Night of the Widowmaker, ten years on

Ten years ago on these pages, I regaled my readers with stories of my heart attack. It was an exciting misadventure. Nobody in my family had heart issues and neither did I. I was struck down in the middle of a working day. The scientific name for my affliction is anterior ST-segment elevation myocardial infarction or STEMI. It’s commonly known as “The Widowmaker.”

I didn’t hear the term from a cardiologist until I was recovering in my hospital room. Such finality. It seemed so 19th century. "Night of the Widowmaker" could easily be the title of a thriller novel. Its shock value was too tempting for a storyteller to ignore. I used it hundreds of times in place of heart attack. When I took the time to describe it in detail, tossing in an encyclopedia of medical terms, I could see my listener’s attention begin to wane. Simply described, the left anterior descending (LAD) artery gets blocked by a clot or plaque and the heart reacts.

The signs are there should you pay attention. Chest pain, shortness of breath, excessive sweating, jaw pain. Mine was a belly ache. Since it happened during norovirus season, I figured I was getting ready to blow chunks and/or get the runs. I got neither. It was Dec, 17, 2012, and the eve of my birthday number 62. I might have to lay off the cake and ice cream. I was off work for two weeks so I could lie around and see what happened. After a week, I went to my GP and he thought I might have pneumonia so sent me for an X-ray. He had a perfectly good EKG machine out in the hall but that never entered into the conversation. The X-ray showed congestion and the doc prescribed an antibiotic and bed rest.

On Jan. 2, I headed to work but only made it as far as my front door. I couldn’t open it. I called my wife. She decided to come home and take me to the ER. When she arrived, she saw I was in pain so called 911. The EMTs got there quick, took my vitals, and said I was having heart failure. They bundled me onto a gurney and sped, sirens blaring, to the hospital. Tests and X-rays showed the heart attack and also congestive heart failure. Dr. Khan wanted to get me to surgery right away but held off because I couldn’t breathe. So he stashed me on the telemetry floor and prescribed Lasik to rid my body of fluids. The next day, I had an oblation which opened the LAD and I began to recover.

Then I started telling my story. My heart, left to its own devices for two weeks, lost some of its pumping power. They filled me full of drugs, sent me home with orders for several rounds of cardiotherapy. Six months later, I got the bad news that my heart had only partially recovered and that I was a prime candidate for Catastrophic heart failure. To avoid further drama, I needed an Implantable Cardioverter Defibrillator or ICD. So I got one. Its battery eventually ran down, so this last Thursday, I got a new one.

The ICD lasts from 7-10 years. I pushed mine to the end so Medicare and my insurance company would agree to foot the bill. Medicare reimbursement for an ICD is 23 thousand and change. That doesn’t include hospital and physician and other associated fees. That will quickly eat up my deductible so my out-of-pocket costs will be manageable.

Someone with a heart condition shouldn’t have to worry about affordability. Someone with breast cancer – my wife – shouldn’t have to worry about treatment costs. My son and daughter, both with mental health and medical needs, shouldn’t have to up their angst to find affordable treatments. Alas, that’s where we are in 2023 in the United States of America.

Next time, I'll explore the status of my heart ten years on.

For some of my ruminations on the widowmaker, put "heart" in the blog's search bar.

Do odd things happen to writers, or are writers just odd?

A question for my writer friends: Do odd things happen to you, or are you the odd thing?

The answer is important. The world is odd, filled with strange happenings that call out to be translated into poems and stories. But I may be the odd one for noticing and then spending hours/days/months on writing a story to make some sense of this odd occurrence. Maybe it doesn't have to make sense, it just has to be entertaining or thought-provoking. It may never be published, never. read by more than a few blog fans. 

To get on with the story...

I had a weird experience Tuesday at a Colorado hospital that will remain nameless. I was the subject of a Cervical CT Myelogram procedure. The docs and nurses in Radiology were supposed to start in on me at 1 p.m.. And then it was 2 and then 3. Finally, the head tech explained to me that the computer had hijacked the hospital. It mistakenly booked me in the fancy Radiology room next door and wouldn't acknowledge that I was waiting in the plain vanilla Radiology Room. I said why don't you put me in the fancy room. He said it was expensive, only used for the difficult cases. I was glad that I wasn't a difficult case. 

The IT guys stormed the premises. They were not like the "IT Crowd" technos who told frantic operators this: "Have you tried turning off  the computer ans turning it back on?" They came to rescue. The problem seemed to be a tough one. The IT guys figured out they had to discharge me from the hospital and admit me all over again, trick the computer into thinking I was a new patient suited only for the cheap room. 

They did that and thought they had it licked when the computer changed its mind and put me back in the fancy room. There must have been ten people in the room, some working frantically on the computer, others preparing the room for the medical procedure that was sure to start any time now. I talked about books with a nice nurse who was writing a children's book in her spare time. Earlier, as she checked me in, she found out I was a writer and said that she thought that I looked like the creative type. I was flattered, as people usually think I look like Colonel Sanders. 

After two hours, they tricked the computer for good and the Radiology team jumped into action. The doc pumped me full of contrast, which one of the techs described as a "sticky oil" which, when scanned, highlights the details of my cervical spine. Once they pumped me full of sticky oil, one of the techs got on with tilting me at various angles on the table while another tech shot images on the scope. They tilted me head first and then prone. They tilted me forward for a second time to make sure the contrast reached into the furthest reaches of my upper vertebrae. I didn't object. I only wanted to do this once. They took some other pictures with me on each side and one of my neck and shoulders. Satisfied, they sent me over to the CT room where another tech scanned me. 

When I got back to the recovery room, a new nurse turned on her computer and looked for my chart. "You don't exist," she said. 

Odd, but I was lying right there. A few minutes later she found me.

"Looks like the computer discharged you" 

Of course. 

The nurse got me readmitted and discharged me again, because that was part of her job. 

As my wife Chris drove me back to Cheyenne, a few things occurred to me. It wasn't a bad way to spend five hours. It was 95 hot degrees outside, cool inside. Chris had taken the day off so we spent some quality time together. The staff was kind and patient. It made me wonder if they were this nice to all patients. The nurses admitted that many who come through their doors are very sick and usually older than me. Some of the procedures involve a lot of physical pain. Pain, as always, turns your attention inward and you are not always aware of others feelings. Me, well, I was in a little bit of pain but didn't want to be a pain. So, after lying around two hours waiting for the multimillion-dollar computer system to recognize me, I decided that resistance was futile. I could have told them to forget it and make me another appointment. But I didn't want to come back another day.  

It was very entertaining. The staff gave me a handful of cafeteria food coupons to make up for the delays. I hope I'm not back at that hospital any time soon, not even for chicken-fried steak night.

Next time you survive a heart attack, try to fine-tune the description

What action verb best describes a heart attack?

Most times, the past tense of have serves the purpose. Dad had a heart attack. That's so bland. You can "have" a heart attack, just as you can have a cup of coffee or a bad day. But it doesn't really get to the heart of the matter.  Something happens when you have a heart attack, something profound. The muscle that keeps you human stops working. It is an experience of a lifetime and, often, the last experience, your deathtime. It deserves a better description.

The heart attack should be the subject of the sentence. A heart attack killed father. A heart attack claimed his life. You can add an adverb: A heart attack almost killed father. Most of us survivors are fond of adverbs such as almost or nearly, Our lives depended on those adverbs. You could also stay with the action verbs and say something like this: Dad beat the reaper. Or, if you prefer, "Don't Fear the Reaper" with jangly guitars and cowbell, always more cowbell.

Heart attacks deserve better treatment, language-wise. They define what comes after, whether that be finality or life's new chapter. I was lucky and got the latter. I paid a price for neglecting the telltale signs. I wear an ICD in my chest wall that sends signals to a hospital monitoring station. I remain confident that Russian hackers will never find the frequency. But please alert me if I ever start saying nice things about Donald Trump.

My widowmaker heart attack on Jan. 2, 2013, nearly killed me. I lived. During my year of recovery, I went through rehab and ate right and exercised and continued not smoking (I quit in 1985). Some things I did not do. I did not read and entire novel. I wrote very little, although I blogged a bit about the widowmaker (links here and here). The experience took a piece of my heart, my soul. I never thought I would write fiction again. I told my wife Chris that I would never write another book, not even in retirement. She was having none of that. I started a novel the day after I retired in January 2016. I'm 30,000-some words into it. Hard work, this novel-writing biz. Better suited for a young man. Now I have experience but not the stamina. Life plays mean tricks. It entertains us with surprises.

How did the term "heart attack" get started? The heart does not attack. It protests. Dad ate too many Big Macs and his heart is mad as hell and is not going to take it anymore. Bam -- your heart seizes up like an engine low on life-giving 10W-40. My original diagnosis was Acute Myocardial Infarction accompanied by Congestive Heart Failure. I could also call it a Coronary Thrombosis. These terms aren't nearly as colorful as Heart Attack. That's what I will continue to say. And will continue to find better ways to describe that thing that disrupted but didn't end my life.

I do not believe Sen./Dr. Barrasso when he says he is "passionate about ensuring that patients are able to get the care they need"

Wyomingites call John Barrasso a U.S. Senator.

Before turning to politics, he was Dr. John Barrasso in Casper. An orthopedic surgeon, like the very capable docs in Cheyenne who replaced both of my knees, operations covered by Medicare and my supplemental insurer, CIGNA. I give a lot of credit to CIGNA for its service. I also pay the company more than half of my retirement income to provide necessary coverage for me, my diabetic wife, and my mentally challenged daughter. My knee docs are not in the Senate. Not yet, anyway. They may have noted how much money Barrasso is raking in as as pal of the Koch Brothers and other right-wing funders. And the senator has great hours and plenty of vacation days. He hardly works at all! 

I'm not sure what to call Barrasso. A physician would not demean his profession the way he does. Lately, he's been up to no good in the U.S. Senate, working to deny health care to thousands of Wyomingites. 

So I write letters and postcards. They are cordial but insistent. I do no name calling or cursing. I don't want to get on the Senate's Shit List, which I hear is getting longer by the day.  

My senators write me back. This afternoon I received an e-mail response from Sen. Barrasso. A laugher, if you're into dark humor. Read it and weep or laugh, the choice is yours. You can get your own response, suitable for framing, by writing to Sen. John Barrasso, 307 Dirksen Office Building, Washington, DC, 20510. Get a full list of his mailing addresses and phone numbers in Wyoming by going to http://www.barrasso.senate.gov

Dear Michael,  

Thank you for taking the time to contact me. It is good to hear from you. 

There are serious challenges facing health care in our nation. As a doctor, who practiced in Wyoming for over twenty years, I am passionate about ensuring that patients are able to get the care they need. Right now, Congress is in the middle of an important debate about the future of Obamacare.  

For the past seven years, patients have experienced the impact of this law. The people I talk to in Wyoming tell me they are facing higher premiums and fewer choices. According to the Department of Health and Human Services, premiums in Wyoming are up 107% since 2013. We also have just one single insurance company willing to sell Obamacare policies.  

This law cannot continue in Wyoming or across the country. This is why I voted to repeal Obamacare and will continue to support this effort. Patients need relief from the law’s mandates and taxes that are making health insurance unaffordable for so many families. Importantly, we can do this while still ensuring that people with serious medical conditions continue to have access to insurance coverage.  

The repeal of Obamacare is just the first step. We need to make changes that ultimately lower costs and improve quality of care received by all patients. In particular, this means letting states decide what works best in their local communities. This is especially important so places like Wyoming can meet the needs of residents in our rural communities.  

Michael, thank you for contacting me. I appreciate hearing your thoughts and comments about this important issue. 

John Barrasso, M.D.
United States Senator

Reflections on a new knee

Funny how surgery can throw you for a loop.

Fifteen days ago, I had a knee replaced. Pulled the 1950 chassis into the OR, went to sleep and woke up with a new part. The old knee saw me through 64 years. Not bad for original equipment. I could say that they don't make them like that any more, but that's not true. Blood and bone and sinew continues to be manufactured into humans on a daily basis. Thanks to modern medicine, the old, worn-out stuff can be replaced. Knees, shoulders, hips, heart valves -- all available for the asking and the affording.

I took the long route to replacement. Despite daily pain, I had the left knee scoped the same weekend Hurricane Katrina hit New Orleans. I watched round-the-clock hurricane coverage almost guilt-free. The weather was glorious in Wyoming and I would have felt awful staying inside to immerse myself in tragedy. But I had an excuse. For the next decade, I relied on exercise and Alleve and occasional steroid injections. Finally I got the word from my orthopedic doc. I had four options. I could do nothing, always a popular option for us procrastinators. I could rely on the calming ministrations of Alleve. More injections. Finally, surgery.

This is elective surgery but should not be undertaken lightly, especially if you're a heart patient, as I am. Dr. Shannon sent me to my cardiologist and my family doctor. After a battery of tests, including a stress test that wasn't too stressful, they cleared me for surgery. Meanwhile, I wrecked my car. There was no replacing parts in my Ford Fusion. Totalled. Not something you want to hear about your favorite car or favorite human. So, I got a total car replacement.

Until Jan. 2, 2013, I had been a stranger to hospitals. I was ten years old the last time I was a hospital patient. I was 62 when dragged to the ER with a heart attack. A five-decade hiatus -- not bad. My heart attack and subsequent surgeries made me comfortable with hospitals. I almost look forward to visiting them now.

Almost.

Knee replacement surgery takes less than an hour. The surgeon applies a tourniquet so staunch the blood flow. The experts work fast. Soon I'm in the recovery room wondering what the heck happened. I'm hooked up to oxygen and IV. My left leg was being flexed by a CPM. Must move that new knee -- no rest for the stunned.

So here I am -- 15 days out. The pain is lessening. Dr. Shannon's assistant removed the 32 staples that sealed the incision on April 8. Doctor's orders say I must keep moving and keep recuperating.

OK, doc.

Wearing red -- and happy to have the past two years

Wear Red Day for heart health. 

A new study shows that many people would prefer to die sooner than take a daily pill. From the Atlantic Magazine Online:

In a study published earlier this week in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association, researchers from the University of North Carolina and the University of California, San Francisco, surveyed 1,000 people on what they would be willing to give up to avoid taking a daily pill—one without any cost or side effects—to protect heart health. 

Here’s what people were willing to trade: 

• More than 20 percent said they would pay $1,000 or more; around 3 percent said they’d pay up to $25,000.

• Around 38 percent of respondents said they’d be willing to gamble some risk of immediate death; around 29 percent of the people surveyed said they’d accept a small (lower than 1 percent) risk, while 9 percent of them said they’d accept a one-in-10 chance of immediate death.

• When the question changed from risk of death to certain death, around 30 percent said they would trade at least a week off their lives, and 8 percent were willing to give up a full two years.

Eight percent were willing to give up a full two years?

Yikes. I wonder how I would have answered had I been surveyed three years ago? Would I gamble some dough, risk immediate death or trade a couple of years?

Not sure. Maybe I’d accept a small risk of immediate death (less that 1 percent) or trade at least a week. That is a bit unreal when you haven’t faced death, especially cardiac death. Once you do, well, it becomes all too real.

I experienced a heart attack two years, one month and 18 days ago. I had a pain in my stomach. I saw the doctor but he didn’t know what it was. Two weeks later I was in the ER with congestive heart failure. My life was saved, through little effort on my own. I received a stent at the juncture of my Lateral Anterior Descending artery or LAD. Its nickname is “The Widowmaker.” A few months later, I returned to the hospital for an ICD, a combination defibrillator/pacemaker. In the two weeks that I didn’t get help for my heart, it sustained blood loss and permanent damage. I now take ten pills a day to forestall another heart attack. Is it a pain in the ass? Yes. Do I wish I didn’t have to take them? Yes. But do I want to live two more years? I already have….

Today is #WearRedDay for heart health. I am wearing red. I took my pills this morning. I went to work today and tonight, my wife and I are going to a party to see our friends, many of whom visited me in the hospital two years ago. I am glad I had those two years. I wouldn’t trade them for anything.

If Sen./Dr. Barrasso isn't going to legislate, he can at least medicate at Wyoming health centers hit by sequestration cuts

Sen./Dr. John Barrasso, Sen. Mike Enzi and Rep./Gazillionaire Cynthia Lummis don't have to depend on the Cheyenne Health and Wellness Center on Fox Farm Road for medical and dental care. They get free care courtesy of the U.S. taxpayer. But hundreds of other southeast Wyoming residents are not as fortunate. These low-income individuals will be impacted by the sequestration cuts soon to hit the Cheyenne center and a similar one in Casper, Community Health Center of Central Wyoming. Since both Enzi and Lummis call Cheyenne home during their many vacay days, and Barrasso is from Casper, perhaps they could look in on some of the people who will be affected by their dilly-dallying and political gamesmanship. Better yet, maybe Dr. Barrasso could take some time out of his lackadaisical schedule to minister to those Casper folks needing sutures or prescriptions. If he isn't going to legislate, he could at least medicate. Read about the cuts in today's Casper Star-Trib.

Making sure that my premiums are spent on health care and not solid-gold Hummers for insurance execs

Pres. Obama takes Sen. Barrasso to the woodshed today at Health Care Summit

Something weird happens to physicians when they're elected to the U.S. Senate. Especially Republican physicians.

I thought Sen. Barrasso's remarks at today's Health Care Summit would be just as thoughtful and as succinct as Sen. Enzi's. They are both conservative Republicans from Wyoming -- Barrasso from Casper and Enzi from Gillette. They have both been in lockstep opposing Pres. Obama's health care reform ideas. As U.S. Senators, they both dwell in a higher income bracket than you and me.

But there are differences. And these may be issues of class and income bracket, possibly even empathy.

Anyway, Sen./Dr. Barrasso said some bizarre things today.

More from Washington Post transcripts (in entirety):

MCCONNELL: Yes, Mr. President, Dr. John Barrasso is going to make our opening statement...

OBAMA: OK.

MCCONNELL: ... on (inaudible).

OBAMA: And then I will call Henry Waxman, and we'll just go back and forth.

BARRASSO: Thank you very much.

OBAMA: And because we are short on time, let's keep our remarks relatively brief.

BARRASSO: Thank you very much, Mr. President.

For people who don't know me, I practiced medicine in Casper, Wyoming for 25 years as an orthopedic surgeon, taking care of families in Wyoming. I've been chief of staff of the largest hospital in our state. My wife is a breast cancer survivor. Bobbi's been through three operations, a couple of bouts of chemotherapy. We've seen this from all the different sides of -- of care.

And this discussion needs to be about all Americans because everyone is affected, not just people that don't have insurance. And I've had dozens and dozens of visits to senior centers and town hall meetings and visited at -- at service clubs. And if you go to any community in America, and you ask the question, do you believe that this bill up here, that this bill will, if it becomes law -- do you believe you will pay more for your health care, you personally, every hand goes up.

And then you say, do you believe, if this bill becomes law, overall health care and the spending -- and spending in the country will go up, every hand goes up.

And then you ask the most personal question of all, do you believe, if this bill becomes law, the quality of your own personal care will get worse? Every hand goes up.

And most worried of all are the seniors, when you go to the senior centers, because they know there's going to be $500 billion taken away from those who depend upon Medicare for their health care. And it's not just Medicare Advantage. It's hospitals; it's the doctors; it's the nursing homes; it's home health, which is a lifeline for people that are home alone; hospice, for people in their final days of life.

That's all going to be cut. That's why the seniors are most concerned. And even the White House's own actuary says, if this goes into play, one in five hospitals, one in five nursing homes will be operating at a loss in 10 years. That's what we're looking at.

Now, for 25 years practicing medicine, I never asked anybody if they were a Republican or a Democratic or an independent and asked if they had insurance or not. I took care of everybody. And many, many doctors -- and I know Dr. Coburn, Dr. Boustany -- do that. We take care of everyone, regardless of ability to pay. Doctors work long hours. Nurses work long hours.

And, Mr. President, when you say, with catastrophic plans, they don't go for care until later, I say sometimes the people with catastrophic plans are the people that are best consumers of health care, in using -- the way they use their health care dollars.

Because a lot of people come in and say, you know, my knee hurts; maybe I should get an MRI. They say -- and then they say, "Will my insurance cover it?" That's the first question.

And if I say yes, then they say, "OK, let's do it." If I say no, then they say, "Well, what is it going to cost?"

And "What's it cost?" ought to be the first question. And that's why, sometimes, people with catastrophic -- catastrophic health plans ask the best questions, shop around, are the best consumers of health care.

But to put 15 million more people on Medicaid, a program where many doctors in the country do not see them, as Grassley said -- you know, you say, how are going to help those folks?

And, Mr. President, you know, when I talk to doctors, I say, I have a way; put all the doctors who take care of Medicaid patients under the Federal Torts Claims Act. That will help them, because they're not getting paid enough to see the patients. But if their Medicare -- if they accept those patients and then their liability insurance is covered under the Federal Tort Claims Act, I think you have a lot more participation in that program.

I do believe we have the best health care system in the world. That's why the premier of one of the Canadian provinces came here just last week to have his heart operated on. He said it's my heart; it's my life; I want to go where it's the best, and he came to the United States.

It's where a member of parliament, a Canadian member of parliament with cancer came to the United States for their care. They all have coverage there, but they want is care. So coverage does not equal care.

What we heard from Senator Conrad is actually -- is also right. Half of all the money we spend in this country on health care is on just 5 percent of the people. Those are people, for the most part, that eat too much, exercise too little and smoke. And as a result, we need to focus on those people.

So the focus ought to be on the best possible care. People are happy with the quality of care they get and the availability, but they sure don't like the affordability because it's not affordable.

And, you know, Mr. President, the first week in medical school, we got our stethoscopes, and the professor of cardiology, who just died this past year -- he said this is to listen. This is to listen to your patients, listen to their heart, listen to their lungs. But it's a constant reminder to listen to them, listen to what they are telling you. And it means to listen to the other people in the room.

If you're seeing a child, listen to what the mother is saying. If you're with an elderly person, listen to what their -- their adult child is saying. And it's a constant reminder to listen.

And I have great concerns that people around this table are not listening to the American people and are fearful of the consequences of this large bill, which is why only one in three people of American support what is being proposed here. And that's why so many people, Mr. President, are saying it's time to start over.

OBAMA: The -- I mean, let me just -- there's one thing I've got to -- there are a number of issues, as usually, that I've got significant difference with.

I just am curious. Would you be satisfied if every member of Congress just had catastrophic care? Do you think we'd be better health care purchasers?

I mean, do you think -- is that a change that we should make?

BARRASSO: Yes, I think -- I think, actually, we would. We'd really focus on it. You'd have more, as you'd say, skin in the game...

OBAMA: Because...

BARRASSO: ... and especially if they had a savings account...

(CROSSTALK)

BARRASSO: ... a health savings account. They could put their money into that and they'd be spending the money out of that.

OBAMA: Would you feel the same way if you were making $40,000 or you had -- that was your income?

Because that's the reality for a lot of folks. I mean, it is very important, when you say to listen, to listen to that farmer that Tom mentioned in Iowa, to listen to the folks that we get letters from.

Because the truth of the matter, John, is they're not premiers of any place. They're not sultans from wherever. They don't fly in to Mayo and suddenly, you know, decide they're going to spend a couple million on the absolute best health care. They're folks who are left out.

OBAMA: And this notion somehow that for them the system was working and that if they just ate a little better and were better health care consumers they could manage is just not the case. The vast majority of these 27 million or 30 million people that we're talking about, they work, every day. Some of them work two jobs. But if they're working for a small business they can't get health care. If they are self-employed, they can't get health care.

And you know what? It is a scary proposition for them.

And so we can debate whether or not we can afford to help them, but we shouldn't pretend somehow that they don't need help. I get too many letters saying they need help.

And so I want to go to...

BARRASSO: Mr. President, having a high deductible plan and a health savings account is an option for members of Congress and federal employees...

OBAMA: That's right, because members of Congress get paid $176,000 a year.

(CROSSTALK)

BARRASSO: ... 16,000 -- 16,000 employees take advantage of that.

OBAMA: Because they -- because members of Congress...

(CROSSTALK)

BARRASSO: It's the same plan that the -- that the park rangers get...

OBAMA: John...

BARRASSO: ... in Yellowstone National Park.

OBAMA: John, members of Congress are in the top income brackets of the country, and health savings accounts I think can be a useful tool, but every study has shown that the people who use them are folks who've got a lot of disposable income. And the people that we're talking about don't.

So... (CROSSTALK)

As always, CROSSTALK gets the last word...

Now we know what Sen. Barrasso believes. If all of us middle class Americans just had catastrophic coverage -- better yet, no insurance at all --- we'd all be better shoppers of health care.

Diabetics in rural Wyoming on their own

From an AP story (via Billings Gazette):

The Wyoming Department of Health reports that the number of Wyoming adults with diabetes more than doubled in the past 13 years.

The department said Thursday that more than 7 percent of Wyoming adults have been diagnosed with diabetes, up from 3 percent in 1997.

Diabetes prevention and control manager Star Morrison said the disease is the sixth-leading cause of death in the state.

From July 2006 to June 2007, diabetes led to 615 Wyoming hospitalizations costing $7.5 million, according to the department.

Washakie County has the highest rate of adult diabetes at 9.3 percent. Teton County has the lowest rate at 2.4 percent.

Morrison said the prevalence of diabetes is expected to increase as the state's population ages.

Let's see. Wyoming's population is aging. The diabetes rate is climbing. Our family knows something about diabetes. Chris was diagnosed with Type II diabetes 17 years ago when she was pregnant with our daughter. She sees an endocrinologist in Fort Collins across the border in Colorado. Each month, she goes to her diabetes educators (also in Fort Collins). She is careful about what she eats. She monitors her blood sugar. Our local pharmacist knows her and her prescriptions. In short -- it takes a team to manage diabetes. Family physician, specialist, nurses, educators, pharmacists.

Last year, the Wyoming Office of Rural Health release a report that showed 13 of the state's 23 counties had a shortage of primary-care doctors.

I posted this on the blog Dec. 26:

Washakie County in the Big Horn Basin hasn't a single primary care practitioner for its 8,000-some residents. No OB/GYN docs for healthy baby checkups. No pediatricians for when Johnny pokes his eye with a stick. No nurse practitioner to find out whether you have the flu or just a bad cold.

Or diabetes.

Star Morrison at the Wyoming Department of Health has her job cut out for her. "Aging" is just one factor. Lack of proper medical care in rural areas is another.

Will national healthcare reform address these issues? Perhaps we should ask Senator and physician John Barrasso. He and his Republican cohorts have done their best to derail healthcare reform. Why? Don't he and Sen. Enzi and Rep. Lummis have any empathy for the rural residents of this state? They say they do. But saying and doing are two different things.

Barrasso practiced medicine and politics in Casper, Wyoming's second largest city. Enzi lived in Gillette, booming coal capital of the nation. Lummis is from Cheyenne, the largest city in the state and the capital.

All of these places have hospitals. All have family physicians and specialists. Sure, some of us with insurance still go out of state for better care. We have that option.

But what are rural residents to do?

Suffer, I guess. Live with the fact that if they get diabetes, they're on their own.

New Repub tactic for luring physicians to Wyoming -- ban same-sex marriage

Several Sundays ago, local right-winger Richard Wall surprised me with some common sense in a Wyoming Tribune-Eagle guest column.

He urged increased efforts to recruit more physicians in sub-specialties to move to Wyoming. He was especially insistent that we don't have enough pediatricians who address the medical and mental health needs of children and teens.

That's a bandwagon I've been riding for awhile. More than once I've pointed out that Wyoming lacks child psychiatrists. When I say "lacks," I mean that literally -- there is not one child psychiatrist in the entire state.

Huzzah for Mr. Wall! Now we have common cause on a very important issue.

But my joyfullness was short-lived. In the very same column, Mr. Wall leaped on his favorite bandwagon -- the evils of homosexuality. He wants the Wyoming Legislature to legislate against same-sex marriage. It's not same-sex marriage that irks him. It's the fact that married gays and lesbians can move into Wyoming and expect the Equality State to live up to its name.

During two of the past three legislative sessions, bills were introduced to ban approval of same-sex marriages performed in other states. Both times, the legislation was killed by outspoken Republicans who obviously take seriously our "Equality State" motto. Since our Legislature is heavily Republican, it's easy to pass any bill if all Repubs hop on board. If some hop off, well...

Read details about last year's anti-gay bill at http://hummingbirdminds.blogspot.com/2009/01/wyoming-legislators-confront-same-sex.html. At the time, I noticed that one of the bill's backers was the Colorado Springs-based Focus on the Family, the same equality-minded entity that brings you today's Super Bowl ad that aims to demonize every woman who's had an abortion -- or even thought about it.

Also find info about the 2007 bill at http://hummingbirdminds.blogspot.com/2007/03/zwonitzer-takes-stand-for-basic.html

As I look at this year's docket on the Legislature's web site, I find nothing about gay marriage. That's not unusual, as this is a 20-day budget session and consideration of new bills is limited (although you wouldn't know it after looking at the long list).

Maybe by the time 2011 rolls around, the legislative loonies who sponsor these bills will have given up. By then, "Don't Ask Don't Tell" will be a thing of the past in the U.S. military and Wheatland, Wyoming, will have re-installed the "No Place for Hate" banners.

There is a dark cloud on the horizon, equality-wise. In his column, Mr. Wall pledged his support to the 2010 gubernatorial campaign of right-winger Repub Ron Micheli. Mr. Micheli is a rancher from Fort Bridger who spent most of his 16 years in the state legislature towing the fundie line on abortion and gay rights. He's also on the 10th amendment bandwagon (so many bandwagons these days) which puts him in the same category as the Tea Partiers who were whooping it up with Sarah Palin last night in Nashville. Of course, this emphasis on the 10th amendment, which most of us never paid attention to until recently, is also a newly-discovered cause of our Democratic Governor Dave Freudenthal.

Let me get back to Mr. Wall. I still support his call for more and better-educated physicians in Wyoming. I just wonder how that recruitment will go when our Equality State slogan has been so tarnished by the likes of the hate-filled wingnuts among us. Yes, some young physicians are conservatives and will prefer the ambience of high plains small towns such as Wheatland.

But most physicians come from cities (even the majority of Westerners now live in statistical metropolitan areas) and are educated in cities and go to school with ethnic minorities and might even be minorities themselves. They may even be LGBT! Specialists in particular seem to gravitate to city life. Cities boast an array of schools and soccer fields and music classes and theatres and shopping. Pay is better, especially for docs.

Rural living is a hard sell anyway. Add to that an unwelcoming attitude toward people who may be a little different -- you really have a problem.

More on shortage of primary care docs

Quote from "Wyoming on the Block" by Ben Cannon in the Dec. 22 Planet Jackson Hole:

Dr. Brent Blue, a Teton District Board of Health member, said the board has taken no position on the proposed legislation, but said the current version could benefit Wyoming by drawing more primary care doctors -- pediatricians, family practitioners -- in a state with “too many specialists.”

For more on shortage of primary care professionals in Wyoming, go to my previous post at http://hummingbirdminds.blogspot.com/2009/12/med-licenses-up-full-time-doctors-down.html.

WYO med licenses up, full-time docs down

Here's the good news:

Wyoming granted a record number of medical licences in 2009...

And now, of course, the bad news

...but fewer newly licensed doctors are setting up full-time practices in the state, newly released figures show.

How can this be? Reporter Joshua Wolfson at the Casper Star-Trib explains it all for you

Of the 301 doctors who received licenses so far this year, only 18 percent reported working full-time in Wyoming, according to statistics from the state Board of Medicine. Industry experts say the figures reflect growth in telemedicine and the number of outside physicians who come to the state to fill gaps in coverage.

The fact that fewer new doctors are starting full-time practices in Wyoming concerns Dr. James Anderson, a Casper surgeon who serves as the board's president. A shortage of primary-care doctors creates the potential for error as patients are treated by different physicians each time they seek medical help.

"It increases the risk, having multiple people taking care of you, without some sort of electronic medical records to know what's going on," Anderson said.

The Wyoming Office of Rural Health release a report this year that showed 13 of the state's 23 counties had a shortage of primary-care doctors. It's shocking to hear that the majority of our counties don't have enough family doctors. Are these 13 counties the most rural?

The WORH June 2009 survey [http://www.health.wyo.gov/rfhd/rural/index.html] carries a few surprises. First of all, primary care physicians aren't just family practice and general practice docs. The WORH definition includes doctors practicing internal medicine, pediatrics and OB/GYN. It also includes non-physicians such as physician assistants, nurse practitioners and nurse midwives. So, even if a rural county has no docs, it might at least have a nurse-midwife around the deliver a bay or two.

Washakie County in the Big Horn Basin hasn't a single primary care practitioner for its 8,000-some residents. No OB/GYN docs for healthy baby checkups. No pediatricians for when Johnny pokes his eye with a stick. No nurse practitioner to find out whether you have the flu or just a bad cold. Washakie County includes Worland, home to the new Washakie Museum (grand opening summer 2010), a sugar beet processing plant (major client: Pepsi) and a great cafe, the Brass Plum on Big Horn Avenue (great sandwiches and homemade potato chips)

I guess that Worland patients have to travel north to Lovell in Big Horn County which has two primary care people. They could go south to Hot Springs County, which actually shows a surplus of docs. Must be those healing hot springs' waters that draw the docs. Rounding out the counties in the Basin is Park, home to Cody and its small medical center adjacent to the much larger Buffalo Bill Historical Center, and Powell and its community college. But Park County is also showing a shortage primary care medicos. Most Wyomingites know that residents of the Big Horn Basin make frequent trips to Billings with its two hospitals and many docs. Bozeman, too. Over the Big Horn Mountains is the V.A. in Sheridan. Casper and its hospital isn't far either. Ditto Riverton in Fremont County.

But preventive medicine is very difficult when you have no family docs in the vicinity.

Rural areas all over the West have similar problems. Well-educated docs and their families aren't particularly attuned to remote small towns and their lack of amenities. Some of those are frivolous (what, no double-shot caramel mochiattos?) to important -- education, arts, hospitals and recreation. Yes, some pediatricians and nurse practitioners may love slow-paced and family-friendly Worland. But others may not like the fact they must drive 100 miles for shopping and surgery and symphony performances. Why not live in Billings if you go there every weekend?

I am not a small-town person. In my adult life, Cheyenne (pop. 55,000) is the smallest place in which I wish to dwell. Laramie County is the most populous in the state and it boasts the most primary care practitioners at 56 and that's not counting the specialists who fixed my knee and psychiatrists who regularly inspect my head for cobwebs and spiders. If I can't get the right specialist here, I can always cruise down I-25 to Fort Collins or Loveland or Greeley or Denver. On Tuesday, our family will take a little trip to Fort Collins to see my wife's endocrinologist for diabetes care. It will take us 45 minutes door-to-door unless we get snow and then it may take an hour or we may not get there at all so we'll have to reschedule. Chris wishes that there was an endocrinologist she liked in Cheyenne -- but there is not. So she doc-shopped and found one.

We have a choice because we have insurance and proximity. Worland citizens don't have proximity. What happens when they're also uninsured?

In the CST article, Dr. Anderson outlines some obvious problems

As challenges to addressing the shortage, the report noted rural doctors typically work longer hours and have lower incomes than their urban counterparts. They generally also receive lower Medicare and Medicaid reimbursements rates.

Wyoming's laws concerning medical liability also serve as a disincentive to doctors, Anderson said.

"That's going to drop us down on the list, being one of the states with minimal tort reform, basically none," he said.

The number of doctors being licensed in Wyoming rose 26 percent this year over 2008. That's attributable to a streamlined licensing processes put in place by the state Legislature earlier this year, Anderson explained.

There are signs the increase in doctors seeking Wyoming licenses may continue into 2010. More than 100 physicians have pending applications with the medical board.

The increase is having a positive effect, said Kevin Bohnenblust, the board's executive director. Traditionally, Wyoming's small population has made it difficult to support medical specialists. The new figures show more specialist are practicing in the state, albeit on a temporary basis. The state still needs to recruit more doctors, Bohnenblust said.

"Things are moving a lot in the right direction because we are getting more physicians who want to be licensed to provide care to Wyoming people," he said.
"That's a great thing. The trick is, we can't let up."

So, specialists are practicing here but living elsewhere. That's great when you're a local doc seeking a consultation with a neurosurgeon in L.A. or heart specialist in Houston. Dr. Anderson even mentioned a doc in Australia who recently received a Wyoming license so he could read X-rays remotely. And who knows how many of those newly-licensed docs are doing the same thing in India or Indonesia?

I'm obviously not a physician. I'm just a poor schlub in Cheyenne who needs the occasional check-up or operation. I'm going to have an easier time accessing healthcare than another 59-year-old who lives in Worland. There's something wrong with that. It's possible that technology and even the new healthcare reform bill may improve the situation. It's also possible that the current economic crisis that's hit the cities of the coasts may cause some docs to reconsider life in bucolic Wyoming. The "local" trend -- local eating, local working, local artmaking --may also boost the number of small-town healthcare providers.

Meanwhile, residents of Sweetwater, Carbon, Washakie, Big Horn, Park, Uinta, Albany, Converse, Lincoln, Weston, Crook, Niobrara and Platte counties will keep on logging those miles on visits to the family doc, many of them located across the Wyoming border in Billings, Rapid City, Fort Collins, Salt Lake City and Idaho Falls. That's not only tragic for efficient healthcare. It also costs Wyoming's economy. On Tuesday, we're going to Chris's specialist in Fort Collins and eating lunch out and Chris is having her Saturn serviced and my daughter Annie is spending her Christmas cash in Old Town. I may visit my favorite place in Old Town, Ben & Jerry's, for an infusion of Chunky Monkey.

Economic development for Colorado but not for Wyoming.

CST reporter Joshua Wolfson has a blog at tribtown.trib.com/JoshuaWolfson/blog