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….

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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


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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.

Measles Schmeasles.


I am SO DAMNED SICK of all the hype about the ‘outbreak’ of measles at Disneyland.  So far, nationwide, there are something like 171 ETA 87 cases connected to Disneyland.  171, 87, people.   And how many have died?  NONE. 

When my children were small, my mother, a former nurse and special education teacher, asked me not to continue with the current vaccination schedule because she had concerns about a possible MMR/autism connection.  Now, keep in mind, this was in the early 80’s, LONG BEFORE DR. WAKEFIELD.  My oldest son did have a change in behavior after receiving his first MMR.  It concerned her enough that she made the request.

She also had concerns based on Japanese research, if I remember correctly, about other problems like ADD/ADHD and vaccine induced encephalopathy.  So I did as she asked.  My children *were* fully vaccinated.  Just not according to the CDC schedule.   And not until they were ready to start school.  The key, I believe is that in the 80’s, and early 90’s, the vaccine schedule was approximately HALF the number it is today, and doctors were much more proactive about NOT giving vaccines to children who were sick.  Today?  Not so much.

Let’s talk about measles for a minute, shall we?  My oldest son is the product of a high school romance, and is actually a half brother to my other two children.  Because I was a single mother for the first part of my oldest son’s life, I had to work to support us.  The day care he went to was in the home of an older German woman, who also watched 4-5 other children.  One of these children got measles when Dear Eldest Son (DES) was 12 or 13 months old (14 mo?).  DES got it shortly thereafter.  And so did I.  Now, DES was too young to receive the MMR yet; it was given at either 15 or 18 months of age then (I can’t remember for sure which).  I, however, had been fully vaccinated as a child and *should* have been immune.  Yes, well.  So, at the age of 19, I spent a week with my child in a darkened house, both of us feverish, rashy, and suffering from headaches and light sensitivity.  And then we got better.

This is the normal course of measles, by the way, in a basically healthy population with good sanitation.  Between 2000 and 2005, I believe there were less than 10 deaths from measles.  There have been ZERO deaths since 2005 from measles.  It’s not exactly a terrifying horrible disease that kills millions in the US every year.  And you should know that the side effects *of* the measles vaccine are the SAME as the measles:  encephalopathy, pneumonia, febrile seizures, death.  Adverse effects per the package insert.  Oh, and you can get measles *from* the vaccine.  This is because it is a live virus vaccine.  12 month old with lab confirmed measles, vaccinated Jan 2015.  The difference is that vaccine induced immunity wears off.  That’s why I got it even though I had been vaccinated.  And that’s why DES got it even though he was breastfed, because my waning vaccine induced immunity couldn’t protect him.  We both are PERMANENTLY immune now, though, because we have actually had measles.  My titers reflect this. 

Contrast my story with this:  Doctor fed up with measles outbreak takes controversial stance.  Oh, yes, those children with measles are such a threat.  It’s such a deadly disease that ZERO people have died in the past near-decade.  Terrible risk, isn’t it Dr. Goodman?

Well, here’s the thing.  The strain of virus in the vaccine is no longer the wild type strain of measles.  This is well documented and can be easily (though expensively) checked when measles is confirmed in lab testing.  So people who are vaccinated, AND up to date on their vaccines, can still get and transmit measles, thanks to genetic drift away from the vaccine strain that causes a less than robust immune response.  The body doesn’t quite recognize measles because it’s not quite the same, but sort of the same, so the immune system can’t decide if it should respond with the antibodies it has already made against the vaccine strain or if it’s something else entirely.  Here is a study that documents the differing immune type responses (in cell cultures) between the two.  Notice the statement that the vaccine strain doesn’t induce the strong immune response that the wild type does.  That’s key to this discussion.  Now I should say that my original major was microbiology and immunology, but I do not pretend to be any sort of an immunology specialist or expert, and this is what I get from the studies I have read.  A less than robust immune response is why people are not immune and get subclinical or atypical disease.

So you get measles, you feel crappy (sometimes) but you don’t look like you have measles.  The good thing is that after you *get* measles, you will actually be immune.  Here are some studies that document measles infection in vaccinated populations:  Subclinical measles in Greenland,   Measles and subclinical measles in Africa,  just for a very small sample.  Google “subclinical measles in vaccinated people” for many many more examples.  In fact, the CDC admits this in the MMWR (Morbidity and Mortality Weekly Report) for August 24, 2013:  “Thirteen (8%) of the patients had been vaccinated, of whom three had received 2 doses of measles, mumps, and rubella (MMR) vaccine. “  You can read the rest of the report here.

It’s not that uncommon for outbreaks to occur, and the hype over how dangerous it is is dreadfully overstated.  For instance, this Wikipedia  article quotes the CDC as stating in the 20 years after the measles vaccine was introduced, it prevented an “estimated 5200 deaths”….that’s 260 per year.  Now I’m not trying to denigrate 260 people dying every year from measles, it’s still tragic, but hardly on the same level as, say, heart disease in which the CDC estimates 600,000 deaths every year – 1 in 4 deaths EVERY YEAR from something mainly lifestyle related.

My personal suspicion is that, since the CDC makes $36.22 per 10 pack of vaccines it sells to licensed vaccine providers (that’s your local doctor), it has a pretty profound vested interest in making sure the population is forced into receiving the MMR.  This is especially true since the two main virologists who worked at Merck, the ONLY licensed M/M/R vaccine producers in the US, are being allowed to proceed with their lawsuit  against Merck for fraudulently inflating the effectiveness of the mumps portion of the vaccine.

So, in conclusion, I think the CDC is as corrupt as any private pharmaceutical company, and just as financially reliant on vaccine sales for their existence.  And because I think this, I believe they are deliberately chumming up hysteria and mongering fear about a relatively harmless childhood disease in order to protect a part of their revenue stream.  Vaccinate, don’t vaccinate, it’s up to you.  I’m just not that worried about a measles outbreak in my community.  Vitamins A and D, decent nutrition, lots of fluids, sunglasses, and common sense should be all we need to recover without sequelae.  And that’s it.

And now back to the regularly scheduled knitting and studying frenzy that is my life until my final exam on February 18.

 

Obamacare just might be going away after all.


http://www.motherjones.com/politics/2014/11/supreme-court-just-took-case-could-gut-obamacare-heres-how-states-can-save-it

So there you have it folks – it’s from a liberal perspective, so they’re all about saving it, but facts are facts.

How do you feel, if you live in a ‘red’  state, about having/not having this?

I’m concerned from the perspective that people won’t just go back on what they had before, if they had Medicaid or in Arizona’s case, AHCCCS (pronounced access).  They won’t have anything at all.  And I can tell you, from dealing with Obamacare in residents who were on AHCCCS and are now on ACA, it’s a poorer insurance with fewer choices, higher costs, and less coverage.  This is fine for those who should really be having some skin in the game, but for the elderly who were on some form of state sponsored long term insurance under medicare/medicaid, it’s really pretty paltry, and denies them access to the medicines they need unless they want to spend far more than half their monthly income on insurance premiums and medications.

I agree in principle that ACA must go.  It’s an insurance company bailout, and a gift to the pharmaceutical and hospital industries, nothing more.  But we really need to be having discussions about what will take its place.  When I get my license, I can provide visits for a quite reasonable fee, or barter for things we both benefit from, but that doesn’t help when the person needs to be hospitalized, or if the medicine they really need costs $249 per month.  By the time they’re at a place where they need a medicine that expensive, there are not many herbs I can prescribe that will do nearly so good a job of controlling symptoms.

Once again, we really need to be having discussions about alternative ways of care delivery.  And about medication costs.  And about hospital costs.  And about the elderly’s idea that medicare should be free for them.  And about the younger people’s idea that Obamacare should be free for them.  We STILL don’t have insurance.  Why?  Because it was too expensive even with the subsidies.  For a $12,700 deductible, we’ll just take our chances.   The penalty is significantly cheaper than buying the insurance would have been.

The system is broken.  We need to look at alternatives.  When can we begin this conversation?  Without having to talk about concierge care type systems that only benefit the wealthy, or subscription systems that still don’t address medications or acute care, or the idea that some should just go without or die?

I hate living at the twilight of empire sometimes.  Hobson’s choice indeed.

Ebola.


I have been very busy with real life recently; my oldest son and his wife whom I haven’t seen in two years came to visit and to be present at my middle son’s wedding. But of course the topics in the news came up during our conversations.

My son lives in a town with a genuine Level 4 containment facility. But here’s the problem: even the staff that are assigned to that area state that they aren’t adequately trained to work in it! Why? Because it costs money, a lot of money, to have the supplies ready to use in doing the training necessary to keep people not just minimally competent but proficient at such a methodologically demanding task.

It’s something similar to Magnet status for hospitals — they all like to promote that they have magnet status, but most of them don’t live by the ethics and level of staffing a magnet status requires — they just up the staffing for the original certification and the recertifying. In between? Just like everywhere else, overworked and under staffed. I know, I used to work for a magnet hospital. And having a level 4 containment facility gets them extra government money just like magnet status does, but they don’t spend the extra money toward what it’s supposed to go toward: maintaining appropriate staff levels and training to back up those special status items.

Dear oldest son said he thinks hospitals are going to have to make a decision on whether they will care for Ebola patients or care for the community; he thinks any hospital that admits an Ebola patient is going to become ‘toxic’ to the rest of the community, especially if other patients get infected from exposure at the hospital, and they will either have to close to the public to care for Ebola patients or they will have to turn them away to Level 4 facilities if they want to take care of the rest of the revenue generating patients they would normally see.  I think he may be right.

I made a comment on another site I visit every so often on a post about Ebola. I said something to the effect that, if it did in fact become an epidemic in the US, that nursing staff were going to begin refusing to care for those patients. Or even refusing en masse to even come to work.  While I haven’t gotten any real negative feedback and plenty of “likes” for the comment, I did get a response that ended with the statement “ebolaf@#kyou I ain’t afraid.” Or something to that effect.  I am, quite frankly, much too lazy to go and actually look up the comment; it wasn’t phrased in an insulting way.

I took that to mean the author of the response thought I was afraid of Ebola, or that nurses were, and that fear is a bad thing. So I crafted this response:

I have been in medical services since 1994. First as an EMS person then as a nurse. I am used to putting my life on the line in service to others. I used to be the one who ran into the burning house you all ran out of. I’ve fallen through floors, been in flashovers, broken bones from collapsing gear, been puked on by contagious patients, been stuck by contaminated broken glass, had exposures to tuberculosis, meningitis and hepatitis among other things. It is part of the job. You just keep working, whiners need not apply. HOWEVER.

I was trained in how to deal with all of the above, and I was given the tools to do my job properly and safely. My supervisors took my safety seriously. I was trained to recognize the symptoms/signs of danger in the situations I faced and encouraged – required even – to take appropriate action to minimize the dangers to myself and my crew.

This is not the case when it comes to Ebola. Hospitals aren’t capable of handling this, just ask any nurse or doctor in a facility near you – off the record, of course. There is no training and no real plans for training. No facility is going to waste the money to purchase the gear and then waste a lot of it in training staff how to safely don and doff it, unlike the training offered to me in HazMat, fire fighting, and EMS training. It’s just not going to happen.

You want people to not be afraid? Then they need to be trained to recognize early symptoms, to be ready to err on the side of safety, and to be aggressive about taking defensive actions. Nurses in particular are held up as these Florence Nightingales with lanterns sacrificing their lives in service to unwashed humanity (even the male nurses among us).

Do you really think, when health care has become a multimillion dollar business, that image is going to be the reality? When what the WHO and the CDC say about transmissibility differs in not insignificant and potentially deadly ways? When Sanjay Gupta can’t doff protective gear without contaminating himself on live TV?

My husband also works in the health care field and had a conversation with a doctor about Ebola. The doctor said straight up that if it became an epidemic he wasn’t going to be bothering to come to work, he was going to be home caring for the safety and health of his family where he belonged. That’s the reality. It’s not pretty, it’s not what the public wants to hear, but reality is a harsh mistress.

I’m not afraid, at least not blindly so. I think one must take precautions, and protect oneself, and be able to assess risk. I have a lot more chance of getting a Norwalk type virus than I do of getting Ebola, thankfully, because one involves 3 days of wishing I were dead and one involves the likely possibility I will in fact die. It’s all in assessing risk.

This whole idea that nurses are, and should be, held to a “higher standard” than the likes of the rest of the great unwashed humanity…?  Bunk.  We’re people just like the rest of you.  Nurses are obese, smokers, diabetics, drug abusers, alcoholics, codependent, crazy, in possibly much greater numbers than the rest of the population as a whole.  As I said in my original comment, I have a license and a calling, not a death wish.

Enough said.

Wool has to be soft…?


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This is hand spun, hand dyed wool from local sheep. It’s reasonably soft, being a Jacob/Merino mix, but not the softest thing I’ve ever felt by a long shot. Who cares, right?

Well, this yarn is for sale on consignment at a local yarn shop. When I was last in there, several women were feeling it and commenting that it wasn’t very soft. Then they asked me why the alpaca yarn was so much softer. I never got the chance to answer, because then they realized it *was* alpaca.

Now, I’m not a fan of really scratchy wool. I don’t know anyone who is, except perhaps people who weave carpets. But because I buy raw fleece from a variety of breeds, and process it myself or send it to my friend Rita at Arizona Fiber Mill, it is not processed by using chemicals to burn the vegetable matter out of the fleece. This preserves the inherent softness. It gets plain old soap and really hot water, just as it’s basically been done for hundreds – thousands – of years. Though to be fair in some regions urine was boiled to wash the wool. Urine actually is a pretty powerful antimicrobial cleaner, believe it or not. The active ingredient is ammonia.

But back to the title of the post.

As a hand spinner, I spend a lot of time with fiber. I want my finished product to be beautiful, functional, and above all durable. There are many types of sheep who produce many types of wool. ALL of these sheep were developed for specific purposes. And until recently, those purposes had to include not only meat, but fiber as well.

Want a durable carpet? Don’t use merino wool! Use the outer coat of an Icelandic, or Lincoln, or a primitive fat tailed sheep variety such as is found in carpet producing regions like Pakistan or Turkey, or Iran.

Want great long lasting socks that stay up? Again, don’t use merino! Use Dorset down, which in my opinion is far and away the springiest and most resilient wool and excellent for socks.

Want a blanket or a jacket? Use Cotswold. Spun worsted, it makes the ideal weaving yarn.

Want a really soft yarn for a scarf or a hat? OK, now use merino. But be aware that it probably won’t last for years and years, not if it’s spun to current standards. Industrially spun yarns are not very tightly spun nor plied. It give a softer hand to the yarn, but it will pill and make your hard work look quite bad in not a very long time. It’s even worse in a sweater unless it’s spun with something like silk.

I’m not anti-merino. It’s a wonderful type of crimpy fleece that is pleasurable to spin. BUT. Because I can spin my own, I choose to spin a slightly ‘harder’ yarn with more twist than you will see in commercial yarns. This is because I want my yarn to pill less and last longer in good condition.

The above Jacob/merino cross is a perfect example of what people don’t understand about wool yarn now days, because our mass produced industrial society encourages overconsumption and throw away items. This apparently includes hand knit items, because the only thing most knitters I know who don’t spin look for is “soft wool.” OOH, it’s so soft!! When I hear how soft a yarn is I automatically picture the product pilling and being discarded after a year or two. This yarn pictured is actually pretty reasonably soft, because the wool itself is medium soft and because it’s spun to preserve a reasonable portion of the ‘soft’ factor.

ETA: after I re-read the above paragraph this morning I realized I should include how it’s spun to clear up the apparent discrepancy between saying I spin a ‘harder’ yarn and spinning to preserve its softness. I spun this particular yarn in a semi-woolen manner. Meaning, I spun it using a modified long draw (picture my arm drawing way back like I’m going to pitch a ball, only I have wool in my hand and a twisted single going into the spinning wheel as I draw back. When I bring my arm forward, that single gets taken up onto the bobbin). This is what gives the fluffy and soft aspect of the yarn. I spin from carded pin drafted roving when I do this which gives the semi-part of the semi-woolen. It’s not quite full worsted (firm and durable) and not quite true woolen (really fluffy and soft, not durable at all). As I said, my yarns have more twist in the singles to start with than a lot of commercial yarns do, so even my softer stuff will hold up better than an equivalent commercial yarn.

In older times, people weren’t so concerned about “soft” because they knew they were sacrificing durability for softness. If they put a wool item on as a warm layer, they usually had something like linen underneath. No one had time to reknit something just because they wanted another one. Things got worn until they were past mending any more. As a hand spinner, my outlook is much more closely aligned with my ancestors’ than with current standards. I want soft, yes. But in small quantities for specific uses. Otherwise, I want durability over soft.

It takes me about a week to wash and comb enough fleece to begin spinning yarn for socks. I make a 3 ply yarn when I make sock yarn, so I spin up 3 four ounce bobbins worth of singles. Then I ply them all together to make my 3 ply yarn. I lose a bit in length by doing a 3 ply because they are circling around themselves in a larger diameter than in a 2 ply, but I also get much better resistance to wear by doing so. A round yarn wears better than a flat one. You want this for socks. It takes me approximately 5 hours to spin 4 ounces of singles at the thin diameter appropriate for making a nice thin sock yarn. Before I’ve even begun to ply I’m already at 15 hours of time at the spinning wheel. Plying takes another 3-4 hours. Then I have to wash it and set the twist.

If I’m going to dye it now is the time, which takes another day for dyeing and drying. I’m now approximately 40 hours into these socks, and I haven’t even begun knitting yet!

I can knit a regular crew length sock in approximately 5 hours. So it takes me 10 hours to knit a pair for myself. 50 hours worth of work is a lot of time to invest in an item! From my 12 ounces I can knit 3 pairs of socks for myself, 2 pairs for a man, or 1 pair of kilt hose. And this is why I won’t use merino for hand spun socks. Not only does it tend to pill, but it felts VERY easily. Which is something you do NOT want in a pair of socks, because felting shrinks them too. Dorset doesn’t felt very well in my experience, at least when it’s spun true worsted (all the fibers aligned in the long ways direction).

It’s a similar process for a sweater. The average sweater requires a pound of wool. And for a woman, approximately 1200 yards of yarn. That’s only if it’s color work or plain knit. If you are doing a lot of cables like an Aran sweater, you need closer to 3 pounds of wool, and 1600 yards of yarn. Regardless of what you may have read about Aran sweaters being a traditional garment, the plain fact is that they weren’t in common use until well after the industrial revolution and most women were no longer spinning their own yarn. No one is going to invest that much time into spinning the yarn for that kind of sweater when they are knitting for their entire family.

So soft…? Only sometimes. Mostly I prefer to sacrifice a little softness in favor of durability. But then, I’m a very practical person. What about you?

The perversion of pain.


oxycontin

In the late 80’s some brilliant (sarcasm in use here people) doctor, who I assume later took a position with one of the companies who manufacture hard core narcotic pain medications, or at least was paid a significant ‘renumeration’ by them, decided that “pain is whatever the patient SAYS it is” and if patients were in pain, then medical and nursing staff were not doing their jobs properly.  This, regardless of whether the patient got better, or even had a medical problem that necessitated pain medication.

Once upon a time, drugs like oxycontin were reserved for patients who were dying of cancer, or in some other profound end-of-life type of pain.  Never used for maintenance.

And now, 30 years later, we have a positive epidemic of patients who are in chronic pain – it even has official diagnosis codes:  338.2 – chronic pain (can’t get paid for diagnosing this one though), 338.4   – chronic pain Syndrome ( whoo baby you can get paid for this one!), 338.29 – other chronic pain (you can get paid for this one too).  Whenever medical ‘science’ (I use this term loosely because a lot of the science is based on getting paid by someone for something) defines a syndrome, what that actually means is a cluster of symptoms that usually go together.  They are NOT a disease.  They are just a bunch of symptoms that go together.

A good example of a syndrome that can be covered under “other chronic pain” or “chronic pain syndrome” is fibromyalgia.  This is a syndrome, not a disease. It probably has an ICD 9 code of its own, but I don’t plan to ever diagnose this so I don’t have any interest in learning it.  Fibromyalgia means literally pain in fibers – muscle fibers.  People who have fibromyalgia are usually (but not always) overweight, sedentary, eat a lot of simple carbohydrates, watch a lot of TV, are depressed, don’t get out much, and don’t sleep well though they usually spend a lot of day time napping and feel fatigued most of the time.  Because of their fatigue and depression, they often feel mentally cloudy.  They hurt all over, even when there is no obvious medical pathology. This is the cluster of symptoms.  The treatment consists of:  1.  Education on what the problem(s) are and why they are affecting the patient.  2.  NSAIDs – ibuprofen, naproxen, toradol.   3.  Exercise – the muscles hurt because the human body was designed to MOVE and if you don’t move, they not only waste away, they hurt while doing so.  4.  A combination drug that both helps with pain and depression such as Cymbalta or Lyrica.  5.  Cognitive Behavior Therapy – you have to come to grips with why you are doing this to yourself in order to make changes to how you avoid or do things.  CBT can be very helpful with this.  It has nothing to do with your childhood or that sort of therapy.  It’s purely to help you change your responses to situations in order to help you take control of your own life.  Note that I didn’t include narcotics AT ALL.  Yet I see people all the time whose only diagnosis is fibromyalgia and they are on MASSIVE quantities of oxycontin, oxycodone, or even morphine pills which they take multiple times a day.  Why?  It does absolutely nothing to help the patient, and isn’t even recommended as an effective treatment.  So why are so many patients prescribed narcotics for this?

The place where I am doing clinicals has a lot of patients who come there for nothing but narcotics, because the provider will prescribe for them.  Many if not most of them have been discharged from one or multiple pain management centers for non-compliance:  they also smoked pot, or they have alcohol in their system while taking narcotics, or they don’t have any narcotics in their system at all – every pain management patient gets urine drug screens every time they go in for an appointment to get their drugs.  Why you would be STUPID enough to smoke pot right before going to get your drugs I don’t know.  I guess you can’t cure stupid.  Why you would drink while taking sedatives I also don’t know.  Perhaps in addition to being stupid you have a death wish.  Can’t cure that either.  And those that sell their narcotics while pretending to have a chronic pain problem deserve to go to jail.  Have fun there.  And good luck with getting narcotics while in there even if you DO happen to need them for a legitimate reason like a tooth extraction.

A patient came in recently who originally complained of low back pain.  Yet when the tests were done in the office to assess his pain, they were negative.  The patient did not realize these tests were to assess low back pain, I should point out.  Otherwise they would have been ragingly positive.  And in fact were ragingly positive when repeated on him while telling him they were to assess his pain.  He was unable to get disability for his ‘chronic back pain’…wonder why??  This patient now complains of headaches.  He was told there was in fact something that showed up on the MRI he was sent for.  He states he doesn’t want to see a neurologist for this though, because he’s trying to get disability and if the neurologist can fix it he can’t get disability.  That seems to be the mentality of the average pain patient we see.  Malingerer.  If this guy spent as much time working as he did trying to get disability he would probably be solidly middle class, instead of ‘working’ poor.

Another patient came in with slurred speech and the inability to complete a sentence – she would flit from thought to thought without ever completing an entire thought through to the end point.  She said she didn’t want to go back to the pain management center she had been going to.  She was in the office to get Valium, a sedative.  She said she had gotten a month’s supply of oxycontin, oxycodone, and morphine from the pain management center and didn’t need any of those.  As it turns out, she had been discharged from not one, but SIX pain management places.  For having alcohol in her urine.  And for consistently running out of her pain medications well before the time for renewal.  Unbelievably, the doctor actually gave her a prescription for a  60 day supply of Valium.

Third patient:  came into the office complaining of low back pain, a ‘chronic’ problem.  Got a prescription for 30 days worth of Percocet with 2 refills.  Her room mate called the office later that day to say that he just wanted the office staff to know that she sold the entire bottle to a drug dealer named Don as soon as she got home.

These are entirely typical.  I am very frustrated and I refuse to bother doing any more assessments on these people because I don’t learn anything and I have no patience for these sorts of ‘patients.’

I hurt my back when I was still fighting fire.  At my original emergency room visit, I was asked if I wanted narcotics and I refused.  I did ask for a muscle relaxant that wouldn’t make me sleepy so I could function at work and at home.  The xray didn’t show anything (which it wouldn’t if it was a herniated disc).  And, while I have had some level of pain nearly every day since then yoga keeps it under control.  That injury though, and the pain it brought with it, was the impetus to change careers.  I was entirely too young to become an invalid, and it scared me to think of becoming one.  I have never pursued further testing because even if I did have a herniated disc I would not consider surgery.   I cannot imagine being unable to walk when I want, to run, to stretch, to garden.  I also have a torn rotator cuff, suffered while working as a firefighter.  That actually causes me more pain on a regular basis than my back, and eventually I WILL have to have surgery, but until then I continue to do strengthening exercises and keep it as mobile as possible.  I cannot IMAGINE living my life under the cloud of narcotics and being in the twilight of consciousness every day of my life.  What a horrible way to live.  I think the fact that I’ve suffered injuries that caused permanent pain in myself makes me even less sympathetic to those who come in wanting, not physical therapy, not surgery, but disability and a lifetime of narcotics.  As my parents used to tell me, if you’re not puking or dying you get up and go to work/school.   I would add to that list also if you don’t have explosive diarrhea.  Everybody hurts.  Deal with it and move on.

The largest group of users of narcotic prescriptions, if I remember correctly, are Medicaid patients.  Meaning they don’t pay, we the taxpayers do.  If even a small portion of the people who receive disability are anything like those I have seen in the ER when I was working there, or in clinicals, we could probably halve the national debt simply by kicking them off and making them work.  Maybe being a brick layer isn’t a good career choice for them, but surely they could answer phones, or sit at a cashier stand, or walk dogs or something.  Once again, it comes down to ‘sick care’ versus health care.  And lining the pockets of the pharmaceutical companies instead of investing in the real health of our population.  Of course, we have no economy to speak of anymore, so I guess disability takes the place of unemployment.  The irony is that those with real issues, with real medical problems, get overlooked because the system is overwhelmed with those who don’t pay for their access and so use a lot more of it.

++++++++++++

Pain tells us we are alive.  Pain tells us something is wrong which we need to address.  Using narcotics to mask pain, unless it’s for an end of life issue, prevents us from making changes to improve our lives.  Why would you want to do that?

When it rains, it pours…


94nissanThat’s not my truck.  It is however the same year, same color, same drive type.

My 2007 Prius blew up 4  days before Christmas this past year (2013).  It had had electrical problems for quite some time, and many of the “essential” functions had quit working – the touch screen gave up the ghost before it even had 100K miles on it.  Toyota knew there was an issue with poor manufacture of it, but refused to issue a recall; a new one was something like $1400 to replace so dead it remained.  It also never alerted to let me know that, due to a design flaw in the engine, oil would cake up and cause it to start blowing out the exhaust.  I ran the car literally dry in between oil changes at 140K miles; from then on it was a race against the inevitable.  I was on my way to work when the engine blew.  I limped it the last 20 miles to work but it was towed from there.  I sold it for a pittance, with full disclosure, to a Mexican (nationality, not racism) man who was sure he could get it running again.

Unfortunately I had planned to finish my holiday shopping the last two days before the holiday, so it was a very meager holiday for several folks in my little family – money that was going to be spent on gifts instead had to be hoarded for a new vehicle.  I still have mixed feelings about this – on one hand, I’m grateful that my busy school and work schedule prevented me from shopping earlier, because it meant money I had been saving for months was still there for us to use on another vehicle – but on the other hand I’m guilty feeling about the fact that I didn’t get gifts for important loved ones.  Not that presents equal love, but I think you know what I mean.

Anyway.  Fast forward to July 2, 2014.  We’ve had said pickup since the first week or so of January; it’s been a good running truck for a vehicle that’s 20 years old and has 200K miles on it.  I was on my way to take my final exam for my pediatric management class when the truck began making a HORRIBLE noise.  If you’ve ever heard the sound of a rod getting ready to go you KNOW the sound I heard.  If you haven’t, imagine the sound of a jackhammer under your hood, metal on metal.  It’s a sound to put fear in the hearts of strong men and women everywhere.  It’s 112 degrees outside, I’m 50 miles from my class, and 40 miles from home.  I try to limp it on side roads, but the noise keeps getting louder.  I finally pull off into a parking lot and call my husband.  “You have to come get me and take me to my final!”  I also text my instructor my problem; she is totally understanding and tells me just to get there when I can.  Mr.  TF tells me to call for a tow truck.  OK, I think, we have towing coverage on our insurance (we have full coverage on our vehicles, even though they’re old, because we can’t afford to be in an accident without it), no problem, we can get it towed to our local mechanic (who is a local resident and we’ve known him for nearly 20 years – good mechanic, decent human being).

This, is where the trouble starts.  State Farm has contracted out this service.  The representative for the service informs me that they will only tow me 10 miles or to the closest shop, whichever is closer.  HUH??  She tells me the name of the closest shop, and I immediately call Mr. TF to inform him of this development.  He is not happy either, and Googles the shop – which turns out to have very mixed reviews.  Mainly in cases, like ours, where the vehicle was taken in for an unknown (to the owner) problem, and they keep finding things ‘wrong’ and jacking up the price of the repairs.  GREEEEAAAAT.

The tow company they contacted gives an ETA of 45 minutes.  An hour and 15 minutes later we are still sitting in the parking lot, in 112 degree heat, waiting for them to show up.  Mr. TF calls the dispatcher – he’s having trouble with another tow and will be there in 20 minutes.  DH calls BS and says the tow truck driver is probably having dinner.  20 minutes later, he’s still now shown.  DH calls them back and tells them we HAVE to leave, I’m supposed to be taking a final exam, can we PLEASE leave the key inside the truck?  The dispatcher isn’t happy, but agrees when DH (nicely) browbeats her and stresses the importance of my FINAL EXAM to her.

I show up to class over an hour late.  I have forgotten some of the paperwork that must be turned in, so I have to go to the computer lab to print it out.  I still finish before everyone else.  Uh oh.  Either I don’t have a clue or I am careless I think.  I end up with an 80% on the final.  Which means the third option I haven’t listed is probably the culprit, in looking over the answers I got wrong — dyslexia is a real problem for me and I misread some of the questions, probably due to my level of stress.  Thankfully, I end up with a 96% for the class.  Thank the GODS.

The shop tells us the next morning that it’s the exhaust manifold that’s the problem, it came loose, and it will be $250-300 to fix.  Mr. TF is ecstatic, thinking I was wrong and it’s a simple fix.  I think that can’t explain the noise, but keep my thoughts to myself.  He agrees with the shop manager that we will be down around 4pm to pick it up.  The bill turns out to be $485, not $300.  And the they’re not done yet.  And the truck is still making the noise.  While we’re waiting, before they fire up the truck so I can hear that they didn’t fix it, we have a chat with someone who is there to pick up his own vehicle.  He says he’s $2100 into repairs on his car and they still haven’t fixed what he brought it into them for in the first place.  This starts off major warning bells in my head.  So when the truck gets started, and I hear the SAME NOISE, I’m rather stressed out.  The manager says “we couldn’t hear THAT noise over the exhaust noise”…I get a little hysterical and contradict him, saying that’s the exact noise that made me pull over to begin with, and I can’t believe he didn’t hear it, and NO THEY CANNOT KEEP MY TRUCK TO FIND OUT WHAT’S WRONG AND FIX IT.

Long story short, the guy refunded our money.  Which was quite a nice thing to do, and goes a long way toward restoring my confidence in basic humanity.  But we’re still left with a dead vehicle making a horrible noise.  So we go to the local Uhaul and rent a pickup truck and trailer to tow the truck to our mechanic.  Mr. TF loads it onto the trailer, I drive it home.  All’s well until I pull into our circular driveway.  By that time I’m emotionally exhausted by the strain of the previous days, and I get careless when pulling into the driveway.  I don’t swing wide enough and get the trailer hung up on the rocks that border the drive.  Yay.

Since it’s raining and it’s the holiday weekend anyway, and we have 24 hours to get the rig back, we decide to leave it in the yard till the morning.  Next morning, we drive 40 miles to FIL’s house to get his truck so we have a way to get to work at both our jobs.  We come back home,  and, after much freaking out by myself, get it UNhung up, and take it to Mark’s shop.

His guy calls us in the mid afternoon and says it’s all done, that the distributor cap arced and caught fire, and we need a new cap, rotor, wires, and plugs.  OK, great, but I keep saying that I can’t understand how THAT could make it make that noise.  DH says not to be so negative, that it’s better than a new engine, after all.  I agree.  Mark’s employee says he wants to test drive it before we pick it up to make sure it’s fixed.  Mr. TF tries to talk him out of it, saying he can test drive it himself, but no dice.

He calls back in a few hours and says he has bad news.  The noise is still there, and radiator coolant is dripping out the tailpipe.  Which means a cracked head and/or a blown head gasket.  New price:  $1685.  NOW I say, THAT explains the noise!!  Oy.

On the bad side, we had to borrow a credit card from FIL to pay for this.  We are now into a 20 year old vehicle for nearly $6000 and it’s sure to have other problems in the future.

On the good side:  the exhaust manifold is repaired, with a new seal, and new bolts holding it on.  The distributor, rotor, wires and plugs are all new.  We will have a new head on it soon.  It should run like a top for many thousands of miles to come.  It’s paid for, and we don’t have car payments or depreciation to worry about.

So, while I wait for my truck to get out of the shop, I meditate on the quality standards of Nissans and Toyotas made 20 years ago versus in the last decade.  We also own a 96 Camry.  It is a dependable vehicle that just goes and goes, and also has nearly 200K miles on it.  I’m sure there are maintenance issues coming up in our future with this vehicle as well, but I also feel confident that THIS Toyota will be worth investing money into to fix, UNLIKE the Prius which was a maintenance sinkhole.  And I know for certain that I’ll be driving one or the other of these vehicles for the next decade at least – one, because we can’t afford anything else right now – and two, because we’ve invested so much into these vehicles that are paid for that it simply doesn’t make sense to buy anything else for quite some time to come.  The Prius was probably the biggest disappointment of my recent years – a vehicle that cost so much money could be so unreliable and of such poor quality as this from Toyota was an eye opener.  If THAT doesn’t show for certain that the empire is crumbling, I don’t know what does.