medical treatments

AGGRAVATION!

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[I know I should be glad I have adequate health insurance and am a smart cookie and can figure out when someone else is trying to pass on their stupid coverage mistakes to me.  But I’m not glad.  I’m Type A, and quick to anger, and also eager to put everyone else on the qui vive.  [Look, look!  Look what happened to me! ]

Life is full of relatively small things that aggravate and take up precious time to rectify. You can be philosophical (although I’ve never found that approach really soothing) when, for instance, a box of paper clips falls from your fingers, opens, and scatters its contents all over the floor — or worse, the rug. But do you leave the mess there, for the cats to play with? And for you to re-discover when you return from whatever you were rushing off to with those papers that needed a paper clip?  Or do you take the time to vacuum up, possibly clogging the vacuum hose and certainly losing a boxful of clips?  Or — an even more time-consuming option — do you laboriously pick them up one by one, even the ones that scooted under the desk, fuming all the while — and be really late to wherever?

Well, the fall of the clips was probably your own fault.  (Clumsy you.) So is discovering you’re practically out of gas when you’re hurrying somewhere, and then having to get yourself to the nearest gas station as fast as possible before moving on to your destination — only to find a long line at each of the pumps.  And if something’s not your own fault, you probably can find a loved one to blame.  The cats for the box of clips, Bill for the near-empty state of the gas tank.

But what do you do when someone, or several someones, who you don’t know at all, and never even knew existed, is just plain sloppy or dumb on the job, and you wind up losing much of your afternoon — plus some of the next day, and possibly more time to come — trying to keep your blood pressure down while you extricate yourself from unsought and unmerited liability and expense?  If you’re smart (or used to be a lawyer) — you eat the time, choke down the bile, and deal with it, so that, hopefully, it will get been resolved once and for all. Even though it should never have arisen in the first place.

And what if you’re less smart, or don’t think fast when you get stupid explanations for why strange things are happening, or are too inexperienced to ask the right questions in the first place?  Well, that’s some unfortunate other person’s blog post, involving even more aggravation and grief.  This one is mine — and while it’s true that my aggravation has been of limited duration, and cost me only parts of two days I was planning to devote to something else, plus $6.49 in unforeseen postage charges — it was more than I should have been subjected to. After all, I was the entirely innocent party in the transaction.  But perhaps it may serve as a sort of Aesop’s fable about tiptoeing through the computerized minefields of the American health insurance system, complete with a short “moral” at the end.

Okay, up with the curtain.  Here’s what happened.  I don’t know if something of the sort could occur under a single-payer insurance system.  But here in the States ours is far from single-payer, as anyone who’s been paying attention to the history of Obama’s struggles in Congress to provide nearly everyone with affordable health insurance coverage can attest.  However, leaving that aside, the closest we have to single-payer coverage is Medicare, which kicks in when you turn sixty-five.  If you have a social security card, or are eligible to apply for one and do, you will automatically receive some hospital coverage, and are able to apply part of your monthly social security benefit to the premium for covering some of your out-of-hospital medical costs.

Original Medicare was therefore entirely single-payer, even though the insured was paying the government a small premium for part of it.  Subsequently, private insurance companies were legislatively enabled to offer insureds Medicare “plans” which monkey with the original concept, and of which I disapprove, so I can’t tell you much about them.  I have the original Medicare coverage, which is, in the “service provider” trade, known as my primary coverage.

I also buy what is known as “Medigap” coverage from a private insurer (in my case Medex, the Medigap coverage sold by Blue Cross, Blue Shield of Massachusetts, the state in which I was living when I turned 65), for which I pay a hefty annual premium.  I buy it because not only does Medicare not pay the entire “service provider” charge for a hospital stay or a doctor’s visit or a “procedure” or whatever; it also approves only a certain amount of the charge, and does not pay all of what it approves.  The Medigap coverage you choose (if you choose it) then pays the remainder of the approved amount, up to 50% of it, usually more than enough to take care of it.  And what of the difference between what the doctor or hospital or other service provider initially charged and what it received as an “approved amount” from the primary and secondary insurers?  They have to say bye-bye to that overly demanding part of its bill.  Any provider which accepts Medicare payments must accept the “approved” amount as payment in full.  (That part is important to this piece, which is why it’s in bold italics.)

When Medicare pays a service provider, it sends you a “Claim Summary” which tells you the name of the service provider, the date of the service, the amount charged, the amount Medicare approved, and the amount Medicare paid.  When your Medigap insurer pays a service provider (after Medicare has identified the “approved amount” and made its payment), it too sends you a “Claim Summary,” telling you most of the above, plus what Medigap paid, plus what’s left over for you to pay (except a service provider that accepts Medicare can’t collect this part from you).  On the former-lawyer principle that if you throw away a piece of paper (a “document”) you will probably need it in future, I keep all mine stashed away in reverse chronological order in a big black box that moves from my office to the basement every year, to be replaced by a new big black box.  I almost never look at the Claim Summaries before I put them in the currently open big black box, and have never had a reason to hunt up a Claim Summary to prove anything afterwards.  Still….   After four or five years, I do throw them away, though.

You may remember a piece I posted in March which was captioned “The Ugh Factor in Getting Old.”  It was about preparing for and having a CAT scan after a prior ultrasound showed something obscure but questionable.  All ended well medically.  But that was just the beginning of the paperwork.  About ten days ago, a Medex Claim Summary arrived for the ultrasound.

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A day after that another one arrived for the CAT scan.  

IMG_0528 I’ve shown you only the top parts, because that’s all that’s relevant here.  Actually though, the Claim Summaries are on  8 1/2″ x 11″ paper, and are always mailed folded in half.  So blasé am I that I didn’t even unfold these two until it was time to stuff them in the currently operative black box.  (Nor did I remember whether they had each been preceded by a similar claim summary from Medicare, as should have been the case. As it turned out, they hadn’t been.)  But when I did unfold them — surprise surprise!  Each had a check made out to me attached on its bottom half.  The first check (in connection with the ultrasound, for which $733 was alleged to have been charged by Princeton Radiology, the “service provider”) was for $715.00.  The second (in connection for the CAT scan, for which $3,258 was alleged to have been charged by the same “service provider”) was for $2,576.00.

$3,291.00 for me?  This had never happened before.  I have never seen the money that passes, probably electronically, between my insurers and providers of medical services.  Reluctant though I am to turn away cash in any form, especially in such an especially welcome large amount, I knew — just knew — I wasn’t supposed to put nearly 3,300 unexplained dollars in the bank or go on a spending spree.

“Call Princeton Radiology,” said Bill.

“What good will that do?” I said.  “They’ll just take the money before I know why I’m suddenly in the middle here.  No, no: it’s Medex which should explain.”  So I looked up the phone number for insureds on the back of my Medex card, kissed the rest of the afternoon goodbye, and waited through about ten minutes of “All of our customer representatives are busy, but your call is important to us; please stay on the line” interspersed with music deemed “popular” by someone but not popular with me.  Finally, when I was already chewing the inside of my mouth, “Danielle” took my call.  (Why are perfect strangers in Customer Relations always on a first-name basis with you — making you sound stuffy or stuck-up if you insist on being addressed as Ms. Mishkin or Nina Mishkin?) Did she want to know why I was calling?  No.  First she had to be sure I was me. (Come on! Who else but me would be complaining about receiving an unexpected $3,291.00?)  We first reviewed my account number followed by the pound sign, my address, my home phone number, the county I live in, my mother’s maiden name, and my social security number before she asked how she could help and I was allowed to tell my story.

Danielle didn’t know why I had suddenly received two checks from Medex, and in such substantial amounts, for the first time in the more than seventeen years it had been my secondary insurer.  She asked if she could put me on hold while she consulted a claims “specialist.” (Would I say no?)

She must have asked because I was on hold for quite some time.  All the claims specialists must have been busy helping other insureds.  Danielle came back on the line every five minutes or so to assure me that it would only be a little longer. Ha!  Finally, she was ready to transfer me to “Mark.”

Mark, thank God, didn’t need my mother’s maiden name.  Just the number on my card, followed by the pound sign.  We went through my story again.  Mark listened attentively, but in the end didn’t know any more than Danielle about why I had received those checks.  He went off to find out, after asking if it was all right with me to hold while he consulted Accounting.  At least Mark had no ability to ease my waiting time with  popular music; this time I did my holding in silence.  I suppose if I were a crossword puzzle aficionado, as many of my contemporaries seem to be, I could have put all that time on a silent telephone to good use. But I’m not, and I didn’t, and eventually Mark came back from Accounting with the “good news” that I’m supposed to pay Princeton Radiology myself.  That’s what the checks were for.

We had by then chewed up nearly an hour of my time.  “Why now, after seventeen years of coverage, am I suddenly in the middle?” I demanded.  “I don’t want to be in the middle.  I want Medex to take care of it. That’s why I’m paying you those obscene amounts of premium money!”

“Accounting says we can’t,” said Mark peaceably.  “Princeton Radiology is a provider that doesn’t take Medicare. And we only pay service providers after Medicare does.”

“That’s ridiculous,” I said, beginning to sound — as well as feel — angry.  “Excuse the language, Mark, but that is absolute crap!  Princeton Radiology has been happy to take Medicare, and Medicare’s payments for the services it provided to me, during the whole eight years I’ve been in Princeton.  They took it for mammograms every three years, for ultrasounds of the abdomen every year or so, even for a CAT scan of the lungs four years ago.”  Memories of signing papers in which I assumed liability for any “service” Medicare refused to approve began to come back to me.  I told Mark about that, too.

“And look, ” I added, really wound up now.  “If neither of these so-called “procedures” is covered by Medicare, I will have to pay an additional $660.94 for the CAT scan, as well as $17.02 for the ultrasound, over and above the amount of the checks.  I would NEVER have agreed to submit to the scan if I’d been informed it would cost me anything, much less an amount as large as that!”

Mark mumbled something.

“What’s more,” I threw in, “your very own Claim Summaries state that Medicare allowed $431.79 for the CAT scan and $157.68 for the ultrasound — both of which sound low to me. But if Medicare “allowed” anything at all, however low, Princeton Radiology must have submitted its bills to Medicare for these numbers to appear on your Claim Summaries.”

He caved.  “Let me call Princeton Radiology.  Do you have the number?”

With Bill’s help, I found the number for him. (It took us another ten minutes.  Mark didn’t seem to mind.  Time is nothing to those guys in Customer Relations.)  Then he put me on hold again.  For what seemed a very long time, even though by then I was getting used to long “hold”s.  After which he came back and said he would have to speak to Accounting again. After which it was almost the end of the afternoon, and I hadn’t written my blog post for next day, or paid some legitimate bills, or gone for a walk on a (finally) glorious Spring day.

When Mark finally returned with some answers, you’ll never guess what he had to say!  Someone had made a billing mistake.  No kidding!  But was it Medex?  No siree! It was Princeton Radiology.  They had billed Medex as the primary insurer, not the secondary.  That’s why I had received the checks.  Hmmmm.  But not to worry.  Princeton Radiology, possibly contrite (although I doubt it), was putting a “hold” on my account and rebilling everything properly.  I wouldn’t be liable for anything.

“Who did you speak to over there?” I asked, pen in hand.  He told me.  At this point I was writing everything down:  the transaction number for my multiple conversations with Danielle and Mark, plus the fact that Mark had obtained his information at Princeton Radiology from one Mary Jean. (No last name, of course.)

“And what am I to do about the checks?  Can you void them? Can I just tear them up?”

Apparently neither of these options was available.  I would have to send them back.  Mark gave me the mailing address.

“Tell me,” I asked.  “Why do the Claim Summaries state that Medicare allowed certain amounts for these two procedures if Medicare never received the Princeton Radiology invoices?”

Mark really didn’t want to go there.  “Well, Accounting just had to put something,” he said evasively.  “There’s a place on the form, you see? But never mind that.  It’s all being rebilled anyway.”

A place on the form?  That sure wouldn’t hold up in any court I knew of. But since it was nearly five o’clock, I decided not to mind, despite the fact I really did.  However, I did not take Mark’s advice to just drop the checks in the mailbox.  The next day I invested forty-five additional minutes in driving to the closest post office at which I can easily park and in waiting on line to pay a certified fee and return receipt fee, totaling $6.49 — so that I should have proof I sent both checks back.  Because having lived as long as I have, I don’t trust anything to go right if it can possibly go wrong.

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While driving there, I also figured out why Princeton Radiology suddenly began billing Medex as my primary insurer after seventeen years of billing it correctly as the secondary.  I remembered that just before the ultrasound that was eventually the cause of the CAT scan, Princeton Radiology presented me with a whole sheaf of new forms to fill out.  Why?  When they had all this information already?  Because they were changing over to a new and more sophisticated computer system!  And you know what that means?  Before the new sophisticated system is up and running, someone has to enter into it, with old-fashioned ten-finger technology, all the handwritten information I put down on the sheaf of paper as well as everything every other radiology client has written down on similar sheafs of paper.  Data entry!  Boring, boring, boring.  Room for error?  Oh boy, is there!  I picture some young thing, thanking God it’s Friday and dreaming of her weekend plans as she tediously transfers my insurer information into Princeton Radiology’s new data bank. She makes, and fails to catch, a teeny weeny little mistake.  She’s only human.

As for the mysterious appearance on my Medex Claim Summaries of amounts “allowed” by Medicare (when Medicare had never received the invoices for services involved) — that was, I think, worse than a young thing daydreaming her way through a data entry job. Someone had made up a figure to fill in a blank because the form required it, which was easier than inquiring why an insured always before covered by Medicare for services provided by Princeton Radiology suddenly wasn’t.  Or than going to get another form, to be used for non-Medicare-covered invoices. If anyone had done either of those things, it would have alerted me — even if I had not remembered to ask the right questions — not to follow Mark’s advice to pay Princeton Radiology with the two checks;   I would have known that if I had done that, I would also have been liable for the amount remaining: $697.02.

So what is the moral here?  Setting aside the problem of boring jobs, which is no longer my problem,  perhaps the moral for those of us no longer needing to thank God it’s Friday is not to assume it’s all going to be smooth sailing from here on in.  Don’t think you left paperwork aggravation behind you in the work force.  It pursues you into the grave.  So if you’re a Type A like I am, you might consider investing in a meditation tape.

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Like I just did.

A ONE-OFF RIFF ON THE USE OF CORTICOSTEROIDS IN A RECENT BOUT OF SKIN DISEASE

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[This is the second in a series of four pieces arising from my recent, and in some ways still ongoing, experience with an obscure and distressing skin affliction apparently extremely rare in adults.  They’re not just about skin, though. Is anything ever really only about what it first appears to be?]

I have no medical expertise whatsoever, and throughout a long educational career avoided science whenever I could.  Moreover, I’ve been extraordinarily lucky, compared to many other people my age, in the relative infrequency with which I have needed to consult internists and other medical specialists.  So you could say I am somewhat inexperienced when it comes to medical and pharmaceutical matters.  I’m emphasizing this up front because nothing that follows should be construed as medical advice.  However, my own recent experience with a very particular kind of non-fatal disease raises certain questions you may want to think about yourself, in whatever way seems applicable, at present or in the future, to your own health situation.

That said, I am observant.  And sentient.  And now there’s the internet, a resource not available thirty years ago, where one can look up matters of interest to oneself.   Which is not to say I don’t respect doctors.  It seems to me that most medical professionals I’ve met really do want to help those who come to them, and do the best they can with the training they’ve received in medical school.  Much of which is remarkable.  The ability to identify and name medical problems, even those coming down the pike but not yet arrived, is extraordinary — thanks to the armament of sophisticated testing equipment which has been developed in the past fifty or sixty years.  Surgeons have also become highly skilled at repairing and replacing broken and worn-out parts of the body. Valve replacements, joint replacements, cataract removal and replacement with artificial lenses.  In addition, they know how to cut bad things out of you — such as many cancers, parts of colons so inflamed that they will kill you if not removed.  And like that.

But when we reach pharmaceutical treatment, we’re on somewhat shakier ground.  There are clearly successes. Some cancers in remission for ten or more years.  Hypertension held in check, without perceptible side effect, by a combination of medications reached after trial and error.  HIV-positive no longer necessarily a death sentence.  But as Bill, my resident now-retired medical guru, used to tell his patients:  medicine is not rocket science.  Meaning — doctors don’t know everything.  Or, in some cases, very much.

Nonetheless, when you feel truly awful, who do you go to?  It’s almost instinctive: if you don’t know what’s wrong with you, go to someone who knows more.  And so, when nearly four weeks ago, I felt weak and listless, and began ceaselessly to scratch first my scalp and then my chest and back, which both soon turned hot and dotted with bumpy itchy eruptions, I betook myself to the local dermatologist, who had a look, asked a few questions, and concluded, “eczema,” or possibly an “atopic dermatitis,” and wrote out a couple of prescriptions.  To make me feel better, until it passes, he said.  Why this, and why now?  He shrugged.  “It happens.”

The prescriptions were for fifteen days of oral prednisone (to be tapered off gradually, in five day increments), for another form of steroid in topical form (to be rubbed over the afflicted parts), and for an oral anti-histamine to take at night.  He also mentioned Claritin, an over-the-counter anti-itch tablet, for daytime, because it’s not sleep inducing.

I had only once in my life broken out in what was either an “eczema” or “dermatitis” on my back and upper arms — in my early sixties, when I was enrobed in professional, emotional and practical stress of almost every kind you can think of, and my skin decided to protest.  That was twenty years ago, and the dermatologist I consulted at the time prescribed an earlier version of a topical steroid, plus an anti-histamine, plus immersion in some kind of colloidal substance that coated the bathtub as well as me, so as to soothe the irritated skin and make the tub nearly impossible to clean. In two or three months, the condition went away and never came back — whether because of the “treatment” or because the problems in my life began slowly to resolve themselves, I don’t know. (Interestingly, the dermatologist had predicted that it would return every winter from then on.) Without speculating further on an issue of the past long since resolved, what I conclude from this is that in twenty years, nothing much has changed:  steroids and anti-histamines for problems of the skin, about which little is apparently understood.

Except that now, twenty years later, the local dermatologist was wrong in his diagnosis. I began to turn boiled-lobster red as the hot, itchy eruptions ran together, and they also moved steadily downwards, in five or six days covering face, arms, tops of hands, lower torso front and back, legs and tops of feet (although I had already begun taking the oral prednisone, as well using the other stuff) — until all of me other than my palms and the soles of my feet were afflicted.  Bill consulted the head of dermatology at Cornell-Weill in New York. He recognized it at once from its symptoms as described. It wasn’t eczema at all.  It was apparently a “general viral exanthem.”  An attack on the skin by a virus. It would eventually go away on its own.  Should I continue with the prednisone?  Yes:  once you start, you shouldn’t stop until the prescribed course is finished.  And it might do some good.

So let us consider prednisone, and other corticosteroids (of which prednisone is one) — the dermatologist’s go-to medicine for problems of skin. [The specific information in this post about corticosteroids comes from the Mayo Clinic’s website section on steroids.]  Steroids are the kind of medication accompanied by the caution that “your doctor has determined the benefits of taking this medication outweigh the risks.”  I have known two people for whom the benefits certainly outweighed the risks, but what was at issue was not skin.  An old college friend was gasping for breath from asthma, and corticosteroids saved her life.  They also made her, a formerly slim attractive woman, blow up (as my mother would have said) like a balloon.  But if the choice is thin and dead or fat and alive, which would you choose?  Similarly, one of the two cleaning ladies who visit us twice a month to keep our condo nice and clean is suffering from rheumatoid arthritis.  She is in her early fifties and if it were not for steroids, she wouldn’t be able to function.  She too is quite plumped out, although her daughter says she used to be a tiny petite little thing.  There are also other future worse side effects of long-term continued use of whatever form of steroid she is taking, some of which she is aware of.  But does she have a choice?  I understand corticosteroids are further helpful in auto-immune diseases, such as lupus, where the immune system attacks the body’s own tissues.

But why is it prescribed for skin conditions? Because corticosteroids mimic the effects of hormones the body produces naturally in your adrenal glands.  When prescribed in doses that exceed the body’s usual levels, corticosteroids suppress inflammation, and thereby can reduce the signs and symptoms of inflammatory conditions.  Alas, they also suppress your immune system. Furthermore, after seven days of doses exceeding the body’s usual levels, the body shuts down its own production of anti-inflammatory hormones, so if you stop taking synthetic corticosteroids suddenly, you will be left without any protection at all against body invaders.   The synthetics have to be tapered off gradually, so that your body picks up the cue that it’s time to start functioning normally again.  Even when you’re no longer taking them, the Mayo Clinic warns that you may feel fatigue and lightheadedness for a while.  Yes, I did, for almost a week after the last pill.  And I’m not fully recovered yet, another week later.

Did it help at all?  Presumably, it was intended to shorten the duration of my affliction — my body’s reaction to the virus — and lessen the inflammation (and therefore the severity of the “discomfort.”).  A general viral exanthem is supposed to last ten to fourteen days.  My inflamed and burning redness faded on the eighteenth day. Today, twenty-eight days after the initial outbreak, my legs — the last to suffer — are still slightly blotchy, and the rest of my skin, although looking normal again, still hypersensitive to touch and hyper-responsive to any form of gentle scratching.  You could say that my age was a factor in delaying complete recovery within the predicted period.  But you could certainly also say that the oral prednisone — the form that affects the entire body — did nothing to shorten the recovery period.  Did it lessen the inflammation?  As I don’t see how it could possibly have been worse (other than to enter the inside of my mouth, which it didn’t do), I answer this question with a clear negative.  So much for the benefits.

Prednisone comes from the pharmacy accompanied by a multi-page printout of possible side effects.  These are the ones I experienced, at first without knowing what was causing them, as I was too tired and confused to start researching this subject until about ten days ago:  Confusion, dizziness, spinning sensation, dry mouth, dry lips, extreme thirst, extremely increased urination (up almost every hour at night), limp feeling, gradual weight gain (two and a half pounds in two weeks despite watching what I ate like a hawk), trouble thinking, trouble speaking — I was groping for words, me! — at times slightly blurred vision, cough, hoarseness, runny nose (without having a cold), shaky hands, chills. I paid less attention to all this than perhaps I should have because I was almost entirely focused instead on the misery of the burning skin, the rash and the itch.  However, I will note, gratefully, that the side effects I didn’t get, perhaps because the course of treatment was relatively short, are even scarier — and include, of all things, skin rash!  Again, I will concede that my reactions were likely exacerbated by age and my body’s inexperience with pharmaceutical substances that tinker with its chemistry.  That, however, was a question of degree, and does not alter the risk/benefit analysis.

[One word about the oral anti-histamine, to be taken at night:  It put me to sleep for about three hours until I woke myself up scratching, still groggy from medication.  So it didn’t really work, either.  As for the Claritin — ditto, and it didn’t take three hours to find out.  Perhaps it helps with something really mild.  Whatever that may be.]

As for the topical steroid ointment, to be applied at judicious intervals to the “afflicted” parts  — even if it had helped, it was a greasy mess to apply (all over!) and precluded the wearing of anything but a long loose nightgown for the four days I kept with it.  I did not keep with it after that because it soon became clear that applying it was counter-productive.  It cooled things down for about five minutes once I had anointed all of myself, and then everything flared up again worse than before.  I will not speculate as to why. Perhaps the inflammation was more determined than the ointment, and refused to be put down!  I have subsequently found some evidence online that this can happen; topical steroids can begin by suppressing inflammation and end by further encouraging it. But as I have now packed all that away in a box labeled “Itch Stuff” (which I suppose will get thrown out in due time, but not quite yet), I will not think about it again, because there are now other things to think about.

Such as: What should I have done when all this began?  My personal opinion is now that corticosteroids are bad news unless you are going to die without them.  They are certainly bad news for skin. And especially as you get older.  There are other ways of dealing with the extreme discomfort of skin rashes, whatever you call them and whatever caused them, that do not carry the heavy burden of side effects that accompany the questionable benefits of steroid application.  (Cold packs wrapped in a towel or washcloth at night, lukewarm showers with Dead Sea salt soap, oatmeal baths, liberal and frequent application of Aloe Vera lotion and — even better — Calendula lotion, which is said to have some healing properties. Wear cotton against your skin; avoid wool and synthetics while you’re inflamed. There’s more, but I won’t continue, unless someone asks.)  On the other hand, when you are truly afflicted in your skin,  or anything else that requires medical attention, do you meekly submit to the pharmaceuticals offered on prescription, or do you dare challenge authority?  Should you emulate Job’s wife, and disbelieve?  Do you curse steroids, and set off on your own, at the risk of metaphorical death (that is, increased suffering)?

At a minimum, if I were doing it again, I would ask Dr. Dermatologist hard questions I didn’t ask.  (Shame on me, the retired lawyer.) What would happen without the steroids?  What are their side effects?  Is this a good idea at my age?  What is the least amount of “treatment” possible? What else can I do to relieve myself?  And even — are you sure I have what you say I have, and how do you know that? And if it isn’t that, but something else entirely (such as a virus attacking the skin),  would the steroids be any use at all?

Then when I had got past all that, and come to whatever decision I had made about following the medical directives I had been given and not looking elsewhere for relief — the fact that I had made it being important here — I would feel better about the consequences, since I had knowingly chosen them and had not had them imposed upon me because “doctor knows best.”

I would also resolve that if I could possibly help it, my immune system would not again so easily yield to viruses and other unseen evils afloat in the world.  I would figure out what I could do to make whatever future I have left as safe and comfortable as possible. But that’s a subject for another day.

 

 

 

OUT SICK — NO NEW POSTS FOR A WHILE

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Nothing fatal. Just a comprehensive case of eczema that makes it painful to sit, think, or type. So if you’ll excuse me while it gets getter, here’s a rerun that should cheer you up until I rise again from my couch of itchy-scratcy, all anointed with Medicare Part D-approved medications that are supposed to relieve the need to tear myself apart with my fingernails.  Please bear with me and enjoy.  It’s a flashmob performance of Beeethoven’s Ode to Joy, recorded in one of the main plazas of Sabadell, Spain.  Some of you will have seen it before; others not.  Whichever category you’re in, my feeling is you can’t get too much joy. 

[Re-blogged from November 23, 2013]

JOY