Monday, January 7, 2013

Day 205 - lungs

 I bet you would like to know how the lung doctor turned out. It was a very easy and painless doctor appointment with good news at the end, so Yeah! First I had a set of pulmonary function tests which were normal. Then I saw the lung doctor, Dr. Tilluckdharry, who said that she thought it all looked like complications of having an infection and that she wanted another CT to be sure it was resolving. She said that I had enough pulmonary reserve as a never smoker who is pretty active that I might not get symptoms from a lung infection until it was really bad so she thought the thing that looked like pneumonia in the past could really have been pneumonia. She thought it was particularly important in my case to make sure things were really moving in the right direction. She also thought--key--that enough time had passed so that if the CT scan did not show improvement, we would need to do something more invasive to sort it out. I really quizzed her on this because I had already done three CTs, each intended to document resolution and each documenting something new that required another CT. Anyway, she convinced me and I got the CT and we compared them next to each other and yippee! the new one did not show anything new and showed partial resolution of everything old, well on its way to being done. She said that I did not need to see her or pulmonary again unless I developed some new symptom.

A recent Annals (Dec 18, 2012) is packed with articles I'd like to recommend to you. I have been so busy with leukemia news and pontificating about non-apologetic doctors that I haven't gotten to it in weeks. Here you go:
1. An article about hospital length of stay and 30 day readmission rate and mortality in the VA. The upshot is over the 14 years in question, all three went down. Is this applicable to the current situation? in non-VA hospitals? Should we be using LOS and readmission rates to determine hospital pay rates? The editorialist thinks definitely maybe.
2. "Does Performance Based Remuneration for Individual Health Care Practitioners Affect Patent Care? A Systematic Review." "outcomes remain largely uncertain." If P4P were a new medication, insurance plans would not pay for it. Just sayin'.
3. A nice article showing that pro-biotics help prevent c.diff in people taking antibiotics, including the statement, "Although results suggested that no important adverse effects occurred in the studied population, the possiblity of serious adverse effects in severely debilitated or immunocompromised populations remains." If I were interested in doing research, I would try to get PCORI to fund a study on the neutropenic diet's efficacy and to find out which of its onerous components were actually helpful.

I think I am getting Ellie's Christmas cold. This will be my first post leukemia virus and I am hoping for an easy time of it for my wish for tomorrow. For you, I think I'll wish for immunity to the collection of virusses that are in circulation right now.

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