Birthday Walk – 2015 Edition (and 2014)

The Statue of Liberty in Signal Hill

          Well I did my annual long walk to commemorate my birthday this year. Just as a refresher, I had been doing 2 hour long runs on my birthday when I was still able to run but in the past 4 years or so, I have had to modify it to long walks instead. I’ve tried to achieve the same mileage I would have done with 2 hours of running, but it has been hard mentally to walk that long. I didn’t even write about my long walk last year because my mind got lazy and I gave up after what I thought was an hour and 45 minutes. Checking back on my exercise log, I was surprised to see that I actually completed two and a half hours, but since my goal was 3 hours, I didn’t consider it a success. That walk was done in the Virginia Country Club area at around noon time on my actual birthday. I completed 10.17 miles at a pace of 14:45 minutes per mile.

          Will I have to reconsider the 3 hour goal and do just 2 hours instead – the amount of time I used to run for my birthday celebration? Sounds like a plan, so that’s what I tried to do this year.

          I wasn’t able to do the walk on my birthday but did it on June 7^th instead due to my work schedule. I drove to Signal Hill with the intention of not doing the usual Long Beach Walking Club course which was 6 miles, but walking around the perimeter of the hill and up and down the streets from Pacific Coast Highway to the top of Signal Hill whatever distance it took me for 2 hours. I only wanted to walk at what I considered a cruising pace which meant no vigorous arm swings and no pushing it like I tried to do last year on flat terrain.

          Starting at the corner of Redondo and Hill Streets, I headed west and turned right on Temple Ave., then left on Willow St., left on Cherry Ave. towards Pacific Coast Highway. This is when I first saw the Statue of Liberty atop the aptly named Liberty Hotel (well it looked more like a roach motel). Who would have thunk it – a Statue of Liberty in these parts? No mistaking this place for Staten Island. I didn’t take a photo, but found it later on the streetview of Google Maps. From PCH, I climbed Stanley St. hill, and kept going and going and going around Signal Hill, descended and climbed several more hills, walked by Community Hospital of Long Beach where I work, and towards the traffic circle, then back again to Signal Hill.

          When I reached my goal of 2 hours, I kept on going with no idea when I was going to finish. My mind began to tire at about 10.5 miles so I thought I may just reach 11 miles and get it over with. By the time my GPS hit the 11 mile mark, I had walked for 2 hours, 40 minutes, and 46 seconds, which was a pace of 14:37 minutes per mile. What?! That was a cruising pace for uphill, downhill, and flats? Strange how that turned out. I was pushing the pace last year on the flats and I ended up walking faster this year when I wasn't pushing the pace and there were long hills.

          Just for comparison reasons, my 1 hour time trial pace nowadays is about 13 minutes and 21 seconds per mile. Heck, I may be able to finish a half marathon comfortably at my cruising pace if I wanted to.

          Well, at least I accomplished the 2015 edition of my long birthday walk with only a modest goal. Next year’s goal will still be 2 hours and we shall have to see if I make it after I take the first step.

A Free Energy Efficient Refrigerator From SCE

The OLD             and              The NEW
Hotpoint and Whirlpool

          Sometimes there are advantages to being poor. A couple of months ago, I received an email and regular snail mail from my electricity provider - Southern California Edison, saying that I may qualify for some free energy efficient appliances. All I had to do was respond within a certain time and a home visit by one of the company's representatives was going to be arranged. Sounds like a scam or an invitation for a home invasion robbery, right? Well, except this correspondence was legit, so I sent in my application.

          A few days later, someone named Mary who represented a partner of SCE, called to ask about my income and when she could come to inspect my home to see what appliances I had. She asked me to make a copy of my income tax return and proof that I owned my home. I did that, but blocked sensitive information from the copies including my social security number and date of birth. With all the identity theft happening nowadays, one can never be too careful. On the morning Mary arrived, she looked around, checked the model of my refrigerator, air conditioner, light bulbs, and power strips. She said based on the papers I had given her, I certainly qualified to get a replacement refrigerator since mine was more than 20 years old. But first she had to verify the information I gave her. Before Mary left, she gave me a couple of CFL light bulbs (even though I've already been using those for a long time), and an "intelligent" power strip where you can plug in low voltage appliances in some receptacles and high voltage ones in different holes. The power strip is only supposed to supply the adequate amount of electricity based on which holes you plug the appliances in, instead of the full dose in all holes. I was hoping she would give me LED light bulbs instead, but she didn't have those. My air conditioner did not qualify for a replacement since I've only had it for about 8 years.

          I had already forgotten about it until Mary called a couple of weeks later asking for the measurements of my refrigerator (length, width, height, depth, and which side it opened). That could only mean that I qualified to receive a free refrigerator! How is it even possible to get things for free nowadays, much less a refrigerator?? Well SCE has a program to help low income people save electricity by exchanging certain old appliances for newer energy efficient ones. It is called the Southern California Edison Energy Savings Assistance Program.

          And how did I become a low income person? Remember I was jobless until May 2014, worked for barely minimum wage as a caregiver till August, then started earning better from August till the end of 2014. Even with the combined unemployment benefits and my wages for all of last year, I was still at the Federal Poverty Level. Thus the reason for my qualification for the free refrigerator. I received another email from SCE saying that their installation contractor named Maravilla Foundation will be contacting me to arrange an appointment to deliver the new refrigerator. Soon enough, I got the call and we arranged for the fridge to be delivered on Monday, May 18th, between the hours of 10 a.m. and 4 p.m. I also asked if they would take away my old one for recycling, and they said yes. Monday came and at about 1 p.m. the delivery people came, hauled the new fridge in, and hauled the old one out. They even installed everything. Thankfully I remembered to pack everything up the previous day so I could move them out of the old fridge quickly while the new one was being installed. When everything was said and done, I signed the delivery papers, thanked the men profusely for their service, then let them and their truck out of the security gate.

          I am now an owner of a brand spanking new, energy efficient Whirlpool refrigerator, which is more spacious and has more shelves than my old one. Of course, returned all the food back in the new fridge afterwards.

          Does being poor have its advantages? Certainly yes in this case. Thank you Southern California Edison! America, what a country! A country where it pays to be poor (sometimes).

The High Cost of Healthcare – A Personal Experience

     

Photo courtesy of SIlive.com

          I’ve been putting off writing about this while I waited for all the medical insurance claims to come in. Hopefully nothing more is forthcoming.

          Remember when I was hospitalized in mid-February of this year? No? Well you can read about my experience here: http://aboutlifeandrunning.blogspot.com/2015/02/chest-pain-radiating-to-shoulders-neck.html and here: http://aboutlifeandrunning.blogspot.com/2015/02/chest-pain-radiating-to-shoulders-neck_28.html

          I’ve been working in hospitals for more than 30 years and was never aware of the financial side of healthcare. We’ve admitted innumerable patients and never questioned how much it cost them or the insurance company. Sure, I’ve been hospitalized twice before but was never presented with a detailed bill by the insurance company until my less than one day confinement last February. The medical insurance I now have from my job sends me an email each time I receive treatment at a doctor’s office or a hospital and when I log on at the insurance company’s website, it shows an Explanation of Benefits or a statement which says what the hospital/doctor/Emergency Room/X-ray/CT/EKG/MRI/ambulance/paramedics/etc., billed the insurance company, what the insurance company paid, and how much I have to pay out of my own pocket.

          Almost $40,000 for being in a Cardiac Care Unit. What?! But I was only there for about 15 hours and the nurse didn’t even have to wipe my butt! Well, ok, so the insurance company’s contract with the hospital “only” let them pay about $6,500. Still a large amount if I had to pay it out of my own pocket. My copayment for this 15 hour stay was supposed to be $250. I’m still waiting for the hospital bill which I hope never comes.

          Another example was the ambulance bill from Long Beach to Whittier: $3002. Higher than a routine ambulance ride because it was a cardiac care run where there had to be a registered nurse present in addition to the usual 2 paramedics. Otherwise, it would “only” have been about $2000. My 3 mile routine  ride from home to the emergency room? “Only” $1937.70. Use of the pulse oximeter alone cost $88. Heck, I can buy my own pulse oximeter from CVS or Rite Aid pharmacy for almost half as much!

          Just a visit to the doctor’s office costs the insurance company $225 plus a $20 co-pay from me. It took about 10 minutes of the doctor’s time.

          It’s not that I’m complaining since the insurance company covered most of the cost. It’s just a shock how much healthcare costs in the U.S. Without the insurance contracted payments, for the first two months of this year my medical bills would have cost $56,502.42. OMG, I don’t even have that much in my saving and checking accounts!

Here is a photo of a summary of what the insurance company sent me:

          Now I’m wondering how Medicare and Medicaid (Medi-Cal in California) can afford to pay all the bills of the patients I take care of in the psych unit who get admitted, discharged, and readmitted several times a year.

          Come to think of it. Those hospital bills which the insurance companies pay, in turn pays for my personal bills since I work in the healthcare field, which I’m finding out is very expensive. How people can afford to be sick, I don't know. The more reason to try your best to stay healthy. Happy Nurse's Week and Happy National Hospital Week indeed!

Well, I spoke too soon. This afternoon I got a bill from the City of Long Beach Fire Department for the portion of the ambulance bill that the insurance company didn't pay, which amounted to $295 and included a $5.00 late fee. More ouch to the pocketbook :(

My First Root Canal (and hopefully my last)

          So I had this root canal work done last week which I had been putting off for more than two years. In the meantime my regular dentist has done multiple repairs on the tooth in question due to chipping, cavities, or decay. When I finally got dental insurance again from my job and with better benefits, I finally decided to follow my dentist’s advice and went to the endodontist she referred me to. My last major dental treatment was about 3 years ago when a couple of teeth were extracted and because of my severe anxiety, had to have the surgery done under general anesthesia (Propofol) in the care of a specialist.

          I went for the initial consultation where the dental assistant took some x-rays of the tooth, after which the endodontist came, looked at the x-rays, then pushed a Q-tip sprayed with an icing chemical against the top of the tooth, and asked me if I felt pain. Of course I did. I was sent back to the receptionist who asked me if I wanted the root canal done that same afternoon and they were quite insistent. Having had a couple of fillings already done at my dentist’s clinic earlier, and having had  nothing to eat all day, I declined and made an appointment for the following week. The receptionist checked my insurance and said I would have to pay $550 out of pocket since my dentist had already used a lot of my funds. The receptionist then said, they were giving me a discount and quoted $350, so I jokingly said “lower?”. She said $250 was as low as they can go and to tell my dentist to keep referring patients to them. I asked the endodontist if it was OK for me to take a mild anxiety pill before I came for the procedure the following week and she said it was OK.

          I showed up at the time of my appointment (12:45 p.m.) and waited in the reception area for about 15 minutes before being told that my treatment would be delayed because they were busy. So I went out and took a 20 minute walk. When I returned, they were still busy but the receptionist informed me that since I had more treatments done by my dentist, my co-pay is being increased from the original $250 to $400. Well, what else can I do but offer them my credit card? I was ushered to one of the treatment rooms and waited some more. The endodontist finally came which was already about 3 p.m. by then, asked me if I had lunch, administered numbing gel on the tooth and a few minutes later injected me with a local anesthesia. There was more waiting before the dental assistant came and isolated the tooth and placed a dam in my mouth to keep the saliva from the tooth to be treated. Then she placed a block of something on the opposite jaw to keep my mouth open. It was most uncomfortable and it didn’t help that there was more waiting.

          Apparently the endodontist was shuttling between 2 or 3 patients and when she finally returned to me, the drilling finally started. I had looked up the procedure beforehand on the internet so I sorta knew what to expect. Fortunately, I didn’t feel any pain during the drilling until the endodontist went deeper, but even that was tolerable. She informed me that there was calcification deep in the tooth and that a dissolving agent had to be put in to soften it before she can proceed. So while waiting for the dissolver to do its work and for the endodontist to return from her round robin routine, I had to distract myself to keep from being more anxious. I got out of the chair, looked out the window, took a couple of selfies, and went to use the bathroom, all the while with mouth wide open.

          When the endodontist returned, she drilled deeper until she was all the way to China. Oh, I mean until she estimated she removed all the calcification. Further x-rays were taken to verify if she actually did that. Finally she confirmed that everything seems to have been taken cared of and proceeded to fill the tooth, but she warned me that because she had to drill hard into the calcification, I may be in pain when the anesthesia wore off. I was finally freed from my mouth bondage and released. I was advised to return to my dentist to be measured for a crown. Did I suddenly become royalty?

          I went to my dentist’s office to tell them that my insurance benefits were exhausted and she said I may have to settle with a temporary crown in the meantime until next year. An appointment was set for the following week.

          I didn’t have to take any analgesics that day and the next day when I went to work, however I had to take a naproxen tablet the following day just so I could get some sleep after work.

Another Root Canal Done – On My Credit Card

          The insurance company sent me an email saying an Explanation of Benefits was available at their website. It turns out, my benefits were not exhausted at all but pretty close to it with about $210 left, despite paying my dentist for 3 fillings and for cleaning, and paying the endodontist for the initial consultation at 100% and for the root canal itself at 80% with the remaining 20% out of my own pocket. This amount was $175 and not the $400 that they billed me because they thought my benefits were exhausted.

          Since it was a weekend, the endodontist clinic was closed and the insurance company customer service wasn’t available either. Come Monday morning, I called the insurance company to verify that I actually only owed the endodontist $175 and inquired as to whether the endodontist was allowed to ask me to pay above and beyond the contracted price. The customer service agent excused herself to verify this with somebody and when she returned, she said no. I then called the billing person of the endodontist to explain my situation and to ask for a refund because of the overbilling and because the extra $225 was a big burden for me. She said she couldn’t give it to me at that time but she would check my insurance coverage again and get back to me. In the meantime, I contacted my credit card company via their website and filled out a form and an explanation disputing the extra $225 charge. For now, I would not have to pay that amount until the dispute is settled.

          You know what? I don’t know what was more painful: the root canal pain in the tooth or the overbilling pain in the butt! I hope everything turns out in my favor toothwise and moneywise.

The Hoka One One Tryout

       

The HOKA ONE ONE Bondi 3 and Rapa Nui 2

          I haven’t bought any running shoes for about 4 to 5 years mainly because I haven’t worn out what I already have due to infrequent running in recent years. In those 4 to 5 years of no purchase, the barefoot running movement had come and gone and in some cases swung over to extra thick soles in some shoes. When some of my running friends started posting pictures of their thick soled Hoka One One shoes, I became curious about them. I knew when they first came out that they were very expensive and cost $150! The shoes have a negative foot drop, a rocker sole, and due to its thickness, a cushioned ride. Being an overpronator with already damaged posterior tibilialis tendons, they were the exact opposite of rigid, motion control shoes I’ve worn for decades.

          I checked the prices online and found some closeout deals as much as 40 percent off on older models. The Bondi 3 was down to $83.99, still steep but considering the price of running shoes nowadays, more reasonable. So I ordered one just to try it out and see what the hulabaloo was all about. Maybe it would resurrect my running, maybe not, and if not then I can always wear them for walking or at work. The shoes arrived in less than a week and a couple of days later, it was time for a test drive.

          I started with baby steps and as slowly as I could jog. Any slower, I might as well have walked briskly. But I really wanted to feel the shoes. At first the cushioning made me feel like I was sinking a little instead of being propelled forward. But then again it could have been that my legs have lost muscle memory from infrequent running. I was expecting it to feel like the 1979 version of the Brooks Vantage which was very cushioned and bouncy when new and was rated best shoe by a running magazine at the time. It turned out Brooks paid the magazine for that rating. But I digress. Another thing I noticed is that it felt as if I was running more upright instead of leaning forward and on subsequent runs, my knees felt more underneath me instead of my usual overstride. Could this be due to the negative foot drop as opposed to the usual wedge shape of running shoes? But, back to this first test run which lasted a whole hour. I kept track of the mileage on Runkeeper and when the run ended, I checked the distance and pace. Heavens to Betsy! It was much slower than I thought! 4.94 miles in 1:00:54 at a pace of 12 minutes and 24 seconds per mile. The upside was that my ankles didn’t hurt and it felt like a good workout despite the utter slowness.

          Two days later, I went for another run but this time, I programmed Runkeeper to alert me to run for 2 minutes and walk for 1 minute. Another one hour run but this time despite the walk breaks, my pace was 11:14 per mile. This must have been a miscalculation by Runkeeper. Maybe the GPS didn’t connect until mid-run. The third run which was only 30 minutes yielded an 11:02 pace using my trusty old Garmin 305. Still no ankle pain.

          I went back to the website I bought the Bondi 3 from and looked for more closeout deals. I noticed the Rapa Nui 2 for 73.99 with an original price of 130. Mind you, these were trail shoes and I don’t run on trails but nobody cares what surface I’d run on them. I hemmed and hawed to myself but ordered it anyway. During the run test, I noticed that even though it was still rated as a cushioned shoe, it felt more like a stable shoe because it was a little stiffer than the Bondi 3. It actually felt like it was propelling me forward a little better and the 11:03 and 11:24 pace on the 2 minute run/1 minute walk intervals seemed to reflect that on the two workouts I tried them on. Either that or I was beginning to regain my running legs.

          Those short run/walk intervals seem to be working for me as an alternative workout to my stationary biking. I’m not looking to increase my pace or lengthen my run. I’m just happy that the Hoka One One appears to have rejuvenated my running. I’ve only had 6 workouts between the two shoes and I hope I can keep on doing what they have allowed me to do so far and not just a placebo effect of having new shoes.

          Unfortunately, two days after writing the above experience, I suffered a strained right thigh which had nothing to do with the shoes. Apparently 3 days a week of running was a little bit more than my body can handle. That's just the way my muscles react to running in the past few years. They can only tolerate about 6 weeks of running regularly before they break down again. Nevertheless, I'm still sold on the Hoka One One shoes. I'll start running in them again as soon as I heal.

Chest Pain Radiating to the Shoulders & Neck - A False Alarm (part 2)

Presbyterian Intercommunity Hospital-Whittier

The first part of this post is here: http://aboutlifeandrunning.blogspot.com/2015/02/chest-pain-radiating-to-shoulders-neck.html

It took barely half an hour to arrive in Presbyterian Intercommunity Hospital – Whittier (PIH), and I calculated that if the ambulance travelled at 60 MPH, then the distance must have been approximately 30 miles. In the ambulance with me were two paramedics and a registered nurse. According to one of the EMT's, normally an RN is not included but since I was considered critical transport, the RN was a requirement for this particular ambulance company. When I was unloaded at PIH, it took a while to find the unit I was being sent to due to the huge size of the hospital. All we knew was that I was going to room 3001 which meant it was on the third floor. But the third floor of which building was the question since the hospital had two buildings. Eventually we found it and I was offloaded from the gurney to the hospital bed. Lucky for the ambulance staff, they didn’t have to lift me and even if they had to, it would have been too easy for them since I’m only about 120 pounds soaking wet.

Hospital Care Kit

My private room and bathroom was spotless and a care kit sat on the bedside table. The usual items in an admission care kit like a basin, pitcher, tumbler, toothbrush, toothpaste, body wash/shampoo, lotion, mouthwash, and a full size box (!) of Kleenex  were already at my tray table when I arrived at the hospital. What was an unexpected surprise were a few additional personal touches to enhance a patient's comfort like an eye mask, ear plugs, and lip balm. Nice job PIH! The only thing I had trouble finding was the remote control for the TV and the wall lights. The next time the CNA came, she showed it to me - it was stowed in a receptacle under the bed. The visitor’s bench on one side of the room also happened to be a pull out bed in case a relative or friend wanted to sleep over.

My hospital bed

The nurse came and introduced himself (Rafael), hooked me up to a Holter monitor, checked my heart and lungs, did a stroke assessment, then asked me about my medical history. He said a hospitalist (doctor) was coming to see me shortly. Rafael come back later to swab my nose for an MRSA (methicillin resistant staphylococcus aureus) test. He said they had to do it whenever a patient was transferred from another hospital. He reported later that the test was negative. Meanwhile, I fired up my computer and connected to the hospital wi-fi hotspot. I hope I did the sequence correctly: call 911, stabilize in the ER, get admitted to the hospital, then post to Facebook, instead of the last one being done first. Well, I couldn’t connect to the wi-fi in the ER so…

The hospitalist came, listened to my heart and lungs, asked questions, did another stroke assessment, then went to the nurse’s station to write his orders but first I asked him if the nurse could give me a snack or if I was supposed to be NPO for the anticipated tests in the morning. Thankfully the CNA came back with a turkey sandwich and milk. It was my first meal since noontime the previous day and it was already 3:30 a.m. While I was eating, my brother apparently read my post on Facebook and tried contacting me via Skype video chat, but I had turned my computer off while the doctor was talking with me. When I turned it back on, I saw the missed call but before I could call back I had to update Skype first. When we finally connected, my brother Larry and his better half Ninette said they had just gotten back from out of town when they saw my post. We chatted briefly and updated them on my condition, then I tried to get some sleep by about 4:15 a.m. Alas, my body reverted to night shift mode and only slept for about an hour. The nurse came to ask me if I wanted the alternating pressure device attached to my legs to prevent stasis and blood clots. I declined and told him it wasn’t necessary since I expected myself to be moving around anyway.

The phlebotomist came next and I asked her about the blood test and since it included blood sugar and cholesterol levels, I informed her that I had eaten only two hours prior. She said she was going to note on the computer that it was a non-fasting result. Soon shift change came and I met the day shift nurse, Emily. To my surprise, Rafael, the night nurse gave report about me in my presence. I have never experienced that before. I told Emily that I was an uncooperative patient because I refused to wear the alternating pressure device.

So this is how Monday morning went: breakfast was served and as I was about to start eating the orderly or transport aide from the radiology department came by to pick me up for my head MRI. He was nice enough to give me a few minutes to eat. I was supposed to be on a cardiac diet (low fat, low cholesterol, low sodium) so it was surprising to see eggs and sausages on my plate. I haven’t eaten those things in years!

Then I was transported downstairs on a wheelchair down long hallways until we reached the MRI room. They were finishing up with another patient, then it was my turn. They checked me for metal objects so they put aside my partial denture and I let them know that I had a metal plate on my left ankle which has been there since 1972 when I broke it in a motorcycle accident. The technician said it was okay. I was pre-warned of the noise of the machine and given earplugs and an ear cover. Pretty soon, the machine started thumping and I started to get anxious. My pulse rate went up and I tried to slow my breathing down. Then suddenly I realized, it wasn’t so much that my heart was beating so fast and hard but it was the thumping of the MRI machine, so I just concentrated on relaxing. Pretty soon 14 minutes in the claustrophobia causing machine was over, and I was wheeled back to my room. It took so much concentration to keep me from jumping out of the machine in the first couple of minutes.

When I got back to my room, I asked Emily if I could walk up and down the hallway for at least half an hour so I don’t miss my daily workout and so that what is reflected on the Holter monitor would mimic what I would normally do at home. She okayed it but told me that if I started having chest pain or dizziness, to alert the closest nurse. With that, I started my walk. I encountered a therapy dog on my first lap and let it smell the back of my hand, then I continued my walk. Alas, it only lasted for 6 minutes. Did I have chest pain or dizziness? Well, no. I saw someone enter my room with a machine so I followed her. The cute girl told me I was going to have a Lexiscan. I asked, who is Lexi and why is she going to scan me? Two other technicians showed up while I was being hooked up to an EKG machine and something which I found out later was the Lexiscan was injected in my vein. While the 3 techs monitored me, my attending physician showed up and I gave him a fist bump instead of shaking his hand because it's better for infection control. He asked me a few questions and told me that my MRI was normal. There was no sign of a stroke that the other hospital may or may not have seen on the CT scan. That was another good news in addition to my normal troponin levels. I was to be taken downstairs again later for a stress test which did not involve a treadmill. The Lexiscan nuclear dye would take care of detecting any abnormalities in my heart and circulation. If you want to learn more about Lexiscan like I did, just look it up on the internet. Shortly after, another phlebotomist came to draw blood for CK-MB test.

I went back out to the hallway still wearing a hospital gown, reset my stopwatch to zero and started my walk again. This time there would be no more interruptions other than dodging nurses, doctors, housekeepers, and visitors in the hallway. Fortunately I wasn’t accused of indecent exposure since I wasn’t wearing anything underneath the gown. I should have asked for a diaper to provide more coverage rather than go commando. I completed 35 minutes and decided that was enough. A nurse's aide came to my room to bring me gray hospital socks so I can wear them instead of the red ones which came in my care kit. She said red socks were for patients who were at risk for falling and after seeing me power walking in the hallways, she didn’t think I was one. I jokingly told her I could fall for her so the red socks would be justified. She said I better not. When I saw her again a few minutes later, I changed the tone of my voice and told her – I could fall for her (as in love). Jokingly, of course J

COW-Computer On Wheels

While walking up and down the hallways of the telemetry unit, I noticed there was a COW (computer on wheels) in every room running e-MD, an electronic medical records system. I’m used to the Cerner and Epic systems. Aside from e-MD, the staff used Vocera to communicate with each other, it was attached to their lapel or scrubs near the neck area then they would mention the name of another staffmember and the system automatically connects to the other person and they can talk to each other. I won’t be surprised if the Vocera is also connected to the patient’s call light.

Lunch-Barbecued chicken breast, mixed veggies, mashed potatoes, oatmeal raisin cookie

Lunch came soon and I checked with Emily if it was ok to eat. She said yes and that the only thing I can’t have is caffeine because it affects the Lexiscan test. Trying my best at being a model patient, I even took my tray back to the dietary department cart out in the hallway and let my nurse know that I ate 100%. While I waited to be picked up for the test after lunch, a social worker stopped by to ask me if I had an advance medical directive. I said I didn’t but had a POLST (physician’s orders for life sustaining treatment) in my doctor’s office. She said that if I was interested in filling out an advance directive she could bring the forms for me, help me with it and have it notarized for free in the hospital. So I asked her to bring me one. Since she was a social worker, I also asked if they assisted patients with transportation if nobody was able to pick me up to take me home. She said they did and I requested the service. She came back with the blank advance directive which I proceeded to fill out. By the way, an advance directive is a legal paper filled out by a patient on what his wishes are if he becomes incapacitated and cannot make medical decisions for himself. The patient also assigns another person to make sure that his wishes are carried out.

Then an echocardiogram technician showed up and she did the ultrasound test while I lay on my left side. A few minutes after she left, I was finally wheeled along even longer hallways to the nuclear medicine department. The myoview/lexiscan test was done while I was lying supine first, then in the prone position. I was sent back to my room to await the results and if everything was clear, I was to be discharged.

I saw the social worker again and asked if the notary public was still available to witness my now completed advance directive. Unfortunately he was gone for the day so my advance directive is still unofficial until witnessed by a notary or two other uninterested parties.

Emily came back to see me at about 4 p.m. and told me my myoview/lexiscan stress test was negative for abnormalities and she would be preparing my discharge papers as well as arranging for transportation. I tidied up my hospital room before getting discharged and took home the care kit because when I asked the CNA if they wanted to return items I didn’t use to the supply room, she said they were going to automatically throw them away.

At 5 p.m. came and unhooked my Holter monitor, removed my IV access, then walked me downstairs to the lobby where the taxi driver was already waiting for me. I thought it was a hospital van that was taking me home and was surprised it was a taxi. I jokingly asked Emily if they used Uber to transport patients. I thanked her for taking care of me and bid her goodbye. Then I boarded the taxi, chatted with David, the driver as he entered the 710 freeway towards Long Beach. Because it was President’s Day, traffic was light and we arrived at my home in about 25 minutes. Thus ended my latest bout with chest pain false alarm.

It was reassuring to know that after all the necessary tests have been done, the chest pain, burning sensation in the neck and shoulders, and dizziness had nothing to do with my heart and brain.

However the cause of all the pains I've been experiencing remains a mystery as it is still happening two weeks after my trip to the ER and one day of hospitalization.  It could be that my body is suddenly reacting differently to exercise now and the soreness is not what I used to experience.

Random notes and observations: Just realized that I had this problem on National Heart Month.

If anything happened to me while I was by myself at home, I might not be found until weeks, months, or even years later, which has happened to other people and became news items.

With two IV sites and four blood draws, my arms look like a heroin addicts’.

As much as possible, I try to minimize my impact towards the world and my relatives and friends because as much as I dislike inconvenience, I do not want to inconvenience anyone either.

This is about the 4th time I've had a false alarm in the last 15 years or so but I've never really told anybody about it, not even my immediate family. Of course there was no Facebook when the first two happened.

I was surprised that neither the ER nurse nor the Telemetry nurse asked me if I was out of the country recently as required by the ebola screening process. Maybe because I didn't have a fever.

I think the reason why I couldn’t be accommodated in any hospitals near my home was because while I was at the emergency room, there was a drive by shooting in Long Beach where 5 people were shot and in another incident, a man in a wheelchair run over by a car.

When I was having those frequent pains, it made me more grateful when I was able to wake up in the morning still alive.

Part 1 of this post can be found here: http://aboutlifeandrunning.blogspot.com/2015/02/chest-pain-radiating-to-shoulders-neck.html

Chest Pain Radiating to the Shoulders & Neck - A False Alarm (part 1)

In the past month or so, I had been experiencing some tightness in my chest, burning sensation in my shoulder and neck muscles, along with dizziness which I can describe as similar to turbulence while flying in an airplane. I’ve always rode it out rationalizing that it was just muscular pain and my inner ear problem which happens from time to time but always suddenly disappears for months at a time. I couldn’t account for the burning sensation though. I finally made a doctor’s appointment and told him about my symptoms. Blood was drawn and the doctor’s office was going to get a preauthorization for a treadmill stress test. My lab tests turned out to be normal except for a slightly elevated creatine kinase (CK), and bilirubin. When I asked the doctor about this, he said those numbers were nothing to be concerned about. In the meantime, they were still waiting for the insurance company to respond to the preauthorization request.

On Sunday morning, February 15^th, I felt the symptoms worsen in the morning, then thinking I might be hypoglycemic, I ate 3 pieces of toast and lay down on the couch for a few minutes, which seemed to help, before I started my workout. Because of the way I felt, I only did a low intensity workout on the recumbent stationary bike and kept it to my minimum of 30 minutes. I had lunch afterwards then watched a video. At about 2 p.m., I started feeling the symptoms again and it worried me. Perhaps it was time to call 911 before anything worst happened. I picked up my phone (Majicjack) and there was no dial tone, so I disconnected the USB cord then reattached it. I dialed 911 and was transferred to the paramedics line. After a few rings, I got cut off! I dialed again and this time the paramedic dispatcher answered and verified my address and was told the paramedics were on the way.

Initially, 3 medics came, then at least 7 more showed up. I said, darn, how many units rolled? One of them said “The city of Long Beach considers you a very important person”, which made me chuckle. They said they were going to take me to a hospital. On the way out of my apartment on the second floor, the paramedics asked me if I was able to walk down the stairs towards the gurney. I said yes. I was already attached to an EKG machine with the wires on my chest. The paramedic holding the EKG machine led the way and I said to him, "this must be how a dog feels on a leash". He laughed and said, "oh, still cracking jokes huh?"

As I was being loaded into the fire department ambulance, the medic mentioned that I was going to be taken to Pacific Hospital of Long Beach (now College Medical Center). I asked if I can be taken to Memorial Hospital of Long Beach instead or Community Hospital of Long Beach where I work. He said that the only emergency department that was would be able to take me is PHLB because the others were busy. So off to PHLB we went, the same hospital that laid me off a year and a half ago, with an ER that I did not exactly trust based on my observations when I used to work there. The medic gave me three sprays of nitroglycerin 5 minutes apart and had me chew and swallow 2 baby aspirins. Time of arrival in PHLB: 3:15 p.m.

The thing with chest pain is that you get seen by the nurse or doctor right away, or so you would think, but since I was still conscious, did not appear to be in distress, with a heart that was still beating, I wasn’t seen as quickly as I had been in my previous hospital visits. I was transferred from the paramedic gurney to another gurney right next to the holding room where the psych patients were waiting to be medically cleared before being transferred to the psych unit. I was hooked up to an EKG/blood pressure/pulse oximeter machine which emitted beeps every few minutes signaling something amiss with my heart. Either that or the machine was not detecting accurately. Blood was drawn, a chest x-ray was done, then a CT scan of the head. I had sent a text message to my cousin Maryann informing her that I listed her as my emergency contact. Shortly, she and her husband Mike showed up at the emergency department and I updated them on what was going on. They were surprised to observe what appeared to be homeless people in the waiting room and the behaviors of the psych patients a few feet away from my bed. Believe me, I experience that every day I’m at work because that’s the population we mostly treat.

Before Mike and Maryann showed up, I heard a policeman mention a 5150 to any designated LPS facility and asked one of the nurses what LPS meant. The nurse didn't know, so being the show off that I am, I proceeded to explain that LPS stood for the Lanterman-Petris-Short Act which basically says that no one can be involuntarily committed to a psych hospital indefinitely unlike before. For more detail, you can read about it here: http://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80%93Short_Act . 

In the meantime, the admissions staff was trying to get authorization from the insurance company to admit me for observation or transfer me to another hospital within their network which have prearranged contracts with the insurance company. That took hours probably because it was a Sunday and the following day was a federal holiday (President’s Day). I was offered morphine for the chest pain which I declined because I felt it was too strong a medication for me, so I was given a couple of baby aspirin. I was told that my troponin level was normal but the CT scan showed a possible mini stroke very recently, however it was inconclusive.

When the insurance company finally gave authorization to transfer me, I thought I would be sent to Memorial Hospital which was only about a mile away and because it was part of their network. Instead I was being sent to Presbyterian Intercommunity Hospital, and I was thinking the one in Downey, but then I was mistaken again and was told it was the one in Whittier which was much farther away from home. Maryann and Mike stayed until 10:30 and when I learned of my transfer, I sent them a text message update. Thank you so much Mike and Maryann for staying with me for a few hours. The ambulance arrived at midnight and shortly after, I was being whisked from Long Beach to Whittier. I learned later why none of the other Long Beach hospitals couldn’t take me.

To be continued in Part 2, as this entry is quite long already.

Pregnancy and the Bipolar Patient

Well, whoever made this sign misspelled monotherapy and arrythmia.

Prologue or perhaps I should call this a disclaimer - Let’s just say this is a fictional account and the writer makes no claims on it being based on a real people. Any similarities real or imagined are merely coincidental.

A woman shows up at the Emergency Department and is admitted to the Psych Unit. Almost a month later she is still in the hospital without any signs of improvement. Thus the difficulty of treating a pregnant woman with Bipolar Disorder. The foremost issue is to protect the baby, then treat the mental illness. Medications must be chosen which do not affect the pregnancy and at lower doses and sometimes like in the case of this woman, it has not worked. The psych ward had a similar situation before but with good fortune, even at her worst the woman was still verbally redirectable and she reconstituted quite quickly.

Just a week or so ago, it took four very patient nurses taking turns in keeping the patient and baby safe because she was wandering all over the unit and jumping on and off beds. The mental health worker (MHW) had never witnessed such patience and compassion before from staff in all his/her years working in psych units.

Then the MHW had his/her own opportunity to take care of this patient since she had to be sent to the semi-medical unit for rehydration, i.e. she had to have I.V. fluids infused. Since she was the type who could not stay still for even a short amount of time, the MHW was tasked on pulling the I.V. pole along with her wherever she went, while at the same time trying to keep her steady. Well, even though the MHW had gained more patience in recent years, part of him/her wanted to quit within the first 2 hours of trying to take care of this woman. If not for the possibility of being charged with abandonment of duties, he/she may have seriously considered walking out. There were other things at play though. They were supposed to have an extra worker take care of the patient but that worker was moved to another unit. The hospital did the same thing to the MHW the previous week when they provided an extra worker then pulling him out after 3 hours. Guess what happened after that? The patients started acting out!

Going back to the pregnant bipolar/manic patient, she ran the MHW ragged, thus his/her thought about quitting. What do you do when medications don’t work and the patient doesn’t listen to redirection? You do the best you can but it’s mentally tiring. She wasn’t the type who slept well at night and that’s the reason why 4 different nurses had to deal with her. The MHW was dreading having to chase her around for the 12 hours of his/her shift. Then, as luck would have it, the meds kicked in and the patient fell asleep close to midnight. The MHW was thankful that the patient as well as he/she was getting some rest. Knowing this patient, the MHW was aware that she never sleeps all night and is usually awake by 2 or 3 a.m. and the chase starts all over again. But one can always hope for miracles like for example if she doesn’t wake up until after the MHW leaves at 7:30 a.m., or if she does sleep well (which she hadn’t for the several weeks she had been in the psych ward), maybe by the time she woke up, her mind would be finally clear. But that would be asking for too much, wouldn’t it? She woke up at about 6 a.m. and she and the MHW started a new trek up and down the hallway with the IV pole.

Mind you, the MHW had to rely on his/her past as a lapsed marathoner and dig deep into his/her muscle memory to keep up with this patient. At least the MHW thought he/she could outwalk the patient if need be. When daylight came, the supervisor who happens to be a runner too, came up to help the MHW, which was really good timing because the patient started dropping herself to the floor and it took two people help her up. The minutes ticked by slowly until the day shift took over. The IV fluids were supposed to run for another three hours before the patient was to be sent back to her previous unit. Knowing that made the MHW feel a little better about coming back the next night. But…

When the MHW returned for his/her shift the next night, the patient remained on the same unit with plans to return downstairs soon after change of shift. Once again, the MHW was supposed to stay with her, but at least this time she was no longer attached to the IV pole which made it much easier to walk up and down the hallway. However, her behavior remained unpredictable. The doctor saw her and made a change in her medication. Another nurse soon joined the MHW from downstairs so he/she could help take care of the three other patients on the unit. At least now he/she didn’t have to concern himself/herself with them but rather focus on just one patient. The supervisor informed the staff that the nurse’s aide from the registry never showed up so they were short staffed again. To add to that, they were keeping Mrs. Manic  for another night. At about midnight, another MHW came to the rescue and relieved the other MHW of his/her duties for a couple of hours. Why just a couple? Well Mrs. Manic woke up at 2 a.m. and began screaming and when the first MHW came in the room with other workers, the patient called him/her a child molester and a one minute man/woman among other things. The two female nurses tried to calm her down to no avail. With great relief, the first MHW was able to break away for his/her half hour lunch. When he/she returned, they had taken the patient to the TV room where she was pacing around but also trying to toss magazines and papers from the bookshelf. So the first MHW took her out to the hallway and they started another 10K walkathon. When the patient finally said she was tired, the MHW escorted her back to bed along with the second MHW who needed to be present as a witness in case the patient claimed the first MHW did something inappropriate. She was restless in bed and would drift off for a few seconds before awakening again. It was like a startle response. The MHW talked to her softly and gently trying his/her best to emulate the horse whisperer. It didn’t work too well because she never went to sleep. After two hours of this, the first MHW had to cut himself/herself loose and let the other MHW take over so the first one could check on the other patients. The other MHW gave the patient a shower and changed her clothes before the first MHW did another 10K up and down the hallway until it was time for the night shift to go home. The MHW was glad to have the next two nights off.

Epilogue – What can the whole treatment team do better to make this patient functional again while protecting her unborn child? Perhaps they can consult with the family on what their expectations are so they can make decisions about the care of their loved one. They need to provide some input about what to do next since the present treatment is not working and thus not making the patient any better. It’s a big dilemma trying to save the sanity of the patient and trying to save the life of the baby too.

Well, that’s the writer’s fictional account of what happened one weekend in the Psych Ward where dull moments are sometimes few and far between.

An Appreciation of Sunrise

Barely three months removed from my abbreviated employment with Sunrise Senior Living, which I would otherwise call my sunset at Sunrise,  I discovered a few things about myself. What I loved most about the job were the interactions with the residents. I learned a lot about caregiving and will hopefully keep that knowledge for a long time and be able to apply some of the skills in the psych unit setting. The training provided by the company was invaluable, but the job itself was harder and more physical than expected. By learning about the Sunrise way of managing the care of its residents, I also learned that I wasn't very good at it. In theory perhaps, I was good since I aced most if not all of the tests I took in company's The Learning Channel (an internet based education program). Maybe if I stayed longer I may have become somewhat competent in the physical side of the job, however I couldn't pass up the opportunity to work in more familiar situations and surroundings. I sincerely appreciate what Sunrise Senior Living of Seal Beach has afforded me and I will truly miss the residents, the pets, and my co-workers who have been more than patient with me with all my fumbles while learning to do the job those few months I was there. Let me emphasize that my co-workers there were very good at what they do and I was very impressed. I feel a tinge of embarrassment for not being able to last long but I just had to jump at a different opportunity.

I tried my best to learn how to become a decent care manager, but based on my personal standards, I really sucked (for lack of a better word) at that job. Maybe that negative self assessment is due to being a perfectionist sometimes.

I also am not a natural people person but I had to transform myself, albeit even just slightly, because despite all the duties and responsibilities of being a caregiver, a huge percentage involved customer service especially if you were working the morning or evening shift. Not only did you have to be good with the residents, but their families, visitors, and potential customers touring the place as well.

I did not resign from Sunrise due to dissatisfaction with the job but rather because an opportunity came up which are few and far between nowadays.

In all the places I've worked, I've never said goodbye to the patients until this time, when I said goodbye to most of the residents assigned to me who were awake between 4 a.m and 6 a.m. (since I was on the overnight shift). I left a piece of myself in Sunrise Senior Living of Seal Beach because the residents and pets stole my heart.

If there is one thing I wasn't comfortable with in the treatment of the residents, it was rushing them through meals, although I can only say that about dinner since I never worked in the morning for the breakfast and lunch service.

My last couple of weeks at Sunrise Senior Living was full and hectic (for me anyway) - working on the PM shift on Thursday, midnight shift on Friday, high school reunion on Saturday and Sunday, hospital orientation at my new job on Monday and Tuesday, tending my one week notice of resignation on Wednesday, then working my last 3 shifts on Thursday, Friday, and Sunday. I was glad to have a few days off before my return to the psych unit. No, I didn't relapse and become a patient, but rather finally found a job as a behavioral health worker after being out of that field for almost a whole year. Goodbye Sunrise. Maybe I’ll consider living  there if I can afford it in my sunset years.

Rainy Days Are Here and I Don't Mean The Weather

Rainy Day Fund

          You all know the phrase "save for a rainy day"? It's something that I practice almost religiously. Along with the unemployment checks for 6 months, it was reassuring that I had saved for a rainy day.

          Since I finally got gainfully employed 3 months ago, there seems to be more rainy days occurring in my life. First was the plumbing problem I had where a new garbage disposal system had to be installed because the old one was corroded. This happened just right after I got my first paycheck.

          Next came the car repair which involved brake pads and rotors replacement, plus a new battery because the old one had 10% charge left. The front brakes had been a problem for several years and I had been putting it off. I had been avoiding driving on the freeway because sudden or hard braking from full speed made the front wheels shake violently feeling like the wheels were going to fall off.

          Then just as winter started, my wall furnace went on the fritz. For the past 22 years, I've been able to relight the pilot on my own by following the manufacturer's instructions. This time the pilot light won't stay lit despite several tries. I called the Long Beach Gas Department and they sent a technician to check it out and he said that there was a problem with the electrical system. So I had to call a heating company whose technician first diagnosed a thermocouple problem. So he replaced that but the heater still didn't work. That could only mean one thing: the price of repairing the heater would get steeper.

         Sure enough, he had a second diagnosis and this involved the generator. He explained to me how the gas, the pilot light, and the electrical system worked. I asked him if he was sure that if replaced the generator, the heater would start working. He said "well, there are really only two parts of this particular heater: the thermocouple that I replaced and the generator". So I asked him for a price quote and again, sure enough, the price more than doubled. Well what choice do I have other than freeze in the wintertime. Unlike the movie Frozen when one of the characters sang "the cold never bothered me anyway", I prefer to keep myself warm because cold bothers me. I had to take a nap before work, so I asked the technician to come back the next day.

          So there you are. Three major rainy days in the past three months of full time employment. The timing couldn't get any better because at least I now have the income to use as an umbrella for the unexpected precipitations. Thank GOD! Oh boy, living in the United States sure is expensive! Too bad my rainy days isn't helping the drought in California.

Update: November 22, 2014 - Well my old Asus Transformer TFT 101 is on its last legs. Sometimes it works and sometimes it doesn't. The thing I like about this device is the 16 hour battery life when attached to the keyboard and nothing comes close to it at a reasonable price in the market nowadays. Time for another rainy day expense to replace it?

CHLB Center for Mental Health NOC Shift BHW Duties and Responsibilities

          I just finished my 3 month probationary period in my new job as a Behavioral Health Worker, and while in orientation the first couple of weeks, I learned about my duties and responsibilities, which I now list below. Although the list may  be longer than what I had to do as a care manager in assisted living, it is not as physically demanding. At least not yet.

          First of course is clocking in to work, then checking the assignment sheet to find out if I'm assigned to Unit A, Unit B, or the Geropsych unit one floor up. Then all the staff hang around the lobby area between Unit A and Unit B in what they call the huddle. During the huddle a short report is given on the number of patients on each unit, how many possible admissions are expected, and how many are being evaluated in the emergency room downstairs or in other hospitals. Reminders are also given on any special things that need to be done. After the huddle, we proceed to our assigned units to listen to report about the patients from the day shift.

          Then we do our first rounds checking the location and behavior of the patients. We do this every 15 minutes throughout the shift. Next, we check the vital signs of all patients (temperature, pulse, respirations, and blood pressure). We are usually accompanied by a registered nurse so they can also check on their assigned patients. After all vital signs are done, we give a copy of the vital signs sheet to each nurse, then we enter the results in the Epic electronic medical records on the computer.

This is as far as I will write in narrative form. What follows is the list of my other duties:

• Make sure water container has cold water (add ice from freezer as needed).
• Assist with admissions as they come in (vital signs, papers signed, belongings; contraband; valuables check).
• Snacks at 2030, Canteen run to vending machines,  and Contraband time right afterwards.
• Prepare new rounds sheets for next day. File old rounds sheets at midnight.
• Break down discharged patients charts & keep dividers in binders. Place D/C chart in cabinet near copying machine.
• Make admission chart packs after 2300. Put nursing paperwork and admit packs in empty binders for new admissions.
• Clean tables in dining room with disinfectant wipes. Order staff pantry supplies from Dietary Department as needed (fill out form then fax). Straighten out dayroom, contraband room and donated clothes (in solarium) as needed.
• On geropsych unit, give a shower to at least one patient in the morning (red key in nurse's station for shower & vending)
• Continue Q-15 minute checks throughout the shift. Approximately 5:30 a.m., enter patient's number of hours of sleep and sleep quality in EPIC./ Print out vital signs sheet and meal/shower/BM log for the a.m. shift./Serve decaf coffee at 0600.

Admission papers:  BHW - Release of Information, Notification of Patient Admission, Telephone List, Consent to Photograph, Patient's Rights, Valuables List, Rounds Sheet.

                                 RN - Medication consent , Interdisciplinary Treatment Plan (multi page), Physician's Initial Assessment, Skin Assessment, Patient Education Record, Discharge Recommendation.

EPIC for BHW's:

• Log in. To find your patients: Click System List on left side, Click Units-CMH. Click CMH 4A or 4B or 5. Click and drag Unit chosen to My list on top of left side of screen.
• To chart vital signs: double click on a patient's name to open his/her chart. On left side of the screen, click Doc Flowsheets. On the tabs on top, click Vital Signs. Enter the vital signs in the designated areas. When done, click File on upper left corner. Close the chart by clicking the X next to the patient's name. Double click on the next patient name on the list and repeat above instructions.
• To print labels and ID wristband: on the left side where you found Doc Flow sheets earlier, click Form Reprint. Click on what you want to print and enter how many, then click Print.
• To chart hours and quality of patient sleep: as above, click on Doc Flowsheets, click Sleep on left side, enter number of hours in designated area, click Quality of Sleep, choose appropriate description from drop down list or type in your own comment (F6 key), click File on upper left corner, close the chart by clicking the X next to the patient's name. Double click on the next patient name on the list and repeat above instructions.

Public comments below, private comments: E-mail Me!

P.T. For The M.F.

          Forgive me, I don't mean physical therapy for the mother fu...er. It's for the mallet finger. After having a consultation with the orthopedic specialist, he said that I didn't need surgery even though my middle finger was drooping slightly. He asked me if I needed physical therapy and I said yes, since I felt I needed more guidance with what rehabilitation exercises to do other than just sending me home with Theraputty® like the previous doctor did. 

 

          So I was given six sessions of physical therapy (three times a week for two weeks). During the first session, the physical therapist asked me about the history of the injury then proceeded test my grip strength

and make measurements of how much angle I could flex and extend the finger to get a baseline. She then told me to show her what types of exercises I had been doing with the Theraputty® and showed her two ways I would squeeze it. She showed me a few more things I could do which included digging into the putty with my fingers and other extension and strengthening exercises. In addition, I was shown exercises I can do with a rubber band and a dumbbell. Afterwards, she held my hand (without even buying me dinner first!), and started torturing me. OK, just kidding, but it sure felt that way initially. What she did was hyperextend the finger ever so slightly to the point of pain indicated by my yelling OWW! She did that a few times until the finger looked slightly straighter. She also did some passive range of motion exercises to the point of resistance which also resulted in some pain. Not that I wasn't expecting any pain at some point. Then she provided me some relief by attaching four electrodes on my fingers - two on top and two on the palm side. She connected the electrodes to a T.E.N.S. unit (transcutaneous electrical nerve stimulation) and turned up the power and started electrocuting me. Well not exactly. She turned the knob slightly and asked me to tell her when my fingers started to tingle and when I indicated as much, she stopped. The same was done for the electrodes on the palm side and a timer was set for twenty minutes. Oh I forgot, my hand was also wrapped with a heating pad. The T.E.N.S. treatment was supposed to improve circulation and break up scar tissue. 

          So I sat there and explored the room with my eyes to pass the time, wishing I had picked up a magazine to read from a rack at a corner of the room. Other patients came and went to do their therapies. Pretty soon the timer started beeping and I survived my time on the electric chair or Taser. The electrodes were removed and kept in a plastic bag with my name on it to be reused in the next session.

Lastly, they tried to make strike anywhere matches with my left hand which was dipped about 5 times in a container of lavender colored hot paraffin wax, then it was wrapped in white paper which somehow reminded me of fish and chips, then the papered hand was inserted in a terry cloth fingerless glove to keep the heat in. When the paraffin wax cooled in 5 to 10 minutes, off came the glove, the paper, and the wax had to be peeled off from the hand like a second skin. The lavender scent from the wax remained in my hand for a few hours and people were probably wondering why I was sniffing my hand so much despite the absence of white powder on it. 

          The session went for slightly more than an hour which I thought would last only half as long, although the time passed pretty quickly. Except for the initial measurements, subsequent treatment sessions were similar to the first. In my subjective assessment, after 5 treatments, my finger feels slightly stronger and more flexible, although I have more work to do by myself for further improvement after the 6th and final session.

          Much thanks are in order for the physical therapist and her assistant for guiding me and helping improve the function of my left hand and more specifically my healing middle mallet finger.  For privacy reasons, they declined to allow me to use their names. Even though the finger injury has been a major inconvenience to my daily activities, whenever I went in for physical therapy and was asked what my pain level was from 1 to 10, I always felt no pain. In contrast, the other patients who came in always mentioned some pain.