I’m so Glad the year past is over.


This has been a year filled with upheaval.

This is the year I took a really good look around me at wider society and realized that, though I was considered a flaming liberal in my younger years, I am now – without having changed many fundamental views at all – considered a conservative, a racist, a white nationalist, homophobe, transphobic, Islamophobe, alt right, …. whatever else people on the other end of the spectrum think is a pejorative.

So let’s look at a few of these.  First:  racist.  Since thanks to my mother I have some NA in me (not enough for a quantum, but the point is it’s there), and my mother was married to a NA, I’m pretty sure we can ditch this right now.  But let’s go further – my family also has some Jewish ancestry thanks to a torrid love story that ended with a Catholic marriage, only to be followed some years later by a Catholic excommunication and a splitting of the family into Protestant and Catholic camps.  I have never put down any race for anything.  I do recognize there are widely differing cultural elements in different peoples, some of which I admire and some of which I find abhorrent – including in my own cultural group, Midwest white lower middle class.  I’m pretty sure that makes me observant, not racist.

Conservative.  Funny how time works.  This may be the only thing where my views have evolved, largely because I went into the work force and actually had to provide for myself and my children.  I used to be very much like the California style liberals – medical care is a human right, food is a human right, water is a human right, sewer service is a human right, housing is a human right.  Well, not so much.  Because taxes are a thing.  And because there are FAR too many moochers out there.

Now I feel differently in a few ways:

1.    First, clean water. Well, having water that isn’t going to kill you is a good thing to have.  And that has been largely taken care of across our country via sanitation systems which include water treatment plants.  The thing is, our taxes only pay a portion of that.  You as a consumer still need to have some skin in the game and pay a service fee.  The idea behind that being that a portion of the service fees don’t go to pay for anything now, but go into a fund for future needs for the community.  Yes, I realize that has not happened in many cases.  But we’re not talking about how it is (in places like Flint for example) we’re talking about how it should be (and mostly works, in places like Missoula for example).  If you don’t pay your fees, your water will be shut off, eventually.  This is not difficult to understand, one would think.  But though assistance plans are available, and though people are informed on ways to conserve water, they continue to waste prodigious amounts of water and to default and, instead of taking responsibility for their non payment, they scream about water being a human right when what they *actually* mean is that CLEAN water, treated by the cities they live in, should be available to them for free regardless of the actual cost of providing said water.  And regardless of the agreements they signed when they hooked up to the city water service.

2.    Sewer.  This operates on much the same principle as clean water does.  The ability to wash your dishes, your body, your clothing, your floors, and use a toilet to flush your waste, and have all that effluent simply run down a drain for someone else to handle is an AMAZING thing.  We happen to have a septic system, but we have lived in cities as well.  This is an expensive service to provide, mainly because the risks to the population if not done correctly are huge, and the liability involved is also huge.  I don’t know if you are aware, but workers are at huge risk of getting Hepatitis C – for instance – from raw sewage.  It’s a nasty, dirty job, and the pay needs to be very good to compensate those who are willing to get the education and training to keep the rest of us safe.  It’s not in fact a human right.  It’s a privilege of living in modern society.  Yes, I’m aware that there have been night soil workers in the past.  But it was still very primitive and people often got sick due to the primitive nature of the system and the fact that raw sewage was often dumped directly into the river system from which people got their water.

The U.N. says the right to clean water and sewage is a human right.   They do not however provide any funding to assure said rights, and their declarations have no force of law.  So, until they pony up the money to all those people in Detroit and elsewhere to pay their bills and keep them in clean water and sewage, I will continue to ignore the U.N.  It’s quite easy to pontificate on a subject about which you have no financial responsibility.

For both of these essential services I was blissfully ignorant of the science and technology involved. When I was small I never considered it, and when I was of the age to begin considering it, we had a well and a septic system so it remained a relative non issue.  It wasn’t until I was an adult that I learned how it all works.  That’s when I realized how very expensive it is to provide water and sewer service, and how important the payments are in providing – and continuing to provide – these services.

3.  Medical care.  This one is a hot button for many people, me included.  I think we as a society have a responsibility to provide basic medical services to CHILDREN.  If we take care of our children, they will grow up to be as healthy as they can be, and are more likely to become productive citizens if they are as healthy as they can be.  Getting regular visits to catch things like a lazy eye, or hip dysplasia, early, will prevent complications and permanent disability later.

For adults….not so much.  People who do not have to pay anything for their medical care are much more likely to over use the system by increasing ER visits than those who either have commercial insurance or are on Medicare, or no insurance at all.  Some patients cite the copays they must pay at their primary care office as a reason for going to the ER, because they don’t have one if they go there.  Here is the original study abstract if you’d like to read it, the one that confirms what every EMS and ER worker already knew.

This is a huge issue.  If people have no financial skin in the game they have no financial incentive – or any other incentive, really, to follow medical provider advice or instructions, no matter how carefully the provider tries to involve them in their care plan.  They will consistently take the easiest, and the cheapest, way out.  Which in America involves the ER, because they don’t have to pay.

Oh, you say, but people on Medicaid are sicker….?  And….let’s go back to the statement about having financial skin in the game.  In AZ for instance, there is a $4 copay for office visits.  Almost ZERO patients pay this, because they know they don’t have to.  They also don’t have to pay the copay for their medications.  If a provider writes a prescription for Tylenol, Medicaid (AHCCCS in AZ) pays for it.  But there’s a price attached for the rest of us, the taxpayers, a very heavy price.  Generic tylenol costs about $2.99 for a bottle.  If you pay cash.  If the taxpayers pay for it, the cost goes up to approximately $34.99 per bottle.

When I worked in the ER mothers would bring their children in for a cold, nothing more.  When Tylenol was recommended, they would insist on a prescription.  Why?  Because they don’t have to pay for it.  Many of these same patients have *very* expensive gold jewelry, the newest iPhone, designer purses, and perfect manicures.  Yes, some of these patients *are* sicker.  However in many cases it’s because they refuse to listen to advice to exercise, lose weight, and eat a healthier diet.  That involves effort, and most are not willing to invest effort if there is a free option such as a pill.  Even though a type II diabetic will likely end up in renal failure or losing extremities to amputation, most will continue to take metformin over making real changes to their health.  And all the new medications developed?  They are there because patients just won’t do what they need to do to take charge of their health.  It’s just too hard to change.  And there’s no financial incentive to do so, because they don’t bear the cost of their health care.  We do, the working taxpayers.  Even their transportation to and from medical appointments is free for them, courtesy of the taxpayer, here in AZ.

There is no cost involved in walking around the mall for a morning, if it’s too hot or cold outside, and there is no cost involved in walking around your neighborhood if it’s safe enough.  There is no cost, when you have food stamps, in choosing healthier foods and fewer foods that come out of a box.  And please don’t give me the BS line about they can’t afford it.  I was on food stamps when I first divorced my ex-husband.  I did not need to feed my children crap.  I fed them mostly from the produce aisle just as I always had.  Rice, beans – from the produce aisle.  Tofu – from the produce aisle.  Veggies and fruits – same.  My crockpot was, and is, my friend.  So is my pressure cooker.

I think the copays must be enforced.  I think everyone should have some financial skin in the game, whatever their income.  I think people need to be held accountable for their health decisions.  How?  I don’t know, other than financial accountability.

Homophobe.  Nope, never have been.  Don’t want to be homosexual, am not homosexual, not wired that way, but could care less if they want to get married.  Go ahead, be my guest.  The political ramifications of homosexuality in our modern society however….*F* that to be blunt.  If you’re gay and you want a wedding cake, then don’t sue the Christian baker who doesn’t want to make it for you.  Go to a baker who doesn’t give a shit.  Ferchrissakes,  buy a clue already.  All you’re doing is creating an even more hostile environment for yourselves where you’re going to be less safe and more likely to be the target of hostilities in the long run.  And you’re giving nut ball extremists Christians fuel for their Satanic agenda fantasies.  As to access to medical care, I really don’t care if you’re gay or straight, bi or a sexual.  If your sexual behavior makes you more at risk for certain things then that’s something we need to discuss, but other than that I honestly don’t care.  Your sex life is your business.

Transphobe.  Nope, see homophobe above.  I think they are seriously mentally ill, but I also recognize that population genetics plays out on a much larger scale than many realize.  I had a neighbor for 2 years who was transgender male to female.  In that time I went from being sympathetic to pretty well fed up.  No, you are not a special snowflake.  No, your needs and wants do not trump mine.  No, you are not entitled to special treatment.  No, you do not deserve to get angry when people mistake you for a cross dressing man because you won’t get the laser treatments for your face, and you refuse to work on the feminine voice and physical behaviors.  And most importantly, the world does not revolve around transgender issues, and not everything is related to transgender issues.

Islamophobe.  Nope.  Although I do have to say that the Golden Age of Islam was the product of Shia Islam, not Sunni.  Shia valued ancient knowledge, both spiritual and practical, and were the keepers of this knowledge and in fact kept it alive by employing the peoples from the areas they conquered in teaching *them* this knowledge.  They are the mystics of the religion of Islam.  All of the radical Muslims in the world arise from Sunni Islam.  Wahabists, ISIL, Daesh….all of them.  They are now, and have from the start, persecuted the Shia.  Their goal was, is, and shall always be, to wipe them from the face of the earth.  Along with the rest of us who just won’t bend over and convert.

White nationalist.  Nope.  Please refer back to racist, and to islamophobe, and conservative.  I care that two of my ancestral homelands on my mother’s side, Germany and France, have been turned into cesspools of terror and violence, and the countries are becoming unrecognizable as their unique identities they cultivated over thousands of years are being systematically destroyed.  I care that my grandparents’ homeland, Ireland, is suffering the same fate.  I care about preserving the cultures that I came from, about preserving the peoples that I came from, about making sure they continue to exist in the future, not becoming subsumed in the current hyper saturation of incoming (invading?) cultures that have no interest in assimilating whatsoever.  I care that Sweden, my sons’ ancestral homeland via their great grandparents, has been turned into something completely unrecognizable.  I don’t want to see the cultures and countries that produced my ancestors disappear completely, to become something unrecognizable as what they have been.

Alt-right.  Still not quite sure what this is supposed to mean, even though I’ve read up on it.  If it means I think people should take responsibility for their actions, to work for their stuff, to be good citizens, to fight corruption by getting involved in a responsible way, to raise their children to be the same, then I guess I am.  Nazi?  Meh.  Hitler had some crazy ass ideas.  He also had some good common sense ideas.  Like anyone else.  The too bad part is that the crazy ass ideas were so awful we can never explore the good ones, simply because he thought of them.

And BTW.  Calling me any or all of these epithets will get you …. exactly nowhere.  Because the power of these has been expended in the last year.  I rather suspect I represent the backbone of America now, more or less.

The saddest part?  Without changing most of my political viewpoints, I have gone from being a liberal in my youth to being called all of these things in my middle age.  Because they political spectrum has shifted THAT FAR in 30 years.

 

 

 

 

 

 

Busy days, or Good Fences Make Good Neighbors


It’s harvest season, which means that in addition to working 6 days a week (3 for my business, 3 for someone else) I have harvesting and preserving on top of work.  Thankfully, my day is light today.  I have an excision biopsy to perform this afternoon but other than that I’m free.  Which is good because I’m going to need the time.

When I finish my coffee and this blog post, I will be girding up my loins (so to speak) and wading into the tomato forest to harvest another probably 6 or 7 gallon sized bags of tomatoes.  Which doesn’t sound like much until you factor in that most of my tomato plants are cherry tomatoes – they fit a lot more into a bag than Romas.  I planted Cherokee purples, Romas, some sort of Italian plant that give fruit that are Roma-esque but smaller, yellow pear, and orange cherries.  I figured at least one variety would produce.  WRONG.  They all have produced FAR more than I ever anticipated.  This year has been AMAZING for tomatoes!

Then, after I finish in the tomato forest it will be time to venture into the prickly pumpkin jungle.  I bought 6 pack flats of honey dew melons and pie pumpkins – one of each.  Except that the honey dew flat apparently was mostly also pie pumpkin, so I have three honey dew plants which have not produced very well, and 9 pie pumpkin plants which HAVE.  I believe I will have at least 25-30 pumpkins by the time the season is done, not including the ones I’ve already given to the chickens.  Good thing my family likes pumpkin bread, pumpkin cookies, pumpkin pie, pumpkin beer, pumpkin soup … you get the idea.

Now keep in mind that I do raised bed intensive gardening.  So my tomato plants, all 12 of them, are in a total of 64 square feet of space (2 4×8 beds) and share some of that space with cabbage and eggplant.  Though I haven’t seen the cabbages in 2 months…   And the pumpkins and melon plants are in a 32 square foot bed (1 4 x 8).  We have all our beds set up with soaker hoses and an automatic timer as well as deep mulch to keep the moisture in.  We fertilize with manure from cattle and our chickens.  That’s really it.  I don’t weed very much once the plants get established, the deep mulch helps with that and mostly they suffer from benign neglect.  I don’t pinch off suckers either, I just let the plants do their thing and other than some tying up that’s really the extent of my care.

Then I need to prep a bed for garlic.  I got organic Italian soft neck garlic to plant later next month.  Supposedly we should plant in November for harvest in July but I’ve found that just doesn’t work well here.  So I want to try planting it earlier to allow it to get a better hold before the frost hits, so the bulbs may be bigger next summer.

Then there are still the harvest of figs to deal with…I let go to waste probably twice as many as I was able to harvest and get into the freezer, and there’s likely 30 pounds or more in the freezer.

Then we have to finish putting up the bamboo 6 foot fencing around the back yard.  I have 4 foot garden fence but I am tired of the skunks, dogs, and cats trying to dig under it to get into our yard – just going to wire the bamboo fencing to what’s already there and put rocks along the base on either side.  We’ll have a little bit of shade in the summer for the more tender plants as well as somewhat of a wind break plus maybe a little more privacy.  Our county code requires a permit for anything over 4 feet but since this is in no way a permanent thing I do not plan to get one.  I’m pretty sure biodegradable fencing wired to an existing fence is not cognate to putting up a 6 foot block wall or to putting up prefab 6 foot wooden panels.  So I’m just not going there.

The one main reason for the fencing in the first place is this:  our money hungry county workers have decided to go to the poorest areas of the county looking for obscure violations of codes that no one knows about and start fining people for these violations. One of my patients, a disabled elderly woman, got a citation for “weeds.”  That’s what it said.  Well duh, it just rained every day for 3 weeks straight and you are going to fine her because she has an overgrowth of weeds????  So the county is saying that if it can be seen from the road, they will fine people.  People who have building supplies in their back yards are getting citations because it can be seen from across the alley on the street behind them.  People who have piles of wood are getting fined because it’s an eyesore.  Yes, I’m serious.  We got a citation for ‘trash.’  Yep, all those nested planting pots, piled bags of mulch, manure, unused raised beds, sliding glass doors and windows for the greenhouse neatly leaned against the house next to the greenhouse, neat stacks of walkway bricks, are all trash… stupid jackasses.  Money hungry bastards.  If I had planned on living in an area with rules like this I wouldn’t have moved where I did.  Hence the fencing.  Keep your damned nose out of my yard.  And out of my neighbors’ yards too.  I know one guy that wants to build a garage but the county won’t give him a permit.  But they were sure happy to give him a citation for the building supplies in his yard!

And, we need to get rid of our van with the blown transmission.  6 years of it sitting is plenty long enough.  Then we need to move our travel trailer over about a foot so we can install fencing along our side border down to the street.  Our neighbor has a pit bull they don’t keep in their yard, they let him wander, and he attacks our cats and us.

Then we need to look into getting a permit for wood so we can replenish our wood supply for the winter.  $20 for a permit for up to 4 cords versus $180 for 1/2 cord delivered…that’s an easy choice.

No, all of this is not going to be accomplished today!  But it has to be done soon….winter is coming and the harvest won’t wait.

Next post will be regarding seasonal harvest feast traditions and localizing one’s traditions to one’s climate zone.

 

 

 

 

Hospitality violation


My neighbor, whom I’ve written about before Here.  Came over today to buy some eggs.  Three dozen eggs.  She paid cash for them.

Now, I’m never really happy to see her, she wore out her welcome a while ago by constantly begging for food when she was here.  That finally stopped when we started telling her “No, we need that for lunch at work.”  Well mostly stopped.

Let me give you some more history and background.

She was discharged from her own medical practitioner last year because of drug shopping.  She came to me to gripe about it, and I told her they have that right.  She is the one who agreed to the terms when she began going there, she has no one to blame but herself.  She then tried to say she has the right to get a second opinion and I agreed with her, but told her she is the one who signed the contract, she maybe should have read it a little more closely before deciding to get a second opinion AND filling a narcotic script from the other practitioner.

She has no job, no visible means of support, yet she gets tattoos regularly – she is covered from neck to feet.  She says people just give them to her, my husband says she is trading sex for them (which might actually be true).  She worked for many years as a stripper.

She has tried to tell me for a year that there is something wrong with her thyroid (there’s not, I saw the tests myself), that there’s something wrong with her sinuses (she saw a specialist who told her there’s nothing wrong), that there’s something wrong with her heart (there’s not, she had an angiogram but before that for months her excuse for lying in bed all day was chest pain), that she has anxiety and insomnia (but when asked how much she sleeps she says about 12-15 hours per day), that she can’t lose weight and feels tired all the time (yes you probably do, you sleep too much and you don’t exercise – and you’re nearly 50!).  There’s a word for this:  malingerer.

She says she can’t get a job (well probably not, your top lip is pierced twice and your bottom lip once, your head is partially shaved and neon red where the hair is actually growing, and your tatted from neck to toes).  This is rural Arizona.  That crap is seriously frowned on.

Today was the final straw.   Nearly every time she comes over here she tries to use me as a free second opinion.  Today she asked me about doxepin.  And tried to tell me she’s going to try to get on Adderall.  Which is legal meth.  I lost it.  I told her flat out that I’ve known her for a year and she does NOT have ADD.  Or ADHD.  She said that yes she does, she took a test and it said she probably does (one of these on line self tests mind you).  Now seriously.  Think about the previous two paragraphs, what I’ve said about her, and tell me if that looks like ADD/ADHD to you.  She’s spent the last year bitching about her heart, her metabolism, her fatigue, her sinuses and NOT ONCE about anything remotely compatible with ADD.  Other than the changing focus on different body parts when they are proven to be just fine, mind you.

I actually began yelling at her.  “Bull $h!T!!  Bull $h!T!!  No you do not! You F*ing do not!  I’ve known you for a year, you do NOT have ADD!  You took a F*ing self test, they’re very easily manipulated to get the results you want!  You just want F*ing legal meth!”  I basically threw her out of the house.  I actually told her right before I shut the door in her face that she just wants it to sell it.  Which is probably a huge hospitality violation.  But really.  Does coming over and bouncing a bogus diagnosis of ADD/ADHD off your practitioner neighbor when you’re purportedly there to buy eggs really count as visiting?

I seriously think she wants the meth so she can sell it – there are several people here in the community who were getting it from the previous physician (who has since gone on to more lucrative pastures) and were selling it as well as using it.  I know there’s a market.  And I know who was selling it.  And she can’t get a job, so the logical thing would be to fake an illness in order to get a controlled substance for sales purposes.

Man I get sick of the people who are bleeding the system dry.  I work 6 days per week, and I have insurance that I can’t use because the deductible is $6500.  My husband doesn’t even have insurance, we can’t afford it.  I’ve been to the doctor maybe once for an actual physical since we’ve been together (nearly 20 years) and twice for employment related physicals, and maybe 3 times for urgent care type issues.  He’s been to the doctor three times  for a physical (all employment related) and once to the emergency room for an allergic reaction.

Our neighbor goes to the doctor, courtesy of the taxpayer, at least once a month!  And gets very expensive medications prescribed, for which she pays nothing, courtesy of the taxpayer!  And then proceeds to refuse to take them.  And there’s no reason she can’t work other than the fact that she deliberately makes herself unemployable!  These are the people who are breaking the system, not the hard working poor people who really do need a little help.  And believe me, I live in a very low income community.  I know which of my neighbors work and which are milking the system.  For all the good it does.

I actually do not have words for the amount of anger I am feeling right now.  And a little shame that I let her get to me.

 

 

 

 

 

 

 

 

 

 

 

Not such a lost art


Spinning in Donegal, 1978

My grandparents on my father’s side come from Mayo and Kerry.  I see the ruddy complexion in my boys (and me) is a ‘thing’ for those of us with Irish ancestry 🙂

When I first sat down at an antique wheel it was as though something ‘clicked’ in my hands.  My hands knew what to do before my brain caught up.  I suspect something like spinning, a skill with such a long history, is carried in genetic memory.

While I can’t speak for my ancestors, who may very well have hated the task, I can say that spinning gives me comfort, a time to meditate, a peaceful space in which to contemplate everything and nothing.

New Year, Big Changes Part 3


Gods I hope I can get this into one last post.  I tend to elaborate too much or else I assume people know/understand things they couldn’t possibly, unless they were there.  so.

I incorporated, I got a Tax ID, I got a group NPI (a must to take insurance payment), a bank account, and I researched what all was involved in getting credentialed with Medicare and Medicaid (or in my state’s case, AHCCCS).  But.  I drug my feet HARD on actually starting it.  Because that, in my mind, was the final step – the step that meant I was really going to do this.  Which meant I was really going to quit my not cushy but mostly predictable job.  Which is a rather frightening thought.

I suppose I should say what I wanted to do for a business.  I never wanted to compete with the other office, that was never my intention.  What I wanted to do was make it easier for those with debilitating chronic illnesses, those without their own vehicles and dependent on medical taxi services, those who were too sick to go to the office, to see a medical provider.  I wanted to do HOUSE CALLS.  I did a lot of research on the idea and it really seems like an idea whose time has come once again.

Mr. TinFoil was initally EXTREMELY against the idea of starting our own business.  He asked one of his medical directors for advice – without consulting me.  The medical director, who just the week before had told Mr. TF he was making so much money working for Mr. TF’s company that he was only seeing patients in his *own* practice 2 days per week, said it was a very bad idea and “the only way to make any money at this is to save up to buy your own business and have the waiting room full all the time.”  Hmmm…not a very reliable source in my opinion, given the apparent hypocrisy and inconsistency between the two statements.

But then he asked some of his coworkers what they thought of it, and all were universally enthusiastic about it.  One of the NP’s who works for his company even asked him to keep her in mind if I expand enough to hire someone else.  Which I thought was a fairly ringing endorsement.

I had already done WEEKS worth of research on Medicare pricing structures for our area so our superbill could be updated (and corrected).  It was simple enough to add in the pricing for home visits to my research.  I kept the results of my research in a separate folder on my computer and also in hard copy to make sure I had access to it even in the event of a computer failure.  Thank the Gods I did, because with the change in ownership and the loss of my job, it was already done and easy enough to put to use.

So after I got canned, I started the processes for getting credentialed.  UGH.  It took me 2.5 days to wade through the Medicare applications, IRS forms, etc I needed for myself and for the business.  And I mean 10 -12 hour days, not 2 hours here and there.  I suppose it’s faster if you’ve done it before though.  Then I began the process for getting credentialed with the insurance companies.  Which has been a problem, because if you don’t have a Medicare number you basically can’t get credentialed with the insurances.  Much of that work time has been wasted, and will have to be done all over again when I get my Medicare number.

This week I will begin marketing my business in earnest.  I live in a retirement state, there are huge numbers of people that this will appeal to!

 

 

New Year, Big Changes


So.  Working in my own community has been a dream of mine since I still worked for the local fire department.  Yes, I worked for my community, but I wanted something more.  Then I hurt my back on the job and re-evaluated my entire career choice.  I went back to school, then went back for more, then went back for my master’s degree.  And got my national certification.  And started working.  In my own community.

Well, the lesson was Be Careful What You Wish For.  My boss literally hated his business and all of the people working for him.  When I started there he was on the verge of both business and personal bankruptcy.  He hired someone I’ve known for years to be office manager/biller and then we hired someone who has extensive (30+ years) experience in the medical field for the front desk/referrals.  We brought in friends and spouses and we spent our weekends there, unpaid, working to make the office presentable.  We cleaned carpets, washed walls and windows, scrubbed floors.  We brought in our own cleaning supplies because he wouldn’t furnish them.  I brought in my own furniture to make the waiting room more pleasant and less like a bus station.

We turned the practice around.  When I started there it was losing about $15,o00 per month (estimate).  Every month since I’ve been there we’ve made at least enough money to pay the bills, and every month since September we’ve made a profit.  A small one, but a profit nonetheless.  In December we made nearly double what is needed to break even.  We brought people back into the practice that had left years ago due to bad management.  We were nice to the patients.  We knew many of them because we too live here.  And they knew us.

But he lied to us the whole time.  He wouldn’t even buy supplies needed to see patients, the doctor bought our supplies out of his own pocket.  He sold the business out from under us – the doctor and I were working on a deal to purchase it – to someone else with cash in hand and a slick line.

And the new owner let all of us go.  He bought the practice on a Tuesday night, and we were all fired by Wednesday at 130pm.  He said he didn’t need us, he was bringing in his own staff.  The irony of this is that if he had seen the practice when I came on board, or when the office manager came on board, he NEVER would have looked twice.  We made it work.  And for that we are out of jobs.

The new owner is from the East Coast, New York or New Jersey, and he doesn’t understand how word travels.  He’s a physician’s assistant, and he needs a doctor at the office to be able to work – the doctor is the only one who didn’t get fired.  But he doesn’t like him, and he doesn’t like how he works.  Which is very slowly.  Because, while he wants to make a living, he’s not in this to get rich.  Which is why he is still here in this community – the patients know that.  And they are loyal to him.

I don’t think this new owner understands small town politics.  At all.  The patients who were coming to see me were coming to me, for the most part, because they wanted to see ME.  Not just anyone.  I’m not a number to them, I’m their neighbor.  The office manager is as well, and so is the front desk person he let go.  And by firing us, by assuming that people would just see him instead and just have to deal with his new office staff, I think he has badly miscalculated.  We are not interchangeable.  If the phone calls I’m getting are any indicator, I think the physician’s assistant owner may be in for a nasty surprise in the financial department.

You see, common sense doesn’t mean what most people think it does.  Common sense is what the peasants have – hard won experience based on the realities of struggling for a living day to day.  It isn’t common, and it’s not something wealthy people have in any degree whatsoever, because they lose it as they get more out of touch with every day realities.  And this guy has no common sense.  He sees dollar signs instead of patients.  I see my neighbors.

Sometimes….


So I started working in my new field.  Well really, an extension of what I was doing before, only now I’m accountable to myself and the board of nursing and my malpractice insurance issuer and my boss.

I’m an independent contractor and I get a straight percentage of the collections on patients I see.  Not a bad gig, I don’t get benefits, insurance, or retirement – but I set my own hours, and my income is limited by how many patients I see and how much income my billing brings in.  The worst part is I only get paid once a month.  And our old biller, who hopefully will fall into a great chasm and never been seen or heard from again, hadn’t even begun to bill for July 29th as of Sept 1.  Jerk.  I’m so glad we have a new biller!

Well the other office got broken into last month, the safe was stolen,and the checks for the business account were in the safe.  My already meager check bounced because the office manager apparently forgot to include my name on the list of checks that were supposed to be allowed to go through on this account, which had been frozen due to the checks being stolen (and four forged checks have already been presented and refused).  So I did not get paid at all this month after all.

I haven’t had a paycheck since July but I’ve been working my @$$ off! The July paycheck is from the old job…the new one hasn’t paid my a penny that I’ve actually gotten to keep.

Sometimes…I think I must be wearing a “kick me” sign on my back, spiritually speaking….

Population medicine


Obamacare treats not for the patient in particular, but for the patient on average, globally, or in the abstract

This isn’t a problem specific to the ACA; it’s endemic in national health systems all over the world, all of which are more or less in the thrall of pharmaceutical companies who control and produce most of the research that determines population medicine.

The problem with the pharmaceutical companies sponsoring research however is twofold:  1, they control who gets into the study and define the outliers; and 2, most of these studies are not appropriate for population generalizations because they are small in size or short in length.  Oh, and I guess this makes it threefold:  any results that are not favorable to their drug will never see the light of day.

Now controlling who gets into the study is related to the outliers in that, if in the pretrial part of the study, people who have adverse reactions right away will be eliminated from the study.  So people who might give a truer picture of the drug’s ill effects will have been eliminated right off the bat.  And outliers are defined as people who have reactions that are supposedly really rare and do not give a true picture of the overall study results.  For instance, take Celebrex.  It’s a nonsteroidal anti-inflammatory drug, in the same class as aspirin, ibuprofen, naproxen, etc.  Pfizer, the manufacturer, said its drug was better than those others because it didn’t hurt the stomach.  Well, as it turns out, that was not the case at all.  The reason they were able to claim that is because, if you read the link above, you will find that they only released the first six months of a year’s worth of data.  Most of the stomach problems developed in the second half of the study; because of this they were able to deceive regulators, medical providers, and the public at large into believing this drug was safer.  They altered the study’s parameters to hide crucial data related to side effects, and they explained “poor results as the result of ‘statistical glitches.'”  ***statistical glitches is researcher speak for outlier***

Perhaps the worst offender in this is Merck.  Their drug, Vioxx was taken off the market because of the substantially increased risk of a heart attack while taking it.  This was defined as an outlier in their results – which means they knew there was an increased risk before this drug ever went on the market.  Yet they chose to define a statistically increased risk as an outlier, dump all the data related to the people who had had a heart attack during the course of the study, and publish results that were very positive toward their drug.  Of course, they also paid for a study to be published that was favorable to their product without disclosing their financial relationship and were subsequently sued.  Multiple times, in multiple countries.

Regarding study length:  In the case of Celebrex, they released results related to only six months of what ended up being a six year long study.  How can one make a decision about a medication’s safety or efficacy when the study hasn’t even been completed?  Where are the critical thinking skills for those who are in charge of approving a drug?  Where are the critical thinking skills for those prescribing the drug?  The public doesn’t have the general ability to decide if a study is good or not, they rely on the government to determine a drug’s safety and effectiveness, and they rely on their providers to prescribe drugs that have benefits that outweigh the risks.  They are being seriously failed on both accounts.

Unfavorable results are related to both of the above drugs.  Data that showed there was substantial risk for certain groups of people in both cases was simply hidden.  In many cases, studies are never published at all – their data is simply buried and never sees the light of day.

So why is any of this relevant?  Well, guidelines are created based on the cumulative results of published studies.  And guidelines are what are forced on providers in order to make sure they are adhering to the standard of care.  Standards of care are based on population medicine, not on individual people.  They don’t allow for individual preferences, variability in response to a drug, differences in financial circumstances or lifestyles, religious prohibitions, or any other individual determinants of a person’s ability (or desire) to adhere to a given regimen.

If we can’t rely on the results of studies, we can’t rely on guidelines that are created from them.  And this is a big problem when reimbursement, and even licensing is predicated on adhering to guidelines.  In a local to me case, an Arizona cardiologist is under investigation because he advocates non-guideline based recommendations for his patients.  This is a huge problem.  If a physician can’t read research and make decisions for his practice, but is expected to blindly follow guidelines or face having his license revoked, how can one trust one’s medical provider that they are doing the right thing for you, the patient?

In an even more insidious fashion, the powers that be (government in collusion with the pharmaceutical and insurance companies) are requiring (here in the States anyway) that a provider have an NPI.  That’s a national provider number.  And it has to be printed on all prescriptions or the pharmacist will not be required to fill them.  So what?  Well, if you don’t follow the guidelines, and you don’t accept the insurances the government wants you to — because you prefer to offer your patients advice that you feel is healthier and safer for them as an individual — you can have your provider number yanked even if your license is not revoked.  Either way you can’t fully care for patients and are out of business.  I wish I had links for you for this one, but I don’t.  I don’t even remember where I read this, but trust me when I say this is indeed going on.

Population medicine.  Peak medicine.  Grasping for financial straws.  And you, and I, the little people suffer.

Makkin Belt


IMAG1052

In the Shetland Islands, knitting is known as ‘makkin.’  Hence the name for my belt.  You see, most production knitting used ergonomic methods that allowed women (and men, and children) to knit quite quickly, with even tension, and allow knitting while walking or caring for family tasks.  In the Shetlands, this involved a knitting, or makkin belt.  It’s worn with the large part on the side, and a double pointed knitting needle (pin, as they’re known in the UK) is inserted into the belt at an angle that allows the needle to remain stationary and enables the hands to maintain a more ergonomic position for a longer period of time.  It also keeps the wrists more or less out of the motion of knitting, which greatly reduces the risk of over use injury.

I purchased the leather, the awl set, the leather needle, and rivets at my local leather shop.  Unfortunately, for whatever reason, I could only get one of the rivets to stay and “grab” the belt so it’s sewn at the other end.  It was a lesson for next time.  The belt was already made, purchased at the thrift store for something like 50 cents.  It’s stuffed with a surprisingly large amount of tulle, as horsehair – the traditional stuffing, while available – was extremely expensive.  I know, it’s not especially pretty, but I’m hoping it will be functional.  ETA:  I used graph paper to sketch out the basic shape and traced it onto the leather.  It’s approximately 8″ long, and 3″ wide.  I used the 1/8″ diameter awl bit to make the holes for the lacing.  I ‘eyeballed’ the holes both for the lacing and for the needles; I didn’t have a tiny awl for small diameter needles so I used a T pin and made those holes; the larger ones are made with a hand punch awl of an unknown diameter.  They are randomly placed on the surface.

I have noticed lately that knitting causes me to have pain at the base of my thumb near where it joins the wrist whenever I knit for more than an hour or two – even if I am a good doobee and get up and stretch every hour.  I currently have a very large collection of circular needles that I’ve accumulated, because I find they are easier to carry around and use wherever I go. The alteration in my style when I use them, however, causes the pain due to my wrists turning more to flick off the stitches.

I have decided that if I am ever going to be a production knitter I need to become MUCH faster than I am.  I’m no slouch right now, but I really want speed without sacrificing quality.  When I knit with single point needles, I have always naturally braced one against the crease of my thigh or into a pillow next to me, which allows me to knit faster and more ergonomically.  I have no idea where I first learned this, but my paternal grandparents were from Ireland so I may have seen Irish style knitting at a very young age and simply copied my grandmother without realizing it (she passed away a long time ago, I have no real memory of her other than her asking me if I understood – in Gaelic).  Using a knitting belt is a natural extension of my instinct, that will allow me to knit in other places than my couch – and to take it with me anywhere I go.  I did try lever knitting, where the needle is held under the arm, and that hurt my wrists very badly very quickly.

This is a video of Isolda Teague using a knitting belt.  It is probably the most clear in the placement of the belt and the use of the needles that I have seen.

I haven’t tried it out yet, but I am anxious to do so on some sort of project that can be appropriately hidden (like socks) until I get the hang of it.

I suspect that in times to come, when hand made becomes a necessity once again, this will be a good skill to know and to pass along.  And I have enough leather left over to make another belt as well.

Doug Ducey is an ass.


I may, or may not, end up updating this particular post with appropriate links, but right now I am so angry I just have to post.

Doug Ducey is the governor of Arizona.  He ran under the guise of bringing fiscal responsibility to our state.

The new budget passed is a travesty.  He says we can’t afford to fund teachers, higher education, social services.  But apparently we CAN afford to fund the building of NEW private prisons that will be run as FOR PROFIT enterprises and we will see only a FRACTION of the revenue brought into them, all the while our taxes go TO those prisons to fund the staff and maintenance.  W. T. F. Doug.

If they wanted to REALLY do something they could legislate that school administrators make a maximum of 10% more than the teachers AND that they have to keep their offices INSIDE the schools they are administering – and superintendents must ALSO be inside one of the schools, or maybe in a rentabox type trailer on school grounds.  NOT in lush separate buildings at a hard to reach location.

If they really wanted to do something they would do the same with the higher education schools.  It’s ridiculous when a nursing instructor with a Master’s degree makes so little he/she still has to work part time as a nurse in order to make ends meet.  And again, the administrators should be making a MAXIMUM of 10% more than the faculty.

I won’t even go into the problem of the school sports programs and the corruption there.  I worked as a tutor for some of the football players when I was a student at U of A.  O.M.G.  Well, first you have to learn to read and write English before I can tutor you.  And no, I am not going to do your work for you.  Obviously I didn’t last long at that job. That was more than 20 years ago; I can only assume it’s even worse now.

So let’s cut social services.  OK, I agree, there are a lot of moochers out there.  But if you’re cutting school budgets, that means students suffer.  If students suffer, they’re not getting an education.  And if there are no social services available to keep them off the streets/get and keep a job?  They become criminals.  And then they end up in the FOR PROFIT PRISON SYSTEM.  Oh, I get it.  We’re paying back our for profit prison buddies who got us into office, not serving the citizens who have to pay the damned taxes for this shit. 

WTF Doug Ducey.