In particular, Happy Birthday to my stents, one in my Left Anterior Descending Artery (also known as the "Widowmaker") and one in my Right Coronary Artery. I was stupid, in denial, and incredibly lucky.

I didn't think I had risk factors for heart disease or a heart attack. I was 65, exercised somewhat regularly, ate a decent diet, had great cholesterol readings (a very high HDL and low LDL), was a good weight, and had normal blood pressure. Was I stressed? Yes, we all are. I was trying to start my business as a Patient Advocate, but otherwise, life was great. We had two trips planned, one to Alaska and one to Ireland (to see Van Morrison) and Iceland. And we were awaiting the birth of our first grandchild!

I was at the beach with our dear friends, when I awoke with severe pain between my scapula.I got out of bed, made a cup of coffee (I thought that would help), and then started to perspire.

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As a Physician Assistant, I had the incredible opportunity of working with an oncologist who taught me how to handle Cancer and bad news, things you can never learn from reading a textbook. It went like this: Sit on the chair with your BACK away from the clock, be at eye level with your patient, and say something like, "Unfortunately, the results of the recent test were not what we were hoping for." And say nothing more; let the patient process the news. They will guide the visit on how much they want to know and go from there.

We should all practice this when we learn of friends or family members who have received bad news. Let them guide the conversations, guide how much they want to share

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Perhaps many of you have noticed that when you leave your provider's office for your routine visit, you are asked to make your next appointment, perhaps six months, eight months, or one year from that day. But who knows what our lives will be like six, eight, or twelve months out? We make the appointment and try to plan for that date.

My husband did just that: he made an appointment with his cardiologist for a six-month follow-up last December 2022 for an appointment in July 2023 (they didn’t have one in six months and determined an eight-month follow-up was acceptable.) As life happens for all of us, he couldn't make it and called to reschedule. He got the "first available" appointment in February! This is 14 months later! He told me (after he hung up), and I got on the phone not to yell or complain but to question how this could be possible and “good medicine.”  

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One of my pet peeves is the cost of prescription medications. Last year I did a piece on the cost of Eliquis, which my husband has to take for atrial fibrillation. At the time, his insurance company made a (probably financial) decision that they would no longer cover Eliquis. He would have to switch to Coumadin, another anticoagulant that requires frequent blood tests but is significantly cheaper. I did my homework (hours and hours) and discovered that the “gold standard” to treat a-fib is with Eliquis; I wrote a lengthy letter to the insurance company. Fortunately, his doctor was wonderful and willing to spend the time to get this accomplished. They put the letter on their letterhead, and the medication was allowed.

Fast forward to retirement, where there are no good options unless you make under $59,000 as a couple for the year or have government insurance. Regular Medicare does not cover Eliquis and can cost up to $500 a month! And then a person falls into the donut hole, which means more money out of pocket. This is why many people stop taking their life-saving drugs.

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Will This Test Change the Plan of Care?

Lately, I have noticed when going to see any of my doctors, I am sometimes offered a choice of tests to be done. For example, when I had a severe ankle sprain, which wasn’t getting better after weeks of wearing a boot, the orthopedist (who I would like to mention owns the imaging suite) asked me if I “would like to get an MRI?” When asked how that would change the treatment plan, he responded, “It won’t, but some people want to get one.” Since when is this left up to the patient?

My internist, at the time of my annual physical, asked me, “What blood tests do you want today?” When I questioned him, he responded, “Do you want a blood count? Cholesterol testing? Vitamin D?” Most internists and doctors don’t leave it up to the patient, yet this “patient-directed” care, is becoming more prevalent. What does it mean for the patient?

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Was it only 3 + years ago that our world shut down due to Covid, and the healthcare system had to find new ways to provide care? Many of us experienced canceled appointments or saw that our visits to our healthcare providers were changed to "telemedicine." Actually, this is something that many people have wanted for years. We could have our visit while in our pajamas, and we didn't have to drive to an office and wait for our doctor, who frequently ran late (because our time is not as "valuable" as the doctor's), pay for parking, and spend umteen hours thinking, "if only I could have done this call at home."

In the early days, telemedicine was far from perfect. My husband had an appointment with his cardiologist early on in the pandemic; however, we couldn't get the video to work, and the doctor couldn't get into my husband’s medical records to review his history. We both felt that the visit was

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Many years ago, when I interviewed for a job as a Physician Assistant in an oncology office, the doctor asked me "why” I wanted to work in a difficult field such as oncology. My response was something I had thought about for years. Everybody deserved a "good death," the truth, and the right to make decisions. This went back to my being 16 when my mother died after unsuccessful cardiac surgery to replace her aortic and mitral valves. My last memory of my mother was in the ICU, intubated (with a breathing tube), and more machines than I ever could have imagined hooked up to her. Thus my journey began. She died six hours later without being resuscitated. Nature, and my father, allowed her to die. And for that, I will be forever grateful.

Back in the early '70s, we did not discuss death. My mother died, and that was it. I was a motherless teenager, but nobody talked about it. She died, I returned to school, people whispered around me, and life continued. There was no therapy; everything was just swept under the rug.

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A couple of months ago, I wrote a blog about my getting hearing aids. It was a tough decision, but not just from a financial standpoint. It made me feel officially "old," however, that could not be farther from the truth. 

Hearing loss is typically insidious; it sneaks up on you. You realize that the television volume keeps creeping up, and you laugh because everyone else is, but you have missed half of the conversation. We get tired of saying, "pardon" or "can you repeat that"?   And while our hearing may worsen with aging, it is not the only reason. Loud noises over the years, genetics, but does it matter? The result is that you don't hear well anymore.

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Recently a client of mine was told by her physician to discontinue a medication that she had been on for quite some time as it wasn't helping her pain, and it wasn't worth risking the potential side effects. Unfortunately, the doctor didn't tell her that she would have to wean down, as stopping cold turkey could cause significant problems. Somewhere in her paperwork, when she started the medication months earlier, it was probably written not to stop suddenly. Still, the physician did not review this with her, and she didn't remember reading it. She stopped that day. So many medications fall into this category that they can't be listed. Some include antidepressants, antihypertensives, heart medications, steroids, anti-seizure medications, and ulcer medications. 

 Two days later, she got up in the middle of the night to go to the bathroom, was very dizzy, fell, and hit her head. She suffered a black eye, broke her glasses, had a slight brain bleed (subdural hematoma), spent three days in the hospital, and underwent two preventable CAT scans of her brain. She is lucky; it could have been worse. 

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