Map of life expectancy at birth from Global Education Project.

Wednesday, January 26, 2011

Random Observations

If I wanted to live in Nunavut, that's where I'd be. But this year, the arctic has come to me. This relentless cold and snow -- snowfall after snowfall after snowfall, and not even an hour of an afternoon thaw to be found -- has me cranky, distracted, and unproductive. However, I don't think it's helpful to say that I have a "disorder." This winter is just for shit, and I'm in it, along with everybody else. However, as you probably know, there is an official disease for people who feel crappy in the winter. Apparently it really helps to blast yourself with bright lights, but a lot of people end up taking pills.

I don't necessarily object to slapping a disease label on this, but I do think it raises interesting questions about what constitutes a disease. People evolved in the tropics, and short days with dim light just aren't what we're built for. Freezing to death isn't a "disease," it's just what happens when we get too cold. Getting depressed when it's dark all the time may be a disease, but it's also pretty much normal.

Item #2: I don't mean to be a downer, but . . . It's natural that people want to feel a little bit better about the grotesque event in Tucson, but I do have to warn you off of all this upbeat reporting about Rep. Giffords. Yes, she's apparently doing well medically considering the horrific physical injury she suffered, but right now, nobody knows what her neurological status is going to turn out to be. In fact, they don't even know if she can speak. But traumatic brain injuries can have all sorts of not at all obvious effects that are nevertheless very significant to the injured person and those close to her. Difficulty in making and executing plans, personality changes -- quite often for the worse, including irritability and hostility -- difficulty in concentrating and focusing on tasks, are all quite common. We'll really just have to wait and see if she can go back to work.

I bring all this up because people with TBI, who have such problems, don't often get a lot of help and support. They can end up socially isolated, economically deprived, and disconnected from the ongoing services they need to improve their functioning and keep a social life. Rep. Giffords will undoubtedly be unusually fortunate in that regard, but I did a study some time ago for a state agency which found that there is often a serious failure of discharge planning. People leave the rehabilitation facility with a piece of paper that tells them where to go for help. Most of the time, they can't or won't be proactive enough to get that help. This is a well-known problem for many Iraq and Afghanistan veterans, and they ostensibly have the whole VA behind them. It's much worse for people who don't even have that level of resource.

Item #3: Speaking of feeling grumpy, I have a small lesion on my tongue -- not to worry, almost certainly nothing to worry about. Still, after I noticed it, it took me two months to get an appointment with my PCP. He looked at it and told me to see an otolaryngologist. It took me two months to get an appointment there. She saw me today and told me to come back next week for a biopsy -- for some unknown reason, she couldn't just do it. So I'm going to end up with three appointments, three co-pays and my insurance company making three much larger payments, and several months gone by, before anything meaningful happens. Surely we can do better than this.


C. Corax said...

"Surely we can do better than this."

Nope. It's the best health care system in the world, at least before Obama-care.

I'm glad you said it. Back when this first happened, the docs kept warning that such brain injuries do damage that can't be assessed right away. The media just blithely pretend they didn't hear. I don't think you're being a downer; you are being honest.

I do hope you are okay and the lesion proves to be nothing.

kathy a. said...

i think the idea she can go back to work in any kind of reasonable timeframe is not very realistic. the doctors are thrilled because she lived and has some basic responses.

Monica said...

Having a lesion in the mouth, did you think of starting with a dentist or oral-maxillofacial surgeon for your lesion?

Just asking. Might have carved off of bit of time until diagnosis and treatment.

Yep; pun intended.

roger said...

lesion is such a nasty word. hope it works out well.

Cervantes said...

My insurance requires a referral from my PCP to see a specialist. Theoretically that's supposed to save money, I think. What we need is to have everything in one place and the ability to respond quickly to exigencies. Requiring people to wait two months for an appointment is obviously inefficient.

robin andrea said...

I think it has actually been warmer than average in Nunavut, at least until last week. It's still dark as hell, but not as cold as usual.

I have been a little taken aback by the lack of understanding of tbi shown by the press. It's like they expect her to simply get better and get back to congress.

I hope that the lesion on your tongue turns out to be something simple to deal with. I don't understand why your PCP couldn't just biopsy it on the first visit. Don't they get taught that stuff in medical school?

Cervantes said...

Maybe they teach it in medical school, but he forgot it. He said I needed to see an oral surgeon or an otolarynwhateveritis. That's what my colleague here who is an internist also told me when I mentioned the thing to him. Marcus Welby doesn't do biopsies, apparently. I don't know why.