system is indeed fucked up. The original sin in fucking it up, though, was the war-era policy of wage controls, which made health insurance a fringe benefit that employers could use to lure the best workers.

I took so much of all of this for granted in my younger years. As I aged and had kids the ridiculousness of insurance nearly kept me from going out in my own at all...and is a constant internal debate about whether or not I should go back to work for someone else. It's a dumb way to promote entrepreneurship and tying it to your employee stifles the ability for creativity and growth in this country.

My healthcare when I worked in Seattle for a major contractor was phenomenal. I paid 0 for me, $50/month for the wife (and wouldve been $25 for each kid). It covered nearly everything. We had our first kid with that coverage and our out of pocket costs for the whole deal was $212.

I switched companies to a smaller company after we moved had a second kid. That one cost me $8200.

Now. Any illness or injury would destroy me.

I pay $1350 for our family. The coverage is garbage. My boy had a cavity and needed anesthesia for the filling. Even with insurance my out of pocket cost for that 1 event was $1740. Absolutely criminal.

Looking for other options but they aren't great.







Meanwhile, I have extended "family" members that contribute nothing to society and go to the ER for every medical event and have no insurance but the state covers all of their needs. They've had 4 back surgeries in the last year (dont get me started on this part....) woth hospital stays and medicines prescriptions etc. Their costs? $0.

Our system is totally broken and needs a complete overhaul, yesterday.

[ChalkRocker]

Our system is totally broken and needs a complete overhaul, yesterday.

I've heard that from others. What to do?!

If only there were other, better approaches. Even if they weren't American.

But there are none. sad.




right?

this is as close as i get to poli bd

[ousdahl]

pretty sure the other better approaches aren't American.

we're the only developed country without universal healthcare.

it's another flavor of the "No way to prevent this says only nation where this happens" Onion headline

[pdub]

Our cat does a good job taking out mice in the house generally. We live kinda in the woods so it’s just bound to happen.

But now there’s one ( or more ) in the walls. I inspected the sofit where I think one night I heard them scratching around and sure enough part of the screen was pulled open. I’ve stuffed that area with steel wool and ordered some galvanized steel mesh to try and custom cut ( not sure how I’ll get it fixed up there as the opening is so slim ). I’m not even sure if that’s where they are getting in and out.

I’ve put “pet safe” snap traps in the basement and built in cabinets next to where the scratching is coming from. Do I put traps outside? Could a mouse that wasn’t planning on getting into the house get attracted to the bait and say nah, I’m gonna check out this house instead?

How else can I get this dude/dudes/dudettes ( without hiring someone )?

[jhawks99]

Go all Al Bundy on that sucker

[TDub]

Our cat does a good job taking out mice in the house generally. We live kinda in the woods so it’s just bound to happen.

But now there’s one ( or more ) in the walls. I inspected the sofit where I think one night I heard them scratching around and sure enough part of the screen was pulled open. I’ve stuffed that area with steel wool and ordered some galvanized steel mesh to try and custom cut ( not sure how I’ll get it fixed up there as the opening is so slim ). I’m not even sure if that’s where they are getting in and out.

I’ve put “pet safe” snap traps in the basement and built in cabinets next to where the scratching is coming from. Do I put traps outside? Could a mouse that wasn’t planning on getting into the house get attracted to the bait and say nah, I’m gonna check out this house instead?

How else can I get this dude/dudes/dudettes ( without hiring someone )?

have you tried the black decon poison bait stations? Put them outside near emauapected entry points. Animals can't get into them, but mice can. The only issue is then they sometimes crawl off and die in your walls.

[pdub]

“ The only issue is then they sometimes crawl off and die in your walls.”

This is what I’m worried about.

[Shirley]

“ The only issue is then they sometimes crawl off and die in your walls.”

This is what I’m worried about.

^^^

Ain't nobody likes that smell.

For 5 years while going to WSU, I lived in a nearly 100 year-old farm house out in the country NE of Wichita. The 2-story house was built over the dugout where the original homesteaders lived. (The ancestors of the wife of the couple who owned the house and farm.) The basement had a dirt floor, and the original tree trunk-pilings, with the bark still on them, supported the walls. Which, of course, only made trying to keep mice out even harder.

One morning I walked out to the end of the dirt driveway to the dirt road to get my morning paper, and someone had dumped two very young kittens, who immediately glommed onto me and became our pets. They were outdoor cats, we never had a "cat box", and they were killing machines. They nearly always spent the night outside and when you'd walk out the door in the morning it wasn't unusual to find feathers or fur all over the ground where they had killed and eaten yet another animal.

Despite having two cats willing to kill everything that moved, the number of mice we trapped seemed to be limited only by the number of traps we were willing to buy and load. Many, many's the night we were lying in bed asleep or watching television when a trap would go off, with that distinctive sound they make. It wasn't unusual to then hear the trap being dragged around behind the stove or whatever, by a mouse that hadn't sustained a lethal initial blow.

I would then take the trap outside to the dormant two-seater outhouse that hadn't been used in decades, and unload them into the abyss below it.

Best of luck, pdub.

[pdub]

I have a bucket trap that ain't caught shit in the basement.
I'll probably move that thing outside around the area where I'm guessing they are coming in.
Why not?

Issue is, i'd put water in the bucket to drown em but now it's so cold out the water will freeze.
And I don't want to have to dispose of antifreeze with dead mice in it in the winter.
I could do the 'humane' thing and drive em out ( if I catch em ) to the park a few miles away.
Or...I could just let em chill in there? Is that bad? That's bad right.

[ousdahl]

https://www.instagram.com/reel/CzoZLFBr ... BiNWFlZA==

[TDub]

“ The only issue is then they sometimes crawl off and die in your walls.”

This is what I’m worried about.

there's not much meat on a mouse. they don't drink long.

I do agree that I would prefer not to let that happen, however.

[TDub]

I have a bucket trap that ain't caught shit in the basement.
I'll probably move that thing outside around the area where I'm guessing they are coming in.
Why not?

Issue is, i'd put water in the bucket to drown em but now it's so cold out the water will freeze.
And I don't want to have to dispose of antifreeze with dead mice in it in the winter.
I could do the 'humane' thing and drive em out ( if I catch em ) to the park a few miles away.
Or...I could just let em chill in there? Is that bad? That's bad right.

don't use antifreeze, why not load up the bucket with salt? big chunky salt.....salt pellets for a water softening system work well. If it's not for animals to drink then load it up with salt and it makes it way more resistant to freezing.

The other option, not a great one maybe...., get one a little trough heater and drop in the bucket. You can get the small ones for like $10.

[pdub]

don't use antifreeze, why not load up the bucket with salt? big chunky salt.....salt pellets for a water softening system work well.

Not a bad idea but it gets below 10-15 degrees here regularly ( 14 last night ).
I'd imagine it'd still freeze.

Next week looks all above 20 for lows though...