Health care blues

We had a discussion yesterday on the Affordable Care Act and how it affects women's health care, especially contraception.  I left the talk totally depressed.  This was further amplified by watching the 3rd presidential debate last night. 

I recognize that the ACA is not perfect, but it is a HUGE step towards affordable and comprehensive health care in this country. I believe that health care is a right, not a privilege.  I also know that we can not continue to afford the rising cost of health care as we can't even currently afford it.  I'm sickened by the fact that politicians play political chess with people's health.  I can not understand that level of disregard for another humans welfare; but I guess that is why they are politicians and I'm a (future) health care provider.

In the discussion yesterday, we were shown a slide from the New England Journal of Medicine article "A watershed election for health care (2012)".  The chart dives up the likely results to the ACA depending on the election outcomes.  It is no shock that Romney winning would be a very large step back for health care in the US (a long with LGBT rights, abortion rights, and so many other things), but what did give me pause was what happens if Obama is reelected with a republican house and senate.  "Maintenance of near pre-ACA levels of uninsured Americans; no substantial growth in levels.  Less aggressive implementation of ACA health system provisions".  Shit.  So basically more political chess with people's lives at stake.  Nothing will be accomplished, will still be stuck in the middle of nowhere.  Lovely.

Needless to say, I'm very worried about this election.

I am also so grateful to be an insured American with unlimited access to quality care. This year off from medical school has been full of many more doctors' visits than I would have imagined. After the horrible car accident with trip to the emergency room this summer, I'm now dealing with a whiplash, a pinched nerve (upper trunk of my brachial plexus), and radiculopathy. Weekly chiropractor appointments in attempts to fix that. I'm also finally address my chronic anemia, fatigue, and constant general yuckyness by figuring out the trigger. A round of visits to a GI and a abdominal CT have ruled out my celiac as the culprit. [Even if I did read my CT as having a "speckled colon and a titled uterus" - thankfully a radiologist who actually knew what he was reading righted my incorrect paranoid diagnosis.] Good to know that I'm not being accidentally glutened. The GI's answer to this was that I'm probably allergic to something (or many somethings) and so I should take a low level steroid to blunt my immune system. Um, no thanks. I'd rather just figure out what the cause is so that I can avoid it. So, today I am finally getting much need allergy testing. Thank G!d that my comprehensive trusty health care insurance is along for the ride.

Being picked up at shul

Nope, I wasn't picked up in the horribly awkward sense of being approached by the strangest, most socially inept, guy (or gal) in the room.  Or worse, by his mother.

I went to shul alone both days in the city that was most recently my home. I split my time between the conservative and the orthodox communities, revisiting my old haunts, and reconnecting with old friends. I didn't decide to travel for rosh hashana until I knew my schedule, leaving me little time to find housing and meal arrangements.  My solution?  I stayed with a non-jewish classmate. I accepted that I would be driving to holiday functions and back for the purpose of having a meaningful holiday.  I packed a box of cereal & refrigeration-free milk as a survival kit. 

It turned out that my survival strategies were unnecessary.  The holiday came filled with blessings beyond expectation.  Sitting in services the first morning, I was approached by the rebbitizin.  She asked if I had lunch plans & if not, would I like some?  I shrugged my shoulders and explained that I was intimidated to show up on someone's doorstep & then have them not be able to feed me.  Since being diagnosed with celiac disease I find myself very anxious at the prospect of last minute shabbos & holiday meals.  Knowing the anthropological song & dance of wanting to feed people who you invite into your home, and being acutely aware of all my food issues (gluten, kosher, semi-veggie, diabetic, etc.), I've evolved into more of an introvert as a way to avoid awkwardness.   Tangent aside, she replied "don't be silly! it'll be fine" and handed me a magical golden (er, green) ticket with a name on the front & directions to their house on their back.  The magic came in learning that the wife, the woman who prepared the marvelous lunch, happened to also be gluten free! Random coincidence = divine inspiration? = rosh hashana meal jackpot!

The rest of the holiday was more subtle, but equally blessed.  I prayed a lot.  I ate a lot.  I listened to and pondered a few really good dv'ra torah.  I spent a lot of time with old friends and people who I don't get to see nearly enough.  It felt like an ideal start to the new year.  May this year continue to be filled with unexpected blessings for all of us.  shana tova u'metukah!

Celiac Disease Awareness Day

I heard a rumor on a friend's facebook wall that today is celiac awareness day.  Like any educated person, I therefore felt it necessary to fact check before posting about it.  According to the almighty wikipedia: "A resolution was passed in the U. S. Senate, making September 13 National Celiac Disease Awareness Day. It is the birthday of Samuel Gee." Therefore, clearly, it is in fact national celiac disease awareness day.

Side note as to not embarrass my librarian friends: I promise you that my medical/scientific research is only partially based in facebook, google and the wikiworld.  I do occasionally also use peer reviewed journals for information and decision making. ;-)

In honor of this very special day, I present to you my recent escapades in gluten-free vegan goodness.  

 

Crepes! With chocolate-hazelnut filling.  We also made ones with daiya cheese. 

Peach blueberry birthday cake for the girlfriend.

Cake donuts! Next attempt will be a yeast version, deep fried &/or chocolate frosted- less healthy and more like what I remember.

Celiac

I was diagnosed with celiac disease in December 2005, over winter break of my senior year of college. My diagnosis was somewhat happen chance. Sure, I was extremely sick, but in totally non-traditional celiac diagnosis type of ways. I'll spare you the exact details. My home doctor laughed at the suggestion that I should be tested for it, but the physician at student health services who had no other idea what was going on, figured it was worth tacking on to the lab work. I came back positive to all 4 antibodies. I was then shuffled off to see a GI doc who confirmed my diagnosis and sent me on my merry [gluten free] way.

Working on the healthcare team at a diabetes camp, I had learned a lot about celiac disease in the summers prior to diagnosis. I knew I was at a high risk due to my strong family history of autoimmune diseases and my personal history of type 1 diabetes. I had suspected that it might be the culprit to my gradual onset of chronic woes and I was the one who suggested the test to the student health doc. I had done my research and was prepared for the results when I came back positive. I wont deny that going gluten free sucked, but emotionally, I rebounded to the news pretty quickly and I was soooooo ready to start feeling better.

When I was diagnosed, it was suggested that my immediate family members get tested. None of them did. Today, 5 1/2 years later, my mom saw a new osteoporosis specialist who screens for anti-gliadin antibodies as part of his comprehensive panel. Turns out that she has celiac disease too. She's 66 years old and totally asymptomatic. Antibodies don't lie. Okay, so sometimes antibodies are confused, but in her case it is a true positive diagnosis.

Watching her come to terms with the reality that she now needs to drastically change her diet is difficult. While she is willing to, she lacks the physical motivation of illness that I had. I imagine that it is also much harder to change your habits at 66 than it was at 21.

To my dismay, my endocrinologist does not screen all of his type 1 diabetic patients for celiac. So every time I have seen him since my diagnosis, I have brought in scholarly literature about the need to annually screen patients with related autoimmune disorders. He argues that it will make a difference in seemingly asymptomatic patients; that they will be unwilling to change their diets for a disease that is not causing acute distress. In lieu of today's events I both understand not wanting to turn someone's life upside down and also the need screen for conditions the patient is at high risk for. Had this doctor not screened, my mom would get to continue to naively live her life the way that she's accustomed, and at 66, who knows if untreated celiac would have left her with any serious term sequela. At the same time, I believe that it is out obligation as physicians/future physicians to supply our patients with all of the information regarding their health despite our personal belief about what they'll do with the knowledge. Example: we need to educate our hypertensive patients on smoking cessation and dietary changes, and the impact not making these changes might have, even if we know that they're going to simply walk out the door with a cigarette still in hand.

Am I just being naive though? Is my endocrinologist right in that we shouldn't screen for problems that aren't yet screaming to be found? Would my mom be better off not knowing that she has celiac disease?