Saturday, October 23, 2010

News & Notes from the Week

  • A rare bald eagle sighting during my run. I took a picture with my new phone, but have no idea how to upload it here.
  • Yes, I finally replaced my mobile, thereby joining the 21st century. Alas, its been very buggy and needs to be returned. Fail.
  • Autumnal colors are great! Autumn is great! This is my favorite time of year.
  • Realize I spent most of the week simply preventing kiddos from hurting each other, often with mixed success. Isaac now sports a fat lip.
  • Cantaloupe plants accidentally sprouted from our compost pile in the spring, and actual cantaloupes resulted. We finally brought the fruit into the house. Only one was fully ripe, and its flavor was fantastic. The others looked great but tasted like nothing. Literally, they had no taste. This visual-flavour discrepancy was tough for my poor brain. It tried very hard to taste some sort of melon, but with no success.
  • Found myself completely unable to memorize Psalm 100. Perhaps too many brain cells trying to solve the melon problem.
  • Fervently wish we hadn't put away the bike trailer, as now I am limited to biking without kids. Which is to say, I am not biking.
  • Accidentally watered the raspberry bushes for 24 hours. Woops.
  • Reason for Isaac's mysteriously truncated nap has been revealed: fever and diarrhea!
  • Attended a fantastic bible study on the Psalms, which followed a great series on Philipians. I am part of a bible study for the women at our church, and I have to say I am loving the group. There is so much wisdom there.
  • Mental note (suggested by an aforementioned wise woman): begin to pray for kiddos' future spouses. Gives me a broader perspective.
  • Date night last night. Checked out a new wine bar which was fantastic. Ordered a flight, which is my preferred way of enjoying wine - little tastes of many varietals. Unfortunately, I forgot about the high alcohol content of port. Had to wait a long time before driving home.
  • Must have more date nights.
  • Cool enough for apple crisp, not quite cool enough for pumpkin pie. Hot chocolate in the forecast.

Wednesday, October 20, 2010

Musings (okay, a rant) on health care.

Everyone knows that the health care system in this country leaves much to be desired. Lately, I've been dealing with some of the reasons why.

Here is the picture:
A while back I had an admitted Mommy meltdown and took Isaac to the ER because there was a slight chance that he had ingested some Tylenol. I asked to have his blood tested for acetaminophen. One test. Just for the Tylenol.

When we got the invoice, I was surprised to see five items for "Laboratory" and charges totaling almost $1000. Intriguing. Numerous phone calls later, it was revealed that Isaac had been tested for Tylenol and aspirin and alcohol and to make sure various internal organs were still functioning. And anyway, what kind of mother would NOT want her child to get tested for all of these substances if given the chance? The last person I spoke to summed up the situation nicely: "We would NEVER make a medical decision based on monetary considerations." Me: "So this is about liability, then?" Administrator, with some shock: "No, this is about the health of a child." Me: "Grrrr....."

I can spot about five things wrong with this picture. How about you?
1) I asked for one test and ended up with many more. The given reason for this was "standard practice." Apparently, if a child is exposed to one medication he is likely to have been exposed to others. Really? In every circumstance? Even in our particular circumstance, where even the ER doc agreed that it was unlikely he had consumed any Tylenol let alone another substance? I don't think so.
So let's do a thought experiment: If patients were allowed to pay less for every test that came back negative, do you think all of these tests would still be "standard practice?"
I'm not saying that anyone is consciously trying to milk money from patients. But surely when income is dependent on the number and complexity of medical tests given, it must influence, to some extent, decision-making at many levels of the administrative tree.

2) I asked for one test and ended up with many more. Repeating myself on purpose, here. I do have a vague memory that the doctor mentioned something about testing Isaac's blood for other things. At 11:00 p.m. When I was trying to keep Isaac happy, and feeling guilty about being there in the first place. I'm not sure that counts as full disclosure. Regardless, subsequent conversations made clear that any protests about extraneous testing would have been met with a decent amount of resistance.

3) Five charges for "Laboratory." I should point out that these five charges were listed on the initial invoice we got from our insurance company. The actual bill just lumped everything together. Of course, even if it had divided the amount into five Laboratory charges, so what? It took at at least three phone calls to figure out what each charge meant. I want to know exactly what I'm paying for - in plain written English.

4) Shock and awe. Medical bills are always scary because you never know what to expect. Why not? Why don't I know what's coming? In other words, not only do I want my medical bills to be itemized, I want to have a sense of how much the total is going to be before I open up that mean white envelope. If Isaac's ER doc had ascribed a dollar amount to each one - even an approximated amount - it would have solved many problems. First, it would have saved me some time later on as I tried to figure out for what I was being billed. Second, it might have clarified the procedures being done. Third, it may have motivated me enough to speak up and at least engage the doctor as to why certain tests were administered. Obviously, upfront cost disclosure isn't practical in all situations. Often, medical decisions need to be fast and furious and sometimes there are no options. But such preventable things have happened to us before. For example, mere minutes before getting a third trimester (i.e., too late to do anything about it now) ultrasound I had to sign a form saying that I would pay for it if the insurance company didn't. No mention of how much it was going to cost (turns out my insurance didn't cover most of it). And I never did find out what they were looking for, or why it was important.

5) We would NEVER make a medical decision based on monetary considerations. Well how terribly convenient, since you are not paying for that medical decision. I am. And as lovely as it would be to think that all of our decisions occur in a monetary black hole, they just don't. Permit me another example: I had a CAT scan administered via the ER since the main medical offices had closed for the day. It was my choice whether to have the scan then, or wait until Monday. If I had known the cost, I would have waited until Monday. Risky? Maybe. But at least a more informed decision.

*End Rant*

I am worried about coming across as feeling negative about doctors and the job they do. This is not so. Some of the people I admire most are in the health care business and they're just concerned with making their patients better. But I do think there is a detrimental disconnect among the money and the medical decisions and the information imparted to the patient. And the whole thing just looks like a black box to the patient - a box shut so tight it seems useless to try and open it. I'm a trusting sort, and I generally go with whatever a medical doctor recommends. I know I should take more control of my health care - ask more questions, and so forth - and I think knowing about cost might provide a bit more motivation to do so. Perhaps it would also motivate other people.
Finally, I'm enough of a navel-gazer to realize that some of my annoyance comes from being in this situation in the first place. No doubt, I'm projecting some of my guilt about taking Isaac to the ER (for nothing!) onto the health care system. But it's such a behemoth, surely it won't even notice. I guess that's part of the problem, too.

Saturday, October 16, 2010

Parents say the darndest things

  • We need to at least shuck the corn before you put it into your mouth.
  • Pumpkin stems are not for chewing on.
  • Who let the poopies out? Isaac, Isaac! (To the tune of "Who Let the Dogs Out?")
  • Get your finger out of her eye. (To Isaac, as Anna naps on the couch).
  • Even if he could reach it, he won't get far. (Said by Jon, in response to my observation that Isaac, who is sitting on Anna's little ATV, is capable of reaching the accelerator. Seconds later, Isaac takes off making it half way across the yard, and hitting the fence.)
  • You can play with yourself later. (During diaper changes.)
  • Who's got the poop? Isaac's got that poop. (To the tune of "We've Got the Funk")
  • No more salad until you finish the cake.
  • Anna, wake up.
  • At a restaurant: Stop licking the table.
  •                           We do not suck up the Ranch dip with a straw.
  •                           You must finish eating the onion ring before you can taste daddy's milk shake.
  • Commuting sounds like fun!
  • Me: "The clouds let out all of their rain." Anna: "The clouds went potty on the earth?"  [This one doesn't quite fit, but I thought it was cute.]
  • I hope that was edible.
 In a similar vein, here are some questions I have recently pondered:
  • Why can't they design food storage containers that fit well in the dishwasher?
  • Why does our toilet paper advertise itself as "long lasting?"
  • Why is it so hard to find whole wheat bagels that also have sesame seeds or poppy seeds or some other topping?
  • Why aren't laundry rooms always on the same floor as the bedrooms?
  •  Why doesn't the Starbucks at the grocery store (the only coffee place nearby, which is itself questionable) offer curbside service?
  • Why can't someone at the drive-thru pharmacy also grab me some dish soap or shampoo along with my prescription?
  • How does my floor get so dirty between breakfast and lunch?
  • Why is McDonalds the only restaurant with a play area?

Tuesday, October 12, 2010


It's been a few weeks since Isaac was weaned, and I'd like to think this was a joint decision. I admit, however, that sometimes when he's in the room while I get dressed, he looks at me as if trying to remember something important. (Or he just laughs, which I try not to take personally.)
At any rate, I've had some time to look back on this experience called nursing. Like many women, I've had very mixed feelings about it. So here's my story.

My initial intention with Anna was to exclusively nurse, and pump when needed. So I was delighted when she latched wonderfully, but less delighted by the excruciating pain (which of course went away) and the pressure to be ever present (which didn't go away). Like many newborns, she nursed a lot. But what was unique about our little girl was how little she slept and how much she screamed. It was a battle to get her to sleep, and one that we usually lost. Since I had zero experience with babies, I just assumed the nursing-screaming-cat nap cycle was normal and that it was my fault for not providing (a) more structure, or (b) less structure. In contrast, Jon suggested that a little formula was worth a try in case it was a milk supply issue. I argued that this was highly unlikely, and that breast was best. "Any hint of formula could permanently damage my supply!"

Well, as usual, Jon was right. By her two month appointment, Anna's weight had dropped from the 40th percentile to the 5th. She was barely over eight pounds, and still screaming. The pediatrician didn't seem to think this was a problem, but I did. So we instituted a bottle before bed, and we forked out some dough for a lactation consultant. The bottle was a hit, with Anna consuming 8-10 oz in one sitting, and sleeping much better afterward compared to nursing. The LC was a bust. She looked at the latch (perfect), inquired as to how I was cleaning my pump (fine), and showed me another way to swaddle (still ineffective). She did not inquire as to whether I had experienced engorgement (no), how much I could pump in one session (1/2 to 1 oz, maybe 2 oz if I was lucky), or do a before-and-after weighing (i.e., weigh the baby both before and after nursing to see how much fluid the child consumed). She also did not approve of the night bottle. From this interaction I concluded that I had failed, that I had only imagined the need for a bottle and that Anna would have been fine without it.

Nonetheless, I was exhausted so the night bottle stayed. Interestingly, over the next few months Anna grew fast and furiously, hitting the 80th percentile in both height and weight, and staying there ever since. 

I nursed Anna for 15 months, and during that time concluded that both nursing and using formula was the worst case scenario. Now I had to take time both to nurse and make formula and clean bottles. I also concluded that nursing was simply a horrible chore that moms did purely for the benefit of their children. I was floored by moms who claimed to enjoy breastfeeding. It just didn't compute.

When Isaac was born (new hospital, new pediatrician) I saw the in-house LCs right away. I wanted things to be different but was doubtful they would be. Again the latch was perfect, but again my milk was not coming in. The LCs recommended an herbal supplement + pumping. In the meantime, however, Isaac was beginning to lose weight (not just percentiles) and I could see that the nursing-screaming-cat nap cycle was beginning. So we just jumped in and started supplementing after every feeding. When that happened, I saw something I had never seen before: a look of contentment on a baby's face that showed he was full and happy and ready to sleep. When I saw that, I understood why nursing could be so fulfilling. If I, and I alone, could give my baby that feeling of fullness and contentment... well, who wouldn't want to nurse?!
So we worked hard (herbs, pumping, supplemental nursing systems) and over the next three or four weeks my milk slowly came in. "The girls aren't so floppy," was how I believe my LC put it. By the time Isaac was two months old, we were down to four ounces of formula a day and he was sleeping through the night. But it was not to last. At three months, he hit a growth spurt and I was never able to catch up. After weeks of constant nursing and night wakings I conceded defeat and upped the formula. Much less guilt this time around, though. I feel I did everything I could, without sacrificing my sanity or Isaac's health.

So my children, while I do feel that breastfeeding is extremely valuable, and although I'm sad about those 10 IQ points you've lost and the health problems you are no doubt experiencing, I have to say that formula probably improved your emotional health. Because it surely improved mine.