Pandemic Panic
Isn’t that a refreshing scene? There’s nothing quite so calming as a tropical island, with gentle surf caressing a sun swept beach while warm breezes sway the palm fronds in a relaxing rhythm. If you squint carefully, you can almost see the natives roasting a swordfish over a crackling fire and smell the heady aroma of fresh island vegetables.
The island also represents what the medical community wants for America. They want us all to hunker down in our homes in hopes of extinguishing the Wuhan Flu, much as we would be isolated and alone on a South Pacific isle. Numerous government leaders have taken them up on this advice. Sadly, they haven’t given each of us our own tropical paradise. While they aren’t actually calling it an enforced quarantine, the lack of the correct verbiage doesn’t make it any less so. If you think otherwise, try leaving your house after 8pm.
Of course, we’re just starting to deal with the fearmongering that resulted in mass panic, and nearly mass hysteria. The national economy is virtually shut down. The stock market almost collapsed,with losses not seen in nearly a half century. Nobody is certain of the damage done, but estimates range as high as perhaps a 40% reduction in GDP and 30% unemployment, numbers not seen since the Great Depression. Social structures have been irrevocably altered, in ways we cannot begin to understand. The very nature of work has been altered, with more white-collar employees working remotely than ever before. When we do get back to work, to school; when the centers of culture and learning do reopen, we have no idea how the changes that were suddenly thrust upon us will reverberate in the future.
The biggest problem with all of this is that the data about this disease is profoundly unreliable. It has been said there are lies, damned lies and statistics and no common experience drives home that truism more than the current situation. From the beginning, statisticians and epidemiologists were dealing with incomplete (and even falsified) data from China, India, Italy and South Korea. As a result, modeling – which government leaders relied on to predict how deadly the COVID-19 pandemic would be to the general population – has been terribly inaccurate. The noted epidemiologist John Ioannidis recently remarked that “the fatality rate could plausibly lie between one in 100 and one in 2,000 cases.” Mind you, he is merely referring to death rate for those who are infected. Nobody has yet put forward a reliable model for the infection rate, because the data simply doesn’t exist. This is a problem that was anticipated. On March 17, Ioannidis wrote, “we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.“
“But,” you say, “what about the rapid rise in cases in the United States I keep seeing on the evening news?” Ah, a fair question. Consider: since the United States started testing, it took us 17 days to administer the first 100,000 tests. It took another 11 days to administer the next 100,000. It has taken only 5 days to administer the last 320,000 tests. At current rates, the United States will be testing over 1 million people per week by mid-April. As the number of tests administered increases exponentially, the number of confirmed cases will also increase exponentially. The key evidence to look at is whether the number of positive cases is increasing at the same rate as the number of tests – and that answer is a resounding no. While tests have increased at a logarithmic rate, the increase in positive tests has followed a gentler curve, suggesting that the infection and lethality rates are lower than first anticipated.
One other note on testing: we have only been testing people showing symptoms. Yet the positive test rate is only about 15% of those tested for COVID-19. This is because what the media refers to as the “coronavirus” is actually a mutated form of the same virus that causes the common cold, multiple strains of influenza, SARS and MERS. Those are all corona viruses. As a result, the symptoms of COVID-19 fall into the same generalities as those other diseases: cough, fever, fatigue. That only feeds into the panic, especially as those are also symptoms of hay fever – and large swaths of the nation are entering spring allergy season.
For a doctor, the choice facing the nation is an easy one. They are worried about immediacy, and their immediate concern is to keep everyone alive and healthy. So recommending that everyone stay hunkered down in our houses and apartments is an easy choice. But for the rest of us, the choice is far from being simple. The president, and all 50 governors, have to weigh the importance of preserving lives now vs. the effects of leaving the economy in a downward spiral. How many people will end up dying from COVID-19 vs. how many people will die from starvation and other diseases of poverty if the economy slips into another massive depression? We can roughly extrapolate from available data that around 130,000 people will die from this disease. We cannot make even a haphazard guess about what the death toll from an economic depression that last months or even years might be, because while we know one is inevitable on our current course, we don’t know any of the particulars. We can’t. We’re not fortune tellers.
Without solid data, it is an impossible question to answer. Yet we’re all answering it, from the President to loudmouth Joey you normally meet at the corner tavern. The problem is, both of them – and everyone else – doesn’t really know, no matter what they tell you.
Will this virus be bad for the country? It already is. Will a deflated economy be bad for the country? It already is. But making everything worse is fear and panic. We can’t keep ourselves walled off forever, living in fear of everyone who sneezes. The federal government, between emergency fiscal expenditures and monetary expansion from the Federal Reserve, has already expanded national debt by nearly $8 trillion. That’s about 40% of last year’s GDP, and perhaps 65% of this year’s GDP. In short, that is an unsustainable degree of expenditure. We cannot afford to allow fear to panic us into cowardice, and we cannot afford to to allow fear to bankrupt the nation.
FDR once said “we have nothing to fear but fear itself.” It’s time for the panic to end, and for America to prove that FDR knew what he was talking about.
I’m Back!
Sorry for disappearing for so long. For those who aren’t aware, on March 28th I had an ileostomy performed. As I’ve been recovering since then, I’ve had neither the energy to write nor the physical ability to sit up long enough to do so.
Of course, there were post-operative complications. My lungs, badly damaged by the chemicals at Camp Lejeune during my time there, nearly failed during surgery. To assist with breathing, I was on an interesting machine called a “bipap” for part of my recovery time. I not only had to recover from the surgery to abdomen, but also from the pneumonia I developed on the operating table. Because not being able to breathe isn’t enough of a complication, the part of my intestine that now forms my ostomy developed an annoying habit of expanding 5 to 6 inches from my skin. But that seems to be resolving itself with time; the doctors assured me that while not common it also isn’t unheard of and it isn’t particularly dangerous. Unless, of course, I run into something stomach first while that’s happening. I would prefer not to think of how messy that would be.
Still, as the saying goes, all’s well that ends well. So far, my recovery is on schedule and it’s time to get back to as much of my regular life as I can manage. I won’t be able to lift anything heavier than a milk jug for a few more weeks and I’m still adjusting to not being able to sleep on my right side. I’m not supposed to bend, twist or otherwise torque my midsection until June. On a positive note, this has been a terrific weight loss program. I’m down almost 30 pounds since the surgery.
I would be remiss if I didn’t take a moment to pause and thank the wonderful doctors and nurses at the Hospital of the University of Pennsylvania. In particular, I want to thank Dr. Najia Mahmoud, Chief of Colorectal Surgery and her amazing team for their compassion and expertise. I also need to thank the nurses of the SICU, who managed to keep me comfortable and goad my recovery while also keeping my frightened family reassured and informed.
So anyway, get ready for a blizzard of posts. One of the things that happens when you spend so much time lying around is you think. A lot. Now it’s time to put those thoughts into something more substantial than a Twitter post.
Now For A Word from The Surgeon’s Table
If you follow me on social media, or have read this blog for a while, then you know I have Crohn’s Disease. Well, today is the day I’ve been dreading since I was first diagnosed in April 1992.
It’s time to get something removed.
I had always made it a point of pride that I would leave this Earth with all of my parts more or less intact. But that’s not to be. My terminal ileum (that’s the end of the small intestine, the part that connects to the large intestine) is essentially dead and has been causing me all sorts of problems since October.
So, out it comes. The doctors also told me there is a good chance they’ll need to remove the ascending colon, as well. They just can’t tell from the CT scans, but will know better once they get in there and see.
Now, I’m not so worried about what they’re taking out (I’ve kind of resigned myself to the changes I’ll have to make), as simply waking up. One of the dastardly things Crohn’s has done is given me pulmonary embolisms and pulmonary hypertension. They refer to these as “extra-digestive manifestations.” That doesn’t change the fact that breathing isn’t as easy as it used to be, and general anesthesia is especially dangerous for me. As in, might not wake up dangerous.
I’ve placed myself in God’s hands. If he wants me home, there isn’t much you or I can do about it. I always figured that with all the times I’ve defied death until now that God had a reason for keeping me on this planet. It could be this surgery is that reason. My medical team almost sounds like a bad joke: “a Muslim, a Hindu, a Catholic and an atheist walk into a surgical theater…” It could be my surgery will do more for world peace than all the diplomats at the UN have managed in 75 years of talking.
Anyway, by now I’m on the table and the doctors are doing a thing. If you’re the praying type, I’d appreciate if you would lift up my medical team. Oh, and don’t let the big guy upstairs forget I am still needed down here.
Thanks everyone. See you on the other side!
An Open Letter of Praise for the VA
Those of you who have been following my blog for a while should know a few things about me. I am a proud veteran, and I have Crohn’s Disease. And I have been an outspoken critic of the Veteran’s Administration, and the Veteran’s Health Care System in particular. But I try to be fair in my criticisms, and when someone does something right they deserve to be recognized. Such is the case with my recent hospitalization at the East Orange VA Hospital. Following is a letter I wrote to the Secretary of Veteran’s Affairs (Des.), David Shulkin and the Director of the New Jersey Veteran’s Health Care System, Vincent Immiti.
Gentlemen,
I am a Cold War era veteran who has dealt with the Veteran’s Health Administration since 1994. Over the intervening years, I have had my share of complaints. I have been either an inpatient and/or outpatient recipient of services at multiple hospitals: Ft. Lauderdale, Wilmington (DE), Philadelphia, New York Harbor and, of course, the Lyons and East Orange campuses of the NJVHCS. I am not writing to tell you that rainbows are blooming over the VHA – only a fool would believe that. But I feel that after years of heaping some well-deserved abuse on what has proven to be a dysfunctional system, my most recent experience is deserving of praise for a job well done.
On Saturday, January 21 of this year I was brought into the East Orange Veteran’s Hospital Emergency Room. I have suffered with Crohn’s Disease since 1994 and this was the beginning of yet another hospital stay for me. I was not looking forward to it, as my previous partaking’s of the VHA’s hospitality always left me feeling more as if I were a POW than a patient. Allow me to say, I was pleasantly (as pleasantly as a hospital stay can prompt) surprised by this admission.
It truly was a night and day experience, compared to all my previous hospitalizations. Whereas in the past, my concerns and questions were met with derision or (even worse) indifference, this time I found the medical staff earnestly answering my questions, explaining the anticipated course of therapy and being attentive to my concerns and those of my family. In past hospitalizations, medications would arrive haphazardly without any semblance of a schedule, nurses would be impossible to find, even when called, and doctors acted as if I, the patient, were a burden they would rather not deal with. The only thing they seemed interested in was prescribing high doses of pain killers and moving on to the next victim.
Hospital cleanliness was always a concern, as I could go days without seeing a mop or broom used. As you’re probably aware, Crohn’s patients in the middle of an extreme flare are prone to having accidental, violent bowel movements. In 2009, after once such episode, the nursing staff did eventually come in to change the bedsheets – but with a set of blood-stained ones. Such was the level of contempt that the overall staff seemed to have for the patients in their care.
As veterans, we do not ask for anything special. Every veteran I’ve ever met is proud of our service to our nation and would gladly reenlist should the nation need our services again. As patients, all we’ve ever asked for is to be treated with the basic respect anyone should give another human being. The anger and disgust many of us feel towards the VHA is rooted in the failure of the VHA to recognize and act upon that humanity.
But as I mentioned, this hospitalization was not only what one would expect at any medical facility, but in many ways surpassed even the highest expectations one could have of any hospital. The staff exhibited all the hallmarks of a professional medical organization: courtesy, attentiveness, compassion and competence. Nurse calls were answered promptly, and if an RN was needed but unavailable, the LPN’s explained the situation. My attending physician not only provided timely and pertinent explanations of my care – in terms a layman can understand! – but proved an exceptional coordinator with the specialists I needed (gastroenterology, pulmonology and cardio). Tests that were performed were explained beforehand, including not only descriptions of the procedures but the reasons for them. The residents, interns and medical students did not treat me as an object of fascination on par with a living cadaver, but as a suffering patient with information they needed to perform their duties. Even the orderlies, janitorial staff and other support staff approached their jobs with a general friendliness and professionalism that made the otherwise dread of a hospital stay comforting.
The change is remarkable. I was going to attempt to single out individuals for jobs well done, but then realized everyone associated with my care deserves special recognition.
I am not a medical professional. I suppose you could say I’m a professional patient, given my history, but that’s the extent of my medical training. However, my post-military career has been in operations and program management. As such, I can recognize and appreciate when an outstanding manager has taken control of a bad situation and is effecting a complete turnaround.
As I began, I’m not going to gloss over the fact that there are still major problems and deficiencies throughout VHA. However, Mr. Shulkin, upon your confirmation I can think of no better place to start turning around the system than seeking out your best, listening to what they’ve done and implementing those practices throughout VHA. Based on my recent stay, you would do very well to begin with Mr. Immiti. The change he has effected is nothing short of amazing.
I thank you for your time and again, congratulations on a job well done.
Semper Fi and Regards,
Raymond Rothfeldt
Honoring Homeless Veterans
(Author’s note: I originally published this post in November, 2014. Now that the Northeast Corridor is bracing for the first major storm of this winter season, it seemed a good time to remind everyone that the problem hasn’t gone away)
On any given night, some 50,000 veterans end up spending the night outdoors or in a homeless shelter. Additionally, there are estimates that as many as 1.4 million veterans are at risk of becoming homeless.
In a nation where politicians trip over themselves to prove how much they care about veterans, this should be impossible. Yet the facts are what they are. Men and women who’ve sacrificed years of their lives in defense of their country often find themselves reduced to begging for scraps of food and a bit of shelter. The reasons for veteran homelessness mirror those in the general population: mental health issues, substance abuse and just plain bad luck top the list. But if any subset of the population has earned the privilege of not freezing on a winter’s night, veterans should.
The VA, for all of its shortcomings, actually does a reasonable job of trying to care for homeless veterans. But funding remains an issue. For instance, there is the VASH-HUD program, which provides homeless veterans with housing vouchers and community support (such as job assistance and counseling). It has proven to be one of the best homeless programs in the country with less than 5% of the veterans accepted returning to homelessness within 5 years.
For FY2014, VA was granted funding to assist 78 homeless veterans in New Jersey. 78. For the entire year. I can go to Military Park in Newark and find 78 homeless veterans.
But there is a solution, and one that would actually save the government money in the process. All across the United States, sequestration and other budget cuts have resulted in hundreds of military bases being closed. They sit, abandoned, awaiting a government auction where the property will be sold for pennies on the dollar. In New Jersey, Fort Monmouth sits abandoned, falling into disrepair while the former megabase of Fort Dix/Lakehurst Naval Air Station/McGuire AFB occupies 10 1/2 square miles in the New Jersey Pinelands, struggling to find a purpose after the 1991 base closures. Today, it is used a training area for National Guard and reserve units, with a federal prison and aircraft maintenance wing. Fort Monmouth once housed 21,00 troops; Dix-McGuire 27,000. On both bases, the buildings sit, more intact than less.
The proposal is this: turn a portion of either base (and the dozens more around the country) into a Veteran’s Homeless Prevention and Community Reintegration Center. Rather than hiring outside contractors to maintain the buildings, grounds, power stations and the like, assign those jobs to the veteran population living there. That would solve two problems that are often at the heart of veteran homelessness: a lack of civilian job skills (infantryman isn’t exactly a skillset required on Main Street) and providing a sense of purpose. Rather than requiring the VA to provide follow-up care on veteran’s scattered throughout the state, they would be centrally located: a VA clinic could be opened there, proving treatment for medical and mental health issues. Finally, rather than spending up to $25,000/year in housing vouchers per veteran, the government would roll that money into a facility it already owns.
Everyone wins. Homeless veterans find shelter, camaraderie, purpose, services and the opportunity to reclaim their lives. The government honors its promise to “care for him who shall have borne the battle.” And our nation’s citizens can rest easy in their beds at night, knowing that no veteran needs to sleep on a sidewalk.
E-B-O-L-A In The USA
Begging pardon from John Mellencamp…
I have a few questions that were artfully dodged, or never asked, during this afternoon’s presser:
1. How many days was the patient symptomatic, and therefore contagious, before going to the hospital for the first time on September 24? I mean, seriously, how many people go to a hospital because they’re running a fever and sneezing? Not many I know of, at least not right away.
2. How many people did he come in contact with, total, before being quarantined? He’s apparently visiting from Liberia. To imagine he didn’t visit any stores, restaurants or tourist sites in the 4+ days we’re certain he was contagious prior to quarantine is ludicrous.
3. How did he get to the hospital on September 24? By private car, taxi, ambulance? Or worse – by public transit?
4. Ditto for September 29.
5. Dallas is, besides being a large city, also a major worldwide transportation hub. How many of those the patient contacted while he was walking around contagious, have since departed by plane, train, bus or automobile…and where did they go?
I’m sorry, but the CDC can tell us they have everything under control all they want. But until they can tell us with a straight face that they have the answers to the questions above, I feel as though they’re recreating this scene from “Animal House “…
Life and Liberty
Those of you who follow me on Twitter or Facebook know I recently spent 8 days hospitalized once again. My ongoing battle with Crohn’s Disease, one that has consumed the last 22+ years of my life, remains unrelenting. Like all of such events over the past three years or so, this hospitalization didn’t end with long-term remission of my disease activity or even the hope of a near term remission.
I could complain and I doubt many of you would be upset if I do so. But I’ve never really been one for complaining about things beyond my control, nor do I think that really accomplishes much. Certainly, venting can ease the mind but it’s only a temporary relief. I pointed out once before that life’s recent turns have, if anything, made me more reflective and this most recent turn only served to reinforce that attitude.
But reflective of what, exactly? Well, in a word: EVERYTHING.
Faith, religion, why we’re here? Yes. My personal history, my family, friends and relationships? You bet. Medicine and medical research? Naturally. My overarching view of our world, our past and our future? Certainly.
There are only so many times a man can stare at his own mortality without contemplating the wonder and the why of it all, I suppose. Or the alternative could likewise be true: all these brushes with Death’s door may have already left me insane – in which case, you’ve been reading the rantings of a madman. We’re about to embark on a journey to find out which is true over the next few days and weeks. I’ll leave the decisions about my sanity to your discretion – which considering my readership, may be the boldest move I’ve made yet!
For a blog that spends as much time on political matters as mine, you may be wondering how I managed to leave any mention of that topic from my list of contemplations. But here’s your first point to ponder in judging my perspicacity: isn’t the political the one realm where we publicly express our personal philosophy?
Tomorrow, we begin…
Another Fine VA Mess
Long time readers already know I have Crohn’s Disease. I’ve dealt with the condition for
almost 22 years, and for large chunks of that time I’ve relied on the Veteran’s Administration Health Care System for medical treatment. As such, I remember the bad ol’ days – when simply signing up for medical care was nearly impossible. The program has made great strides in the past decade and medical care has improved. This isn’t to say the available care is good everywhere; it simply means that fewer VA medical centers seem to have killing veterans as their top priority. I’m also more fortunate than most vets. Because of where I live, I can actually pick and choose from four medical centers. If I lived in Montana, that option wouldn’t exist – I would be stuck with whatever quacks the local VAMC could find to staff the place.
But beyond the quality of medical treatment, there is another problem that, quite frankly, I can’t see any way the VA can correct. The Veteran’s Administration is a government agency – and as such, a ridiculously bureaucratic nightmare to navigate. Just the simple process of checking in for an appointment is a time consuming mess (it means seeing three different clerks, in different offices, before actually getting into the clinic – where you then need to fight with another clerk in order to see a specific doctor).
But there’s another aspect to the bureaucracy that most people (especially those who defend government programs as both necessary and infallible) often forget about: that bureaucracy is staffed by people whose competence is often less important to keeping their position than a host of other factors. A perfect example is what I am now experiencing. Because I’ve been dealing with Crohn’s for so long and every other medication ceased working, I’m now undergoing chemotherapy treatments. It’s a “Hail Mary” attempt at getting this disease under control and it actually seemed to be working.
Enter the VA bureaucracy. As part of the treatment regimen, I stopped the infusion therapy and was supposed to switch over to pills. Great! Fewer trips to the local VAMC, no need to hit up friends for rides, fewer side effects. The pills were supposed to be mailed to me two weeks ago. When they hadn’t arrived by last Wednesday, I spent 45 minutes on the phone to ask where my medication was. Not to worry, I was assured. Because of the holiday weekend, it might take an extra day or two for them to arrive in my mailbox. The weekend came, the weekend went and still no pills. I called back today and after another 38 minutes (most spent on hold), I discovered that somebody, somewhere, placed a “Do Not Mail” flag on my VA pharmacy account. No reason, no rhyme, no excuse – and the faceless person on the other end of the phone assured me they were incapable of releasing the flag.
But wait! It gets even better. A week and a half ago (three days after the pills were supposedly mailed), I spent another hour at the VA pharmacy to get other prescriptions. The clerks (another bureaucratic mess, you need to see four clerks to get a prescription filled – and there isn’t even a paper form, it’s all in the computer) all had access to my account. All of them saw the prescription in question was ordered, one even asked me if I wanted to wait for that one, too. Not one mentioned the “Do Not Mail” flag or offered to remove it.
Is it incompetence? Bureaucratic overlap? A simple failure to communicate? Whatever the cause, the result is the same: another dissatisfied and confused customer. On the surface, an example of how the Veteran’s Administration can screw up a simple task. At a deeper level, it’s a perfect metaphor for why the less government does, the better.
For my friends wondering how I can simultaneously avail myself of a government program and decry government programs, you can find extensive arguments in my archives. But this is an earned benefit, through my prior service to our nation. And for myself and the millions of my fellow veterans, the VAHCS can be done away with by simply issuing us medical insurance that allows us to see private physicians. (Yep, it would cost the government less, too).
Why I Support the #Defund Obamacare Movement
Obamacare & Your Career
If you spend any time on Twitter or Facebook, you’ve undoubtedly come across the “#Defund” hashtag. If you follow the news even cursorily (and odds are you follow it more closely than that, if you’re reading this) then you also know the House of Representatives voted yesterday to continue funding government operations until December. Everything, that is, except the Affordable Care Act – more popularly known as “Obamacare.”
The President’s reaction? He’s taking the CR personally, certain that the motivation behind it cannot be ideological in nature. “They’re not focused on you. They’re focused on politics. They’re focused on trying to mess with me. They’re not focused on you” he stated during yet another campaign speech yesterday. (As an aside, why is he campaigning? I thought the election was last November.) While my personal dislike for the the man in the Oval Office has grown considerably over the last five years, my disdain for Obamacare hearkens all the way back to its inception. Trust me on this one, Mr. President. My opposition is nothing personal – and neither is it for the people with whom I’ve conversed with on the subject.
I support the defund movement, because it is our last, best hope of getting rid of the “train wreck” (Max Baucus, the guy who helped write the ACA, called it that) and replacing it with something that actually addresses the rising costs and failed delivery of health care in the United States. I support the defund movement, because the economic impact of even a temporary federal shutdown would be far less than realized from your weapon of Mass Economic Destruction. Finally, I support the defund movement because the American people have had about all they can take of Obamacare.
Let’s start with that last point first. That you’ve always a had somewhat regal view of the Presidency is certain. Since early on, you’ve complained that you aren’t a dictator, or king, or emperor, or president of China. The actual concerns of the average American were hardly the thing that kept you awake at night; why else the dozens of “pivots to the economy” over your 5+ years in office? Over the past year, overwhelming evidence was exhumed that you consider yourself above the American people. From the failure in Benghazi, to the IRS crackdown on conservative and libertarian groups, through the revelation that the NSA is spying on everyone, to your recent attempt to force the nation into an ill-conceived war in Syria, said evidence is damning. You really did think for a while there that you are a de facto dictator.
Obamacare was our precursor. Yes, the American people wanted something done about health care. But what we wanted and what we eventually got are two very different things. Instead of reform that lowered costs and made delivery easier, we simply got told we had to go buy health insurance – or else. No matter, we were assured countless times since: once the law rolls out, you’ll love it! Why, didn’t Nancy Pelosi tell us that in order to find out all about the wonderful goodies in the ACA, Congress had to pass it first? The sycophant press quickly dubbed the new law “Obamacare” and you ‘begrudgingly’ accepted the name. FDR had the New Deal, LBJ had the Great Society, BHO had Obamacare.
Never mind that your signature piece of legislation has never been popular with the very people it is supposed to help. Polls show what support existed at passage has slowly slipped away. It’s your signature piece of legislation, by golly! So of course you’re right to be mad at Congress for attempting to undo the damage done, for seeing it as a personal attack and a personal affront. Never mind that the CR defunding Obamacare is actually more popular than the law and never mind that it enjoys popular support (and not just among the Tea Party). Never mind that it’s very passage is regarded is the single most important reason your party lost control of Congress in the 2010 mid-terms. If you refuse to sign that CR, then it’s the Republicans’ fault that the government runs out of operating cash on October 1. Not your own pigheadedness, not your own wanting to be a dictator – or failing that, being seen as the most “transformational” President since FDR.
About that threatened federal shutdown. We’ve been down that path a few times and quite frankly, they aren’t that scary to most Americans. There will be an inconveniences, of course. For instance, I won’t be able to track a flight on the NTSB’s website. I won’t be able to call the IRS with a question about my taxes (which, by the way, I’d probably sit on hold for 20 minutes and then be told to ask my tax professional). But we already know from past experience that essential government functions will continue: the Army won’t be disbanded, the FBI will keep hunting bank robbers, grandma will still get her social security check. Even progressive economists admit the actual economic impact would be minimal, resulting in a reduction of less than 1% of GDP.
But the economic impact of Obamacare is already being felt across the economy. Nobody has a full accounting thus far, but in the past week alone nearly 500,000 people have had their hours cut to 28 or fewer and their existing health coverage terminated. Another 35,000 have lost their jobs completely. Although you love to tout the million jobs created in 2013, you have yet to acknowledge the fact that 1.2 million of those jobs are part-time, without health coverage. Those are real economic impacts directly attributable to your signature legislation. Here’s another impact you may not want to acknowledge: those workers are not only facing a drop in income from reduced pay, they are now going to be hit with a new expense: mandated health coverage. Sure, there’s a subsidy headed their way (provided Obamacare is fully funded) – but those subsidies won’t cover the full cost for health insurance. A government shutdown might reduce GDP by 1%. But Obamacare is easily dropping GDP farther than that and will cause it to crash even further. All this was avoidable, but neither you nor your progressive friends apparently live in the real world, the one in which businesses aren’t going to spend a dime more than necessary. You were warned by everyone from the Chamber of Commerce to (gulp) Donald Trump, but still you refused to listen. The economic mess your signature legislation created is wholly owned by you, as well as the Senators and Congressmen you bought off.
Finally, there is the train wreck. I could list everything that has gone wrong so far with getting this mess in place, but I did that a while back. To that list I add three more fiascos: the doctor shortage, the uninsured and one I’ll keep you guessing about until the end.
The doctor shortage was known and supposedly addressed in the ACA. Simply put, there aren’t enough primary care doctors available to cover everyone. Getting an appointment to see your doctor is already hard enough (and let’s not forget the wait times once you’re in the waiting room). The AMA now anticipates that wait times are going up by about 6% – and nobody anticipates getting an appointment will get easier. Will we see British-type difficulties in getting an appointment, with waits as long as a month? Will they be more like typical waits in the VA system, where it can take up to 6 months to get an appointment? Nobody knows, but the alarm bells should be sounding: in the New York metro area, a recent study found that time to appointment was now ranging from 6 to 61 days, with an average of 24.
The uninsured? When Obamacare was trotted out to the public, we were told that all but a few, perhaps 3 million, of those without insurance wouldn’t be covered. In March, CBO blew that apart with a new estimate: 7.5 million. Last week, that get shattered again, when DHS announced that because of the rollbacks, waivers and deferments, that as many as 30 million people still would be uninsured come January 1, 2015. That would mean we went through all these gyrations over the last 36 months to insure an additional 2 million. Call me what you will, but that amounts to the second biggest load of crap ever handed the American people from Washington DC.
The biggest load of crap ever? Well, here’s the caboose of the Obamacare train wreck. Mr. President, you have promised us that “If you like your health plan, you can keep it.” You’ve pummeled the American people with that line for over four years, even though as far back as June, 2009 you admitted yourself that the statement WAS A LIE. Now millions of Americans are finding out what a monstrous pile of horse manure that line really is. Insurance companies, because of the regulatory morass that this demon child legislation created, are gutting health plans and informing their customers that come January 1, 2014 their current insurance will no longer be available.
In short, I’m supporting the #DEFUND movement because really, what other choice does our country have?
Liberty and Fairness
“The natural distribution is neither just nor unjust; nor is it unjust that persons are born into society at some particular position. These are simply natural facts. What is just and unjust is the way that institutions deal with these facts.” ― John Rawls, A Theory of Justice
Recent events in my own life have forced me to re-examine some of my most deeply held convictions. During the time I’ve been absent from this blog (wait – you didn’t notice???), four events in particular gave rise to self-reflection:
- Crohn’s Disease, with which I’ve done battle for 22 years, once again reared up and forced me to the sidelines
- My eldest son, who was born with a developmental disability, is now caught up in the nightmare that is the state mental health system
- I’ve rented a room to a family that is emblematic of all that is wrong with the way government abuses good people
- Another of my tenants passed away during the night
You’re probably wondering why I would spend the time to ponder what one prominent politician describes as “esoteric debates” when life brings such immediacy. You’re probably wondering further why I would take the time to write about that internal debate. The answer is that such internal debates are neither esoteric nor a thriftlessness exercise. It is by determining if our views are malleable to the events in our lives that we discover if our core values are the result of dogma or the sound exercise of judgement.
The overarching theme of President Obama’s tenure is that of “fairness.” Only, in Mr. Obama’s world, the fairness is defined by outcome; one in which those aggrieved receive what they deem to be their just share. This doctrine is exemplified in the policy objectives of his administration. Be it the underlying argument for Obamacare (that the only fair medical system is one in which everyone has health insurance), economic policy, the tacit embrace of the Occupy Wall Street movement, the management of foreign policy (attempting the equal embrace of islamist and democratic ideologies abroad) or dozens of other initiatives pursued, Mr. Obama is clear in how he defines “fair.” Further, his actions (including his insistence on defending the possibly unconstitutional and certainly intrusive domestic spying program) demonstrate a certainty that governmental institutions are the best method of obtaining this measure of fairness while denigrating the roles of other, traditional venues.
Unlike many of the President’s critics, I do not think he is an uncaring ogre bent on instituting a draconian new way of life on the American people. Although we disagree on most issues, I certainly applaud his efforts to afford all people equal protections under the law. I think it is indicative of his nature, in that he actually cares about the quality of life afforded ordinary Americans. I think most of my fellow countrymen have that same feeling and that underlying belief in his nature is the ultimate reason he won re-election – even though most of us remain opposed to his specific action plan.
I also think that more than a difference in political philosophy, we have divergent views on reality and possibility that slice to the core of our differences. The President is what might best be termed a government interventionist. Government Interventionism infects both the modern liberal and conservative movements. It is characterized by a belief that not only can the government positively effect outcomes, but that it should. While conservatives and liberals often have different goals in mind, they agree with the principle of a results-based system. As anyone who follows me on Facebook or Twitter is well aware, I have never subscribed to this view of governance.
My introspection of the past weeks has called me to wonder if, perhaps, this approach is best. One of the criticisms of Libertarians is that we are a callous bunch, uncaring about how life’s travails affect our fellow men. Those who know me personally know this isn’t the case. Of the root causes for my self-reflective journey, two involved people that I know cursorily. Yet, they are people who strike me as somehow getting less from life than their character would indicate they deserve.
Allow me to begin with the woman who died in her room last Wednesday. Although I knew her only a few months, what I did know belied her situation. She worked full-time (a rarity in today’s economy) and was well-respected by both her coworkers and employer, she had a large and close-knit family and she was outgoing, gregarious even. Yet, she died alone in rented room, the victim of a long battle with a chronic illness; in her case, diabetes. From what I could see, it was not a pleasant or painless death. She must have known she was in desperate trouble – I found her collapsed at the foot of her bed, in a position indicating she struggled to get to her door, with her phone fallen from her outstretched hand and smashed into bits. If we live in a results based society, why did she die in this manner? What could society have done differently that would have ensured that at the very least, one of her family would have been with her in her time of greatest need? At her funeral on Saturday, meeting her family and friends and seeing the outpouring of grief that overcame them all, I wondered why a woman so beloved by so many, who had done all society asked of her, should have been subjected to such a terrible death?
The week prior to her passing, I rented a room to a family of four. One room, four people, sharing a kitchen and bath with three other tenants. These are decent people, again doing all society says they should do. Both parents work and the mother attends nursing school; the children are incredibly well behaved (I wish mine had been so well behaved!). But they are victims of governmental bureaucracy as much as anything. The father openly admits to making mistakes when he was younger, which resulted in a felony conviction two decades ago. Since then, he’s done the things we tell him he should do: work to support his family, avoid the drama of street life, return to school and complete his GED. He would like to continue his education, but supports his wife as she works towards getting her degree. This is a family, in short, that is playing by all the rules our society dictates – yet they are reduced to living four to a single room, because it is all they can afford. The welfare system, the one that liberals tell us prevents this type of thing from happening and conservatives insist is too generous, is unavailable to them unless the father abandons his family. It is his decades old prior conviction that denies them access to it. Somehow, this result doesn’t seem fair to me.
Along the same lines, my personal struggle with chronic illness – in particular, a 22 year battle with Crohn’s Disease – has become much more difficult over the past two years. Over that time, I’ve had to shutter a business, spent nearly 8 months (cumulative) hospitalized and watched my family’s wealth get drained until we were destitute. I’ve rebounded some financially, but am in no way near the same fiscal position I was in 2011. Most of those around me think it unfair that my life has taken such a drastic turn, or that my reality is I’m likely wheelchair bound within the next two years and probably blind in less time than that. Certainly I wish there were a better prognosis.
Finally, there is my oldest son, Dennis. Some of my long-time readers are aware that he is what society euphemistically calls “developmentally disabled.” His reality is that he will never comprehend things the way you or I do. His IQ is 54; intellectually his development is equivalent to a second grader, emotionally he is at roughly the same stage as most 13- or 14-year olds. So while physically he’s a strapping 25 year old young man, his mind has yet to catch up to his body. Odds are that the two will never be in sync. This is the crux of his current problem. Because of his condition, he finds it difficult to express his feelings, except to occasionally blow up the way most 14 year old boys will. About 6 weeks ago, he found himself in a situation where he was being teased (not an uncommon situation, unfortunately) and lost his temper. The police were called; they followed protocol and brought him to the emergency room for observation. Which is where the nightmare began. Rather than checking his medical records, the hospital diagnosed Dennis as a violent schizophrenic and packed him off to the closest mental hospital. The doctor (I use the term in deference to his degree, not his competence) there confirmed the diagnosis, again ignoring his medical condition. A competency hearing was held, in which the doctor amplified his diagnosis to include the term “homicidal.” And so my son sits in a mental hospital, not understanding what’s happening or why as we fight to have him moved to another facility and have a new diagnosis issued that accounts for his disability. I’m not sure who would consider this outcome “fair.” If the President thought the justice system was ultimately unfair to the family of Trayvon Martin, I can’t see how he could consider this fair.
In reflecting on these incidents, each with an outcome which seems disproportionate in outcome to circumstance, I wondered if the results would be different were the fairness doctrine imposed by society replaced by libertarian values. Chances are that in three cases, the results would be the same but the perception would be different.
- In a Libertarian society, we would acknowledge that the young lady who died chose to live her final days alone. While there still would be sadness accompanying her death, it wouldn’t be considered unfair that she had neither friends nor family with her in her final hours.
- For the family renting the single room, society wouldn’t consider it unfair that a hard working mother and father would resort to housing their family in these conditions. In a Libertarian society, they would be celebrated as examples of how to face adversity.
- As for my health, nobody would consider it unfair that I’m sick and fated to becoming sicker. Unfortunate? Unlucky? Sure, those sentiments would be common. But the choices my family made in previous years were our own and left us in the financial position we find ourselves. I knew my health was precarious before launching my last business; it was our choice to take that route as opposed to my taking a job in what is a poor economy. Using Libertarian values, we took a calculated risk that proved unwise. But in the interventionist society we live in, we demonstrated incredible recklessness and need to be saved from ourselves.
Libertarians believe that fairness in opportunity is far more important than fairness of outcome. After all, if everyone is free to pursue their life’s goals – if they are truly at liberty – then the outcomes are inherently fair. Differences in outcome will have more to do with natural ability and desire than anything a government can do. While the odds are that the above situations would not be dramatically different than in a Libertarian society, there is one important way in which one of those situations would be better. The people above would be less constrained by a restrictive society. The family in one room may well be much better off, since Libertarians tend to look at most drug laws as counter-productive – meaning no felony record for the father. He would certainly have better employment opportunities without that black mark.
As for my son, a Libertarian society would probably mean all the difference in the world for him right now. Without the modern police state in which presumed innocence is nothing more than a tired cliche, it’s doubtful he would be where he is now.
So, yes, I’ve reflected and pondered. You’ve read my conclusions. You may not agree with them, but I end this period of introspection confident in my core belief that the equitable outcomes can only be guaranteed by the one truly fair system ever known to humankind. That is, that by believing in the individual and providing them with the liberty to achieve to their individual potential, a government does its best service to the governed.
The End of the Beginning
Some of you may recognize the title of this post as part of a quote from Winston Churchill:
“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
Although Sir Winston was talking about the Battle of Egypt, the same could be said of Obamacare today. Since this is a holiday week, there is a good chance that you missed the announcement from the Treasury department on Tuesday afternoon. The Obama administration unilaterally decided to delay implementation of the employer mandate part of the law until 2015. Never mind that this is another example of a President who repeatedly decides which laws he’ll enforce (in direct contravention to the Constitution). That’s a another post for another day. No, this is yet another example of what was supposed to be the greatest thing since sliced bread is actually what a whole bunch of us realized it was from the beginning: in military parlance, a BOHICA SNAFU. (For those of you unfamiliar with military terms, this is a family blog. Feel free to use a certain search engine to look it up).
How bad has this been? There are bad laws and there are poorly executed laws. But this law was less about the stated intention (revamping the American healthcare system to provide easier access, with lower costs, for all Americans) than it was about a political power play between the two major parties. The result was a poorly conceived law, rammed through an indifferent Congress by a power-hungry administration, crammed full of pork and incapable of actually working. Every day seems to bear out the fact that nobody read the ACA before the final vote (even if they had, it would have taken a year more just to figure out the details).
To date, there have been 10 instances where the Obama administration has been forced to admit defeat on a particular program in the ACA. The reversal on the employer mandate is the latest, and one of the most critical. The reason they gave, that businesses needed more time to figure out the paperwork, is as believable as the tooth fairy. The real reason is that businesses already figured out how to avoid the paperwork completely: keep workers under the 30 hour limit which would trigger the mandate. Friday’s jobs report, which showed that more part-time jobs were created than full-time jobs, underscored this.
Score one for those of us who warned that Obamacare was an economy killer.
Unfortunately for the American worker, the individual mandate is still in place. The removal of the employer mandate means that some 36% of Americans are now going to be forced into purchasing private medical insurance. The employer mandate proved politically unworkable in practice, I suspect that by October (when everyone needs to start shopping) the individual mandate will prove even more politically impractical.
By the way, here are the 9 previous ACA failures:
- The CLASS Act: a long-term care insurance program that died last year. The reason? The law, as written, couldn’t be funded. The supposed budget savings amounted to 40% of the total deficit reduction attributed to the ACA.
- Federally mandated insurance exchanges: States were given literally unlimited funds to set up insurance exchanges that would allow uninsured folks to shop for coverage. The problem is that only 17 states have bothered with setting up the exchanges and the law requires HHS to set up exchanges for any state that doesn’t. But the ACA failed to foresee that states might not want to bother with the regulatory and administrative nightmares in trying to create a health care exchange and provided zero funds. HHS estimates it will cost at least $1.5 billion dollars to get the exchanges up and running. Good luck with that.
- Small business exchanges: along the lines of the individual exchanges, these were intended to allow small business employees to access the same rates enjoyed by employees at major corporations. They aren’t dead yet – but like the employer mandate, they have been delayed until 2015. The problem isn’t political here, though – it’s a real-world issue. Namely, how do you get the same actuarial certainty for an employee at a company with 10 employees as one who works with 1,000 other people? (Trick question: you can’t do it. But remember, the math geniuses in Congress who dreamed this up also raise government spending, then call it a “budget cut.”)
- 1099 reporting: This was a major funding tool for the ACA that was scuttled because it amounted to both a new tax and a reporting headache for every employer in the country.
- The Great Waiver Debacle: a provision in the ACA allowed HHS to issue waivers to organizations that could prove they needed them. Lo and behold, the Political Patronage and Payback Machine kicked into high gear. Over 1200 waivers have been granted (nobody knows for sure, because HHS stopped reporting the numbers a few months back). But if you gave to the Obama campaign or the DSCC, it looks as if you got a waiver. Funny how a law that was supposed to benefit everyone has proven so incredibly unpopular in core Democratic Party constituencies.
- The Pre-Existing Plans: great idea, on paper. Anyone who has a preexisting condition knows how difficult it is to find medical insurance. But once again those Congressional mathematicians didn’t realize how much it would cost to insure everyone – and the program has already run out of money. No more people are being accepted, even though HHS estimates that only 30% of those eligible are covered.
- Children Only Plans: under the ACA, if an insurance company sells child-only healthcare plans they need to offer coverage to kids with preexisting conditions. Somebody forgot to tell Congressional Dems the way the marketplace works (that companies do not willingly increase costs without some future benefit). The child only plans have virtually disappeared from the marketplace, a casualty of Obamacare.
- The “Basic Health Care Plan”: What’s that you say? You’re in perfect health, you’re young and you really don’t want to pay for full coverage that you can’t afford, even with the promised subsidies? Well, not to worry: the ACA mandated that states offer a basic plan – or essentially, catastrophic coverage-only. Except, as with the other mandates, it has proven unworkable and pushed back to 2015.
- “If you like it, you can keep it”: I saved the best for last! The greatest example of marketing hucksterism exhibited by the Obama administration was the President’s repeated assurances that if you liked you current health coverage, you would get to keep it after the ACA was passed. It’s pretty clear at this point that either the President is as dumb as rock when it comes to market economics or a bald-faced liar, because millions of Americans no longer have the health insurance options they had 4 years ago. Heck, HHS expects that some 126 million Americans will see a “significant” change to their health coverage as a result of the ACA.
The administration and Congressional Dems keep telling us that we’ll love Obamacare once it fully takes effect. They insist the law’s problems have more to do with poor marketing and Republican obstructionism than any basic flaws. But the record on implementation has more failures than successes and the law keeps proving to be more and more unpopular across all demographics.
Here’s a suggestion for the President. Admit that the latest reversal is, in fact, proof that the ACA is a disaster. Politically, it swept your party out of power in 2010 and is threatening to reinforce those losses in 2014. If you are truly interested in your legacy, which seems to be the general consensus among the DC elite, then do something no President has done.
Declare that your “signature accomplishment” is failing to deliver on the promises it made. Ask Congress to repeal it, scrap it and consign it to the dust heap of history. Ask Congress to work together to craft a healthcare reform package that actually works to improve delivery and reduce costs. In short, take ownership and command the respect true leadership creates.
This is the beginning of the end. The only question at this point is whether the President can rewrite the script and create a happy ending. If the past 5 years are any indication, he is politically incapable and (more importantly) personally unable to do so – and the nation will suffer as a result.
John Roberts is not a Villian
I’ve read today – far too often today – that Chief Justice of the United States Supreme Court John Roberts is a cross between Judas Iscariot, Pontius Pilate and Benedict Arnold. Or maybe something worse. Although I doubt Chief Justice Roberts needs me to come to his defense (or that he even cares, to be honest), I’m going to give it a shot. Let’s look into what the Supreme Court ruling on the PPACA actually means before passing judgement, shall we?
The Supreme Court ruled that the government cannot compel anyone to buy anything. Ever.
Big? You bet this is huge. We’ve heard for two years from academicians and progressives that under the Commerce Clause, Congress has the ability to force us to buy stuff. Their theory was that because everyone needs health care at some point, we all engage in commerce related to the health industry and the very act of not purchasing health insurance was an action. Well, not so fast.
“The individual mandate, however, does not regulate existing commercial activity. It instead compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce. Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority…The Framers gave Congress the power to regulate commerce, not to compel it, and for over 200 years both our decisions and Congress’s actions have reflected this understanding. There is no reason to depart from that understanding now.”
So, the Obama administration’s argument (echoed by the same academicians above) got the royal smack-down. Chief Justice Roberts may as well have wrote, “What are you, a bunch of moe-rons?”. The result is the same. Rarely does a published opinion go this far (nearly 16 pages) to explain why an argument is so plainly stupid.
The Supreme Court ruled that ObamaCare is the biggest tax hike in US history.
Yes, they ruled the PPACA can move forward, but that the government can no longer try and hide behind the facade of an individual mandate. No, they ruled: ObamaCare is actually a tax increase. Or more precisely, a combination of 21 different tax increases that total $1.2 trillion in new revenue annually. How big is that? It amounts to new taxes that consume 8% of the nation’s economic output. With only a little over 4 months until the election, I’m not sure how either the President or his minions in Congress feel about running for election on a platform of delivering the biggest tax increase in history. I doubt they’re relishing the chance to find out. Already the cries are being raised about the impending sequestration, with it’s 1.5% tax increase and strong possibility of pulling the economy back into recession. ObamaCare represents a tax increase more than 5 times that impact. By ruling as they did, the Court hand-delivered a gift-wrapped campaign theme for the Republicans this Fall. “If you thought the economy was bad before, just wait until ObamaCare sinks it forever.”
States cannot be forced to participate in ObamaCare.
A big part of how ObamaCare delivers affordable insurance to the masses is through a massive expansion in Medicaid, by enrolling anyone at 133% of the federal poverty line or below in the program. A big part of how the administration covers up the cost of that expansion is by removing federal subsidies for it by 2017, but still compelling the states to pick up the tab. As of right now, 13 states are balking at the idea of pushing their budgets into the red to make good on this mandate. The Supremes issued another smack-down on this, ruling that unfunded mandates are unconstitutional, even if the mandate is to an existing program.
“It is enough for today that wherever that line may be, this statute is surely beyond it. Congress may not simply “conscript state [agencies] into the national bureaucratic army,” and that is what it is attempting to do with the Medicaid expansion.”
Either the administration can relent and pick up the entire tab for the Medicaid expansion, or live with fact that the original goal of covering more than 95% of Americans in some form of health plan is by the boards.
So, is this really a win for Team Obama? Only in Pyrrhic sense. Yes, the PPACA stands for now – but not all of it. The Medicaid smack-down means that a very large part of the administration’s base of support won’t see any benefit from the law. As for the rest of it, Team Obama is now left to campaign on the largest tax hike in history, in the middle of the worst economy in 80 years. It is also already galvanizing support for the Republican challenger as nothing else could have – especially given Mr. Romney’s own dubious record on health reform.
The President may be heading to bed this evening with a smile on his face. But I bet the one on the Chief Justice’s face come November 6th will be a bit bigger.
ObamaCare Constitutional (Sort of)!
The Supreme Court issued their ruling on the Patient Protection and Affordability Care Act earlier this morning. The short story is, the act stands. But there is much in the ruling that I can see making the President and entire Federal government wishing they had never taken this up to begin with.
For staters, the Individual Mandate is completely unconstitutional. No ifs, ands, or buts.
“Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority. Congress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle that the Federal Government is a government of limited and enumerated powers. The individual mandate thus cannot be sustained under Congress’s power to “regulate Commerce.'”
Instead, the Court ruled that Congress can impose a “health tax” as part of the individual tax code, but again, it cannot apply a penalty to persons who refuse to participate in the insurance market. They can only impose the tax uniformly – on everyone – and then refund or credit people who do buy insurance.
But the biggest bombshell coming from this ruling is the Court’s take on unfunded federal mandates. They’ve basically eviscerated one of Washington’s favorite ploys – requiring the states to do something, but not paying for it. In this instance, it is the expansion of Medicaid to cover all persons up to 133% of the federal poverty line. Although Congress offers short-term relief for the increased expenditure, that ends in 2017 and the states eventually pick up most of the tab – or face losing all of their federal funding for Medicaid. The Court ruled that if the Feds want to expand Medicaid that way, they need to pick up the full tab – permanently.
“The Medicaid expansion thus violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion. The constitutional violation is fully remedied by precluding the Secretary from applying §1396c to withdraw existing Medicaid funds for failure to comply with the requirements set out in the expansion.”
Taken broadly, this opens a Pandora’s box of mandates to legal challenges, in everything from education (“No Child Left Behind”) to transportation (Federal Highway Funding). Fun times lie ahead, I’m sure.
I’ll have more in a few days, once I’ve fully digested all 193 pages of the decision. If interested, you can read the full thing here.
Help a Jarhead (or maybe a million)
Two Marines affected by contaminated Lejeune water
Undoubtedly, most of you have heard about Love Canal, NY. But what would you say if I told you there was a place where contamination levels were worse, with a population 500 times greater? And what would you say if that place was owned by your government? And that while acknowledging the contamination since 1984, the government has done nothing in the intervening 28 years to assist those affected by it?
This is the situation for the more than 1 million Marines and sailors who served aboard Camp Lejeune, NC between 1957 and 1987. During that time, the wells used for drinking water at the base were contaminated by more than 200 known toxic substances. Nobody can say with any certainty what the effects of ingesting this many poisons, in the volumes and combinations by anyone who lived on the base for any length of time, might be. What is known that there has been a rash of strange diseases in people who lived and worked on the base: male breast cancers, digestive diseases and cancers, brain diseases and cancers. While they cannot be 100% conclusively linked to the contaminated wells and ground water, the unusual rate of incidence of these diseases certainly suggests more than a casual causal probability. In some cases, the incidences are more than 1000x what is found in the general population!
But the government understands that actually taking care of the men, women and children who ingested these chemicals is an expensive proposition. And so, rather than live up to the Marine Corps motto of “Semper Fidelis,” your government has seen fit to lie, obfuscate and deny assistance to them. Rather than display faith and fidelity to the Marines who were assigned to duty at Camp Lejeune, the government has decided it better suits their needs to shun us and pray we all die off before they need to do anything. The Obama administration has decided that rather than lend a hand, more study is required. Congress has allowed legislation aimed at helping languish in committee, despite having bipartisan support and 42 co-sponsors.
There is something you can do to help, though. First, sign the petition to let the President and Congress know that you, the taxpayer and citizen, support the Marines fighting what may be the most desperate battle of our lives.
Second, the Janey Ensminger Act would classify any Marine or sailor, or their dependents, who lived at Lejuene as having a 100% service-connected disability. That would allow them to receive free, lifetime medical care through the Veteran’s Health Administration. As mentioned above, the bill is currently stuck in the Veterans Affairs Committee. The committee rules allow the committee chairman, Rep. Jeff Miller (R-FL 1), to pass the bill out of committee without a vote. So, write Rep. Miller and urge him to send the bill to the full House of Representatives for a vote. You can also message him through Facebook.
Let’s get it done, people. When duty calls, the Marines are the first to answer. Now it’s your turn to do the same for them.
RIP, Mr. Jobs
I’m writing this with a heavy heart. Well, typing might be the better description. I hardly ever actually write anything any longer. And if I really wanted to be exact, I would say that I’m typing this on my smartphone.
30 years ago this would have been unimaginable. I wrote almost everything. Even when I typed something on my old Olivetti, I wrote it first – since making corrections on the fly was time consuming and rarely came out right, anyway. 30 years ago a handheld device that could do everything this smartphone can didn’t exist, not even on Star Trek. 30 years ago, if I needed to make a call away from home I had to find a public phone – and pray I had a dime in my pocket. 30 years ago, video recorders were the size of a car battery (and just as heavy) and portable music consisted of tinny sounding radios. 30 years ago, computers took up an entire room. The idea of having one in every room in my house, along with one I can fit in my pocket, was unimaginable.
Unimaginable, except to one man who had the vision of making personal computing a reality. Over the next three decades his vision would transform the way the world communicates, interacts and thinks. That innovative spark would not only change the world as a whole, but change the future of one geeky, 16 year old from a sleepy little town on the Jersey shore. The way Steve Jobs envisioned the way the world could work fired my imagination and led me into a career in tech.
So, you’ll pardon me if I occassionally break into tears over the next day or so. When Mr. Jobs passed away earlier this evening, the world may have lost the greatest technologist since Thomas Edison. But I lost a hero.
So you want to talk pain?
I came across an article from Catherine Hinton that just may be the best description of the pain from which Crohn’s Disease patients suffer. I usually compare it to being in labor, but not being a member of the fairer sex I’ve relied on descriptions of that pain from my wife (and others).
Catherine begins her description this way:
“If you have Crohn’s Disease you are familiar with pain. Not just a ‘pain’, but the whole repertoire of pain sensations that the human body can manufacture. Sometimes you might be treated to a solo rendition that can be quietened down with over the counter meds, but more often than not Crohn’s pulls out all the stops and decides to delight you with a symphony performance that inclues the equivalent of timpani drums and death metal guitars. You might think that the pain is limited to bowels (it is after all Inflammatory Bowel Disease) but oh no, if Crohn’s can drag in other parts of the body, it will!“
I highly suggest you hit the link above and read the rest of her description, then share it with your friends and family. It’s both funny and highly accurate!
Crohn’s Disease: Know your symptoms
As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.
In this post, I’ll cover symptoms.
Crohn’s Disease is, without a doubt, one of the more debilitating medical conditions around right now. For those unfamiliar with it, Crohn’s is an auto-immune disorder that affects the digestive tract. Symptoms include weight loss, frequent (and often uncontrollable) bowel movements, diarrhea, nausea, bloating, intestinal discomfort and pain (which can mimic appendicitis) and fatigue. Symptoms also include the typical aches, pains and fevers usually associated with the flu. Because it is an auto-immune disease, people with Crohn’s often find themselves later developing other auto-immune disorders – for instance, I have rheumatoid arthritis and developed hay fever about 7 years ago. I’ve met other patients who developed even more severe types of auto-immune disorders, such as lupus.
Very little is really understood about Crohn’s. Nobody knows why it occurs – there seems to be a genetic factor (an extra gene is found in about 90% of Crohn’s patients), but nothing has been completely ruled out. Ethnicity, diet and activities all may be related – or maybe not. Likewise, there isn’t a cure. What has advanced since I was first diagnosed 20 years ago is understanding how the disease functions and causes other functions of the body to stop. That has led to better treatment options and generally, a better quality of life for those of us affected. Once, the disease was thought more prevalent in women than men, but the rates of affliction, once adjusted for populations, are actually about the same. Almost every ethnic group is affected, although peoples of Asian and African descent have lower incidence rates than Caucasians.
Odds are if you’re a new patient, then you are in the 16-25 year old range: this is when about 80% of new cases are first diagnosed. (I was 6 weeks shy of my 26th birthday when first diagnosed). That being said, new cases are diagnosed in every age group. Since I’ve no personal experience with pediatric Crohn’s, I won’t pretend to offer advice for anyone looking for information about Crohn’s and young children.
Symptomatically, Crohn’s is similar to Ulcerative Colitis. The similarities often confuse a person only cursorily aware of both conditions, which often leads to them confusing the two. I’ve had past co-workers and current friends often assume that because Crohn’s and UC are related and so similar symptomatically, that they are the same. But when I’ve had severe flare-ups of the disease, they are often shocked when they come visit and find me hooked up to dozens of tubes and wires, all needed to keep me alive and stable.
The symptoms are where the similarities end. Both cause ulcerations (inflamed areas) to appear in the colon, but the ones from Crohn’s disease burrow deeper into the tissue and can appear anywhere in the digestive tract. In my particular case, the upper palate, gums, a section of the small intestine called the duodenum and another called the ileum are affected in addition to two spots in my large intestine and another in my colon. Another big difference: in severe cases of colitis, a type of surgery called an ostomy can be performed, curing the disease (although at a high price). For some severe cases of Crohn’s usually where the tissue is badly damaged), surgery is also done – but removing the affected areas doesn’t cure the disease. It will reappear in another area of the GI tract.
Since Crohn’s patients generally have difficulty digesting food, it isn’t uncommon to find them malnourished even when relatively symptom free (by the way, those of us in the Crohn’s community generally refer to these periods as being in remission). Unfortunately, the type of malnutrition can vary from patient to patient. The reason is because so many different parts of the digestive tract are affected and each part is responsible for processing different nutrients. Regardless, the malnutrition is a major contributor to all types of related problems. Since each part of the body relies on the digestive system to function properly, people with Crohn’s often suffer from other system breakdowns. Their hair, skin and nails can become dry and brittle; they may suffer anemia, dehydration, high blood pressure, osteoporosis – the list includes virtually every other organ in the body. Add in the side-effects from long-term use of some of the more common medications used to treat Crohn’s, and the results can be even more system breakdowns. For example, the use of Mesalamine drugs can lead to excessive (and particularly foul smelling gas). As for myself, repeated exposure to very high doses of corticosteroids has resulted in cataracts and osteopenia (the precursor to osteoporosis). The calcium deficiency from my Crohn’s along a Crohn’s inflammation in my upper palate and the drug cocktail I’m on, resulted in my losing all of my teeth before I was 30 (although, my dentures look damn good!).
Crohn’s Disease: Coping
As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.
In this post, I’ll cover what living with Crohn’s is like.
Once diagnosed with Crohn’s Disease, odds are your doctor gave you some version of “you’re going to need to make some changes.” They probably prescribed a bunch of new medications and told you that you’ll need to take them for the rest of your life. You were told that you’ll need to make some changes to what you eat and what you drink. Since the odds are you’re still young, you’re probably feeling as if life is essentially over. That’s normal, but as I and millions of other “Chronies” can tell you – life isn’t over. It just got more interesting. If you haven’t read through the posts on symptoms and treatments yet, take a few minutes and do so now. One of your best weapons in the fight against Crohn’s disease is education and this is good place to start. I also suggest going through the Crohn’s & Colitis Foundation’s website. It is an invaluable source for information.
Your first major change is that you and your doctors are about to become fast friends. Before my diagnosis, I didn’t have a regular doctor. I was a typical, healthy 25 year old and only went to see one if there was something really wrong – and it had to be really wrong before anyone could force me to step foot into a doctor’s office. The gastroenterologist who diagnosed me was as strange to me as an alien who dropped in from Mars. He was a nice enough guy, but I didn’t particularly like him and because of that, wasn’t sure I should how far I should trust him. So rule #1 about living with Crohn’s: find two doctors that you not only like but can absolutely trust with your life: a gastroenterologist (for your guts) and a general practitioner (for everything else). Because how you handle those relationships will go a long way in determining how well you live your life. In my case, I’ve had the same primary care physician for 10 years now and GI doctor for 8. The reason is not only are they very good doctors, but we have a great relationship. They know me by sight, including my medical history. How well? About three years ago, I had my left knee rebuilt and was in the hospital for the pre-op when my GI doctor was racing down the hall past my room. When she spotted me lying in bed, she put on the brakes, turned around and walked into my room – concerned I was having a flare. Then she made sure my chart mentioned my Crohn’s and that I’m allergic to tetracycline before continuing on to where she was headed. That type of relationship with your doctor is crucial to not only living with Crohn’s, but living well. Besides the peace of mind you get from that type of relationship, it has practical implications. When Cimzia was first approved for use, my GI doctor called me with the news and asked if I was interested in trying it. Had I waited for my scheduled appointment, I would have waited another four months before beginning treatment.
That brings up my next point: make certain you keep all of your medical appointments. Things come up that we never expect in our lives, but it is critical that seeing your doctor regularly. Even if you’re feeling well, your doctor may spot something and be able to put out the fire before it begins. Make certain you take all of your medications as prescribed. There’s a good chance some of them will need to be taken multiple times a day (mine do). A tip: nowadays, almost everyone carries a cell phone. And many of us carry a smartphone. A great way to remind yourself to take your meds is to set reminders on your phone. In many cases, you can synch those reminders with your computer, too.
It’s also important to have a good support network, other than the medical professionals. Friends and family are going to be important as you live with Crohn’s. Some of the people you consider friends won’t want to be bothered with helping out when you’re having a flare – it’s actually a fringe benefit to Crohn’s. You’ll find out who your real friends are and who was just a hanger on. Part of the reason is mental. Nobody may have told you this (although you might have suspected), but living with Crohn’s can have some very down moments. You need to mentally prepare yourself for frequent hospital stays and often feeling like – pardon the pun – crap. There are times when you will be so physically ill you can’t leave the house; having a friend or family member willing to run errands during those times is invaluable. Depressed feelings go hand-in-hand with so often being unable to do much more than run to the bathroom, with the frequent hospitalizations and being isolated. Having friends who are willing to drop by, make hospital visits and just generally keep your spirits up is more valuable than having a million dollars in the bank.
I also suggest finding a Crohn’s patient network, or if you’re ambitious starting one yourself. There are a lot of us Chronies out there – probably more than you imagined. Nobody has an exact count, but it’s estimated that as many as 43,000 people in the United States have Crohn’s. There are also on-line support groups available, such as the Crohn’s Disease Support Network, MD Junction and Daily Strength. Why join a support group? Because while having friends and family is important, it’s also important to be able to discuss how Crohn’s is affecting your life with other people who have experienced exactly what you’re going through. If you’re reading this, chances are you want to find out more from someone who’s been there and done that. Support groups offer that and more.
IF you’ve read this far, you are almost certainly wondering what in the world you did to deserve this. After all, all I’ve written about is that you can expect pain, hospital stays, frequent bathroom trips and finding people to talk to. None of that stuff is fun and you’re probably saying to yourself, “My life is OVER!” Well, now for the good news: your life is hardly over. You’ll need to make some changes, sure, but consider them course corrections. Having Crohn’s doesn’t preclude you from living a full, happy and productive life. If I’m not proof enough of that, Wikipedia has a list of some pretty famous people who also have Crohn’s Disease – and it includes athletes, actors, musicians, politicians and others. The steps I’ve outlined above are just preparatory to living the life you want. Here’s some common, everyday hints and tips for not only surviving but thriving with Crohn’s:
Work
While it’s true that some Crohn’s patients are permanently disabled, the vast majority of us work for a living. And most of our employers are glad to have us, even if it means having to make a few accommodations to allow us to work. The key is to make certain you let your employer know that you have Crohn’s Disease ahead of time. I obviously haven’t held the same job for the past 20 years (who has, nowadays?) and one of my keys to finding productive employment is to always let prospective employers know I have Crohn’s. I may have lost a few jobs because prospective employers didn’t want to bother with it, but I’ve always looked at it as their loss. Your co-workers will understand the reason you take a few extra bathroom breaks during the day, pop pills at odd times and are occasionally late arriving.
Eating Out
Eating out can pose a special challenge for Crohn’s patients. Rule #1 about eating out: avoid fast food. While McDonald’s, Taco Bell, Wendy’s and Burger King are cheap, quick and tasty dining alternatives they play havoc with our insides. They’re just as fast coming out as going in. Like everything related to our diets, you can’t necessarily rule them out forever. But it should be on your “last alternative” list. Rule #2: be proactive about asking how food is prepared and what ingredients are in a dish. I made the terrible mistake of not asking several weeks ago and paid for it for two days. Remember, it’s your health and your right to know what you’re eating. I’ve yet to find a restaurant that isn’t willing to tell me.
Along with eating out is drinking. Again, this is the “anything in moderation” meme. If your friends are going out to get hammered, volunteer to be the designated driver. If you’re having a beer after work with a couple of buddies, listen to your gut. If your symptomatic, it’s probably best to have a glass of water (or ginger ale) instead. If you’re otherwise healthy, one or two drinks is probably ok. But more than that and you will be asking for trouble. And if you’re drinking anything alcoholic, eat something – it helps slow the absorption of alcohol and your stomach will thank you. Trust me on this one – a hangover with Crohn’s is twice as bad as any you ever had without it.
Traveling
There might be no greater horror for a Chronie than being on the road and needing to find a bathroom – NOW – and not being able to find oneThis has happened to everyone with Crohn’s; you’re not alone in this experience. But there are a few tips that can reduce the chances of it happening. First, map your route and the public restrooms along the way. There are some great on-line resources for this, generally localized to your region. If you happen to have an iPhone or Blackberry, download the SitOrSquat app. It’s a terrific resource for finding a public toilet. (For the rest of us, you can text 368266 and get back a list of nearby bathrooms). Tip #2: check with your doctor if it’s ok to take an anti-diarrheal before heading out. If so, then go ahead and pop that Immodium® or Kaopectate®. Third, do your best to use a toilet before leaving.
Even doing all of this won’t prevent accidents from happening. They will, so it’s best to be prepared. I always carry an emergency pair of underwear in my briefcase, along with some baby wipes and one of those plastic bags you get from the grocery store. Most of my friends understand why my briefcase goes with me everywhere (even to the beach, although I don’t take it on the beach). Ladies, you can do the same with your purse.
Dating
Most of what I covered above applies to dating, as well. Your date will just need to be understanding if you need to excuse yourself from the table during dinner, or take a leave of absence during a movie. But one thing to note about Crohn’s is that stress can bring on symptoms – and dating can be a stressful event. As with work, let your date know ahead of time that you have Crohn’s. If they beg off or stand you up, well, then they definitely weren’t right for you, were they? Romantic situations can be difficult (after all, excusing yourself and running to the bathroom can ruin the mood), but you and your significant other will figure those out as you go along.
Starting a Family
One of the most important decisions a person ever makes is if and when to start a family. For a Crohn’s patient, the decision becomes even more difficult. I can’t tell you whether or not to have children, or when the time is right. I can only relate my personal experience and that I wouldn’t trade my three sons for all the tea in China. But things you definitely want to consider include the possibility of passing along Crohn’s (about 1 in 3 Cronies have a family member who suffers). You also need to take into account how well your Crohn’s is responding to treatment and how the additional stress of children may affect you. Finally, while all prospective patients need to take into account their financial situation, Crohn’s patients need to be especially mindful of the fact that as a result of their condition, they may face periods with reduced (or no) income.
Stress
Moderating your stress level is key to living well, either with Crohn’s or without. It’s just that for those of with Crohn’s, we need to pay a bit more attention to it than most people. If you perused that list of famed Cronies, then you’ll notice quite a few of them had stressful occupations. (Imagine the stress Dwight Eisenhower was under, first as the man tasked with defeating Hitler and later as President of the United States!). None of them could reach the pinnacles of their professions without learning to manager stress and the good news is you can, too. Whether it’s working out in a gym, running, prayer, meditation or something else, find it and practice it. For me, it’s a combination of prayer and working out. I work out at least three times a week and every morning starts off with a bible reading and prayer.
Outdoor Activities
If you’re anything like me, you probably enjoy being outdoors and doing things. And there’s absolutely no reason you can’t, even though you have Crohn’s. I played baseball until age and bad knees caught up to me, I’m still an avid bicyclist, I play golf and I still love taking hikes through the woods and spending time on the beach. If you enjoy the great outdoors, just follow the tips for traveling above and you should be fine. If you’re also into organized sports, most leagues are willing to grant you a “time-out” so you can use the restroom.
Ok, I think I covered most situations here. But if you have any other questions, feel free to drop me an email at rayrothfeldt@aol.com.
Crohn’s Disease: Treating the Symptoms
As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.
In this post, I’ll cover some of the treatment options available and the improvements made since I was first diagnosed. But before deciding on a treatment or treatments, discuss all of these options with your doctor. You may want to read to read the section on symptoms before reading this post, so that you understand why certain treatments are used.
When I was first diagnosed in April 1991, there weren’t any truly effective treatments for Crohn’s Disease. The treatments were either drastic – an ostomy – or did their best to mask the symptoms . Medications included a form of sulfa, antibiotics, oral steroids and anti-diarrhea solutions. Since these medications rarely induced remission of the disease (that is, a significant reduction of symptoms), most of us with Crohn’s were hospitalized often. Between 1991 and 2000, I was hospitalized 18 times for Crohn’s or Crohn’s related symptoms. All told, I spent 318 days in a hospital bed during those ten years.
The principle reason treatments were so ineffective was that so little was understood about the disease or how it functions. Fortunately, great strides have been made over the past ten years. Thanks to the work of researchers, current treatments are much more effective. I’ll go through each of these.
Corticosteroids
Corticosteroids are artificial hormones often given to patients in during “flare-ups” (periods of extreme disease activity). During a flare, what happens is the tissue surrounding the disease inflames, causing the extreme pains for which Crohn’s is noted (I’ve joked that I know what labor pains must feel like – my wife actually agrees!). Corticosteroids such as Prednisone, Prednisolone and Deltasone work by reducing the inflammation. These drugs are artificial replacements for the corticosteroids generated by the human body, but are given in much higher doses than the body normally makes. I’ve received as much as 120mg of prednisone a day, or about 60x the body’s normal production. While they are as close to a miracle drug as any for ending flare-ups, they pose serious risks with extended or frequent use. The first is dependence; when receiving such massive doses the body stops producing its own. This is why they are usually prescribed for short periods and ramped down while prescribed. Prolonged use can also lead to cardiovascular disease, osteoarthritis and cataracts. Also, patients taking corticosteroids should note that weight gain and mood changes are common when taking them.
Sulfonamides
This type of medicine is used to help maintain remission. It’s been used since I was first diagnosed, but the delivery of the active ingredients in sulfonamides has improved greatly in that time – meaning lower and less frequent doses are needed for the same effect. The first medication I was prescribed was Sulfasalazine; I had to ingest three 600mg tablets 4 times a day. If you’re not interested in doing the math, I was taking 7200mg every day, without much positive effect. Today, I take 1200mg of Lialda daily. The most commonly prescribed sulfonamide for Crohn’s today is Asacol (or its generic equivalents, Mesalamine and 5-ASA ), usually at a 800mg dose three times daily. The side effects are relatively minor, such as excessive gas and bloating. In rare cases, it can exacerbate pre-existing heart and lung cases. And some studies link these drugs to reduced fertility in men.
Antibiotics
Everyone has bacteria lining their digestive tract. We actually need them to help with proper digestion. But during Crohn’s flare-ups, the bacterial populations literally explode. Nobody is quite sure why, or what the connection may be. Regardless, most gastroenterologists will prescribe one or more antibiotics during a flare-up. The most common is flagyl, given intravenously.
Anti-TNF medications
The first major advance was in understanding the role an antigen called tumor necrosis factor
(or TNF) plays in Crohn’s and the use of anti-TNF drugs in fighting Crohn’s. TNF forms naturally within the body and is one of our immune system’s defense mechanisms against cancer. It works by inflaming the cells around the cancer cells, in essence choking them. Nobody is quite sure why Crohn’s patients suffer this type of inflammation, but studies in the mid and late 1990’s showed that anti-TNF drugs actually reduced the chronic tissue inflammation. Since then, drugs like Imuran or 6-Mercapturine (6-MP) have been introduced. They can’t actually induce remission, but they are effective in maintaining remission once it’s been achieved. The big downside is since they reduce the body’s principle anti-cancer agent, patients taking them are at much higher risk for developing cancers. Recent studies show the possibility that Crohn’s patients who have been on one of the anti-TNF medications for extended periods are at substantially higher risk for a type of leukemia.
Biologics (TNF-A inhibitors)
An offshoot of anti-TNF medications, biologics as used in Crohn’s treatment are designed to essentially “turn-off” the immune system. There are three currently in use: Remicade, Humira and Cimzia. Each has some unique side-effects; ask your doctor about them. In 1998, Remicade was the first of these drugs approved for use in Crohn’s, so it has the longest track record. However, it also has the most common allergic reactions and needs to be administered by IV over a course of several hours. Humira and Cimzia are similar to one another, but whereas a Cimzia injection can last 4 weeks, Humira needs to be injected every other week. Generally speaking, since the immune system is kept in a very depressed state while taking these, the patient is very susceptible to any airborne illness and contracting one can be deadly. If you are planning to take one of these, know the risks and make certain you discuss them with your doctor. I’ve been taking Cimzia for close to a year and it has made a HUGE difference in my quality of life.
Surgery
Crohn’s patients often require surgical procedures. These can range from the relatively benign (colonoscopy for examining the lower GI tract and removing polyps for closer examination) to a full-blown ostomy. Before undergoing any surgical procedure, make certain you discuss all of the implications with your GI doctor and meet the surgical team. You should also try to have a trusted friend or family member with you for these consultations – odds are if you’ve reached this point, the pain has also become nearly unbearable. Whether you’re fighting the pain au natural or with painkillers, you won’t be in the best command of your mental faculties.
Diet
For Crohn’s patients, diet is truly a four-letter word. We obviously need to eat, but many foods (including what can seem like most of the yummy ones) will cause an exacerbation of symptoms. Eat too many of them and you may wind up with a full-blown flare. Match that with the fact that as a Crohn’s patient, you need to ensure good nutrition even more so than most people and you stand a good chance of being baffled by your diet – or going insane J. Your best bet is to avoid foods that are hard to digest, such as nuts, popcorn and seeds. As for everything else, keep a log of everything you eat and if you experience increased symptoms, then avoid it in the future. Personally, I try not to exclude anything unless I’m in a flare – I just make certain my “avoidance” foods aren’t a constant part of my diet.
Also, you may want to consider nutritional supplements if you find you can’t get enough nutrients from eating. These can range from vitamin supplements to more robust liquid supplement shakes, like Ensure or Boost. In any case, working with a registered nutritionist is always a good idea. And one more thing: most Crohn’s patients find eating large meals tend to make them symptomatic. Try to eat smaller meals and eat more often. For instance, I typically eat 6 times a day – I cover this in more detail in the lifecyle adjustments post.
Alternative Medicines
There are quite a few alternative (or herbal) therapies out there for Crohn’s patients. I do not recommend any of them, although parts of them can be helpful. For instance, I find mint tea can help calm my stomach if I overdue it. Regardless, before trying any of them, be sure to check with your doctor and investigate them fully to find out how they can interact with your medications or each other. Just because they’re herbal or all-natural doesn’t mean they can’t have side-effects.
Ongoing Care
Perhaps the most important part of treatment is your ongoing care. Your doctor will likely send you for seemingly endless tests. CAT scans, GI studies, barium enemas, X-rays, colonoscopies, blood tests and more are part of the typical “Crohnie’s” regimen. Undergoing these and maintaining your relationship with your doctor are crucial in keeping Crohn’s at bay.
Political Baseballs 