Wednesday, September 29, 2010

Attack of the Machines

This is the week that was.

It's only Wednesday and I feel as if I have been catapulted into the next century. Cleveland Clinic uses a wonderful Electronic Medical Record. As with every other hot program, it gets updates and upgrades.

Welcome to Monday morning 8am. 40,000 Cleveland Clinic employees are faced with a tennis racquet in the face with our latest upgrade. Yes, we were given classes ( weeks ago ) yes, they delayed implementation to give us more time to prepare ( we blew it off ) yes, we had mandatory computer based training ( we glossed it over ).

Reality hit just when the coffee was starting to perk. I expect by Friday, we may have more than a few fried employees.

How bad can it be? It's like taking all of your ABCD type files and then going to a numeric system. All the information is there, go find it. I am sure someone thought this was a good thing, and that it solved lots of user problems. It's just that if you look at my desk, to the casual observer, it is messy. I know where every piece of paper is located, albeit several layers deep. The very moment someone cleans up the desk, poof! I need one of those papers that I now cannot locate. Sound familiar?

Just like thowing away that coupon you are never going to use, you suddenly need the next day.

Well that's what life has been like at our place this week. Work has expanded to the point where I think the patients are getting the Swiss Rest Cure during their office visit while I fiddle with the program to close the visit encounter ( four attempts at least until the darn thing lets me out! ). I pride myself on running on time. Not this week. There are casualties everywhere on my schedule. Lunch has been nixed three days in a row, bathroom breaks are a thing of the past. Forget coffee. Idle gossip is history.
I am a one woman automaton stuck with that computer screen in my face. Waiting for the point where I can finally log out of a patient visit!

Tomorrow I am thinking about bringing in some flowers, incense and a rice bowl to place before the screen of terror. Perhaps an offering will help. It's like my son told me the summer he worked at my old office: The copy machine used to look at me and say" Give me toner, and the blood of innocents. "

So It is not late but I feel wrecked. The best part is that I am on call all weekend. :)

Tuesday, September 28, 2010

Low Desire, The Sexual Doldrums

First, let me say that women and men are different. 

To some people this comes as a surprise.

Sometimes it seems we expect men and women to think and act the same. We are wired differently for different reasons. In the evolution of the species, Darwin theorized that there was survival of the fittest. That meant that stronger, healthier, smarter individuals lived and reproduced. Males needed to be at the ready in case they came across a receptive female.Females chose who to allow to father their offspring, selecting the best male according to her criteria.

Fast forward to modern times. Women no longer need men. We are independent, educated and earning.
Want a baby? Order out from the sperm bank. However, WE WANT MEN. To have and to hold.

You get the idea.

 Now to sex.

Research tells us that the biggest turn on for a man or a woman is a new partner. Remember those days? Hot , hot, hot! Then things settle down, and after 15 years nothing new has happened in your bedroom. You get the come hither and know exactly how the next 20 minutes of your life will be spent.He does this, I do that, etc, etc.etc. 

NO NO! Boring sex is not something we look forward to.
It is something we endure. 

Now, the truth is that most men are terrified of women, and sexual rejection is about as bad as it gets for them. They will stick with the tried and true forever. Do they like your meatloaf? Will they eat it every day of the week? Will you throw the pan out the window by Thursday? You betcha.

Women thrive on variety and men on constancy. We live at cross purposes. You have to be the one to initiate novelty into the bedroom. How are you going to do that? 

Be the new partner.

FIND THAT Twenty something that is hiding inside you. You know, the one with the red hair , high heels, and tight black dress. She is some woman! Bring her out and let her loose. 

My late husband loved his cars. A trip to the car wash was worthy of a date. So one Valentine's Day we are driving home from work and he turns into the car wash. He plunks down his money, and we drive in. The bubbles spray over the windows, and the next thing you know, my bra is hanging from the rear view mirror.

I nearly killed him right there. WHAT ARE YOU DOING??? He asked. WHOOPEE in the CAR WASH, says I. 
You know, he never got into a car with me again without thinking twice, what I might do next. :)

So find your muse, she is there inside you. If your run out of whack o ideas, there are whole books written for seduction scenes with titles like 1001 nights of Great Sex, etc. You get it. Make sure your man knows that the sun rises and sets in his pants, and you will be one happy girl. NO more boring anything. You have given him the big green light to spice things up.

Monday, September 20, 2010

After 3 pm

There are days when I think that Central Scheduling makes an announcement:



 Heavens, it seems that way. I take pride that I take the time patients need during a visit. I run on time, almost all of the time, but there are days.........................

I retired from OB two years ago after about 4000 babies. Wheedoggies..that was a rollercoaster for me, the office staff, and my patients. When I entered the world of ambulatory GYN with Cleveland Clinic I thought the chaos was behind me. OH NO, not for me. You see, I am a gynechiatrist. That means that I dispense a healthy dose of psychiatry with each annual exam, consultation, and patient who is about to faint from fear.

This takes a certain amount of time, and finesse. Mostly I get it right the first time. Occasionally I have an abysmal flop, and read someone completely wrong. Oh well, lessons learned, apologies made, and then moving on.

Back to time. Lately I have noticed that the witching hour is 3pm. I suppose that the scheduling department starts at the 8am slot and fills accordingly. Somehow 3 pm and after is "bottom feeders only" time. That would be patients that need to get in "right away", have a time crunch for some other reason, or have kids they have to pick up in 30 minutes.

These patients come with predicatble problems.

For example, there are ladies who have seen three other physicians. All of  whom are of a single diagnostic opinion, offered all of the options, and they don't like it one bit. It is now going to be my job to figure out what they don't like, explain everything again, but this time they will get an explanation they understand ( or I die trying ). I help them get from confusion to a decision.

Other women haven't seen a doctor in years, and my name was on their insurance list. They decided to drop by for the afternoon. These good ladies have never heard of a primary care provider, let alone know what one does. They think everyone is Dr. Welby and does cardiac bypass surgery in the office while they have a pap. These folks need the Cliff Notes of managed care lesson, and I help them get a grip on reality.

Still others went to the family reunion last summer, found out someone's version of family medical history and have decided that their aches and pains are certain signs of the same thing Aunt Martha had just before she passed. They have had these symptoms for years, but today decided to "check out everything". These women get a lesson in what's inherited, and what's not.

Then there are the legions of the half informed. They come in and want "tests". Sometimes they want CAT Scans, MRIs, blood tests, ultrasounds, and all manner of breast imaging. When asked what diagnosis I should ascribe to the tens of thousands of health care dollars they propose to spend, they are not sure. I certainly should know. Doesn't everybody get "tests" ? They need some education in being a good steward of health care resources, and what sane health related maintenence entails.

So between the hours of 3pm and closing ( also known as TBD), I inform, assist, educate, reinforce, assure, diagnose, and explain my way through the day. By quittin time I am one pooped pup.

Until next time.................................:)

Thursday, September 16, 2010

Fibroids! Fibroids EVERYWHERE what is one to DO??

This is a daily issue for me in practice. I see a woman for the first time. I take her history, she has had heavy bleeding on and off for years. No big deal for her. I do her exam and ZOWIEE! I discover the enlarged fibroid uterus. Sometimes about the size of a five month pregnancy. Now you know she knew about this.

If I don't find it, it doesn't exist.

Why do women want to hide their heads in the sand?

BECAUSE someone once said the H word.


That is about as misunderstood and feared as Breast Cancer ( we'll go there another day ).

So, she has been suffering with heavy menstrual bleeding, urinating 15 times a day, constant pressure, having to put up with difficult bowel movements, and pressure, not to mention YOWSER cramps for YEARS.

All in the hopes that menopause will rescue her from the dreaded Hysterectomy.


Fibroids do not usually need the BIG H.

Fibroids are benign smooth muscle cell tumors of the uterus. The uterus is made up of the opening, the cervix which stretches ( dilates ) to allow a baby to be born, the lining ( the stuff that comes out as a period ) and the myometrium ( the muscle that is the body of the uterus that grows to accomodate the baby, and then contracts to deliver the baby ).

Fibroids can be on top of the muscle layer, in the muscle layer or protrude into the lining. At any rate many women will have them by age 40, and most don't need any treatment. They can be anywhere from the size of a corn kernel to a basketball. Most hang out and don't cause trouble. Some are some bad girls and cause bleeding and pain, not to mention the bulk symptoms of frequent urination, pressure and constipation. Oh, did I mention PAIN?
Yes, they can be bad.

So what is someone to do? There are many ways of evaluating and managing fibroids. Even when I practiced in rural America, I offered options.
So wherever you live, get the facts.

1. Women who no longer desire childbearing can have Uterine Artery Embolization.  Check it out with Dr. Google. It is a procedure done by a radiologist wherein the arteries feeding the individual tumors are injected with beads to reduce bloodflow and therefore shrink the beasts. No surgery, you get to keep your innards.

2. Myomectomy is for women who desire childbearing. It is done either as a traditional operation ( think C Section scar ) or as minimally invasive ( think through a Bic pen). We have some master gyn surgeons at Cleveland Clinic Florida who do these robotically. VERY SLICK. They remove the individual tumors and sew the swiss cheese back together. You keep the organs, you get to have periods and everything. They are good. No hysterectomy.

3. Removal of the body of the uterus only. This is called a supracervical hysterectomy. Hysterectomy is actually the name for removing the body of the uterus, not the ovaries, not the cervix ( that would be a total hysterectomy ). So you just get the part out that has the tumors. The advantage is shorter operating time and less blood loss. Great for women who never want children and don't want periods again. You keep the cervix and need Pap smears. You keep your ovaries and can continue to be as hormonal as you please. One day in the hospital and one week at home. EXCELLENT!

4. Sometimes hysteroscopy can help with a single fibroid that is in the lining causing heavy bleeding.

5. Sometimes the use of hormones or medication or a Mirena IUD will help for bleeding that is heavier than normal without much pain.

The Bottom Line is that you have OPTIONS. And OPTIONS are good :)

So the next time someone comes in with fibroids, hopefully they have read my blog and know I won't be recommending a hysterectomy any time soon................

Wednesday, September 15, 2010

Breaking Cycles

Have you ever noticed how everything breaks at the same time?

Mother taught me that if you have $10 you will soon have a $15 problem.
If you have $100 you will have a $300 problem, and so on. It's just life.

Breaking cycles are the ones where the dishwasher decides to spray water everywhere, the highest lighbulbs in the house go out, and the check engine warning lights up on your car all in the same day. It takes three months to get everything back to "normal" and pay off all the vendors.

I will see a patient a for her yearly exam who has gone through one of these cycles. The dog died, her gallbladder was removed a month later, and now she has some funky aches and pains. It's a breaking cycle. We will investigate, patch her up, and get her back in the game, but it takes months of doctor visits, tests, therapies, new medications, not to mention navigating the bills from hospitals, doctors, labs, etc. Just when you think you are A OK, its time to start up with the routine maintenence.

Oh joy.

Then you sit back and relax with the delusion it will not happen again. NOPE. You will have breaking cycles. They happen all the time. Life finds your weak spot and just for fun, pokes the heck out of it just to see you squirm.
Since I don't personally believe in hell, the universe must conspire to relieve its boredom from living in geologic time somehow. That's my theory of breaking cycles. Why do we go back into denial that now that everything is fixed, it will  always stay that way? Is that what our inner voice want us to hear? Is it a protective stance to shelter us from the inevitable?

Just my thoughts today about why mother told me there would be days like this...........

Until next time

Saturday, September 11, 2010

Customer Service, the Oxymoron

I have just spent 30 minutes of my Saturday with three "customer service reps" from AT&T. No, not from offshores,  these are native English speakers right here in the US of A.

I pay most of my bills on Auto Pay, direct debit from my bank account to pay in full for recurring bills like utilities. When I moved ( see earlier posts about the pain of moving ) I dutifully filed a change of address form with the Snail Mail, US Postal Service. My AT&T service was set up on auto pay. I moved in May. I switched to Vonage and terminated service with Ma Bell.  In July ( I moved about 1/2 mile BTW)  I get a paper bill stating I have a final balance of $27.17 with AT&T and they have sent my account to a collections agency.

I am not happy.

I call AT&T. I explain that I am registered for Auto Pay. They say when you close the account, the Auto pay is void, and they send out a final paper bill ( which through the magic of the postal service has taken six weeks to travel 1/2 mile ). I pay the bill over the phone. I think I am done. It was a final bill.

September 2010.I get a final EDITED bill for $5.00 for a convenience fee for paying over the phone.

Now I am PISSED. A charge for paying my bill.

I call AT&T again. I speak to Sharon. She doesn't really want to hear what I am saying and asks me to bear with her. I tell her I will after I am finished telling my tale. She cuts the conversation short and puts me on hold. For a long time.
I think this is designed as a cooling off period.

I am transferred to customer service rep #2. I go nowhere again.

She transfers me a third time to Danielle who asks if I want to save $45 on my next bill. I reply, no I want to save $5 now. She is confused. I tell her my story. She is unsympathetic. I have stopped being polite and tell her she will find a way to get this fixed. After all, if she is giving away $45 a pop, $5 should be chump change.

She takes my name and number and says she cannot help me today. She has entered in a "request" to have the $5 removed from the bill. Someone will call me in 24-48 hours. Am I expected to believe she doesn't have the authority to reverse a five dollar "convenience" fee for making my payment over the phone? And I remind her, there was no mention of an additional fee at the time of the phone call. Check the records, since you record all calls for qualtiy purposes. Right.

Does anyone think American Business has a chance?

Customer service and excellence was the business mantra of the 80's and 90's. The new millenium has seen our manufacturing disappear, brains are borrowed from India and China. I recently had to do a module about diversity and cultural sensitivity at work to find out that 43% of the American public reads at a 5th grade level or below. What a sad state of affairs. Any suggestions??

Tuesday, September 7, 2010

When did parenting start?

I am visiting my #2 son this weekend. He is making his third attempt at college. So far so good. This time he had to work through two semesters getting good grades to prove he was serious. Now he is admitted as a degree seeking student. Makes a parent happy:)

This is my tree hugging, friend of the earth, protector of the meek and small, part time vegetarian kid. He looks like Goliath, with the heart of a butterfly. He acts like a turtle. Moves slow and at the slightest sign of trouble, pulls in all fours and his head and waits for the perceived threat to pass. If you move him, he will pee on you. You get it, a turtle.Any obstacle in his path could lead to years of pondering what to do before action.
This he did not get from me, I am thinking. As his Mom, I love him and accept him for who he is. Understand him, now that's a different story. He is, and we are together, a work in progress.Somehow I thought the surroundings he would be living in would be brighter, cleaner, and somewhat more organized. No, not yet. That will come with time. Right now it looks like something from a pizza commercial for 20 somethings. Yuck.

So I am writing about parenting. In the old days, you just had kids, they popped out, you raised them. Now it is all about the fine art of parenting, being developmentally savvy and proactive in your approach to your kids. Add some guilt and a few hard earned bucks, and you are a modern parent. The conversations are an endless query of how did we do what we did at their age??? Why don't they grow up faster?? How did we let this happen? Will they return to the nest, and will we let them?

I have had this conversation many times in the last five years or so, as my children have made their fledgling flight from the nest. Others bemoan the fact that their children are once again on the parental payroll after going bust in this economy. Some are disappointed regarding their inability to cut the umbilical cord. That inability goes for the parent and the child. Some have taken to raising their grandchildren when the unions their children have made dissolve. It's a mess.

Parenting can be learned. I know, I went to school for it. Oklahoma State University Child Development Labs required any parent sending sonny or sissy to their daycare had to attend classes. Not bad, saved me from killing myself a couple of times when the kids were tots. They knew children and insisted that we did too. Fast forward fifteen years. They did not do this when the kids were teens. I was forearmed. I collected a stack of books in anticipation for their adolescence. Looking back, it was a great time, and I still enjoy teens. They are easy for me to understand.

Young adulthood came as a surprise..I thought I was done. Out of the house you go! Have a nice life. I am sandwiched between my mother's comments about how can I let "him" spend $4 on coffee and the puppy dog eyes of the kid needing something? This is a no win situation. Since they passed the 18 year old speed limit, they are more or less on their own. The success or failures they have are their own. I get to sit back and  (1) worry (2) relax (3) bask in their accomplishments (4) die of embarrassment when they do stupid stuff.

I was listening to NPR recently when they quoted a study showing the mental and physical health of parents suffered when they had one child they described as "struggling". It did not make any difference if they had a dozen more they decided were "doing well". This was decided by the parents. SO  I decided I am not going to let my health suffer. I would re-frame my children as "doing well". Nobody is an axe murderer, so far they have not tried to move in with me, I'm good. I can feel my blood pressure leveling out.....NOT.

So its back to the drawing board for me. Each one of my kids is unique and the lessons learned with the first one are not translating into an easy ride with the second. So I will bungle my way though their young adulthood. Perhaps there are more books out there for this one. Come to think of it, my mother is still learning with me:)

Until next time.............