Ebola in the USA

This flyer was sent home with the kids from school today. Apparently Ebola in the USA is different to elsewhere! At least that's what the flyer would imply - why else include the words "in the U.S"?

 

And then a friend posted this on Facebook:

Rabies

Rabies is not something I had to think about about when I was growing up in the UK. With the UK being an island with very strict quarantine laws, rabies was something that was basically non-existent. Although I was aware that rabies exists in North America, I hadn't particularly thought about it much here either. However, twice this spring my son has brought warnings home from school about rabies. Despite the fact that the warnings admit that it is very rare for anyone to die from rabies, we have been encouraged to put the following notice on our fridges:

Serious as rabies can be, with the very mild winter we have had this year, I think they are sending notices home about the wrong thing. The local media has been full of information about how it is likely to be a record tick season because the warm winter didn't kill off the ticks the way it usually does. Ticks carry Lyme disease, which is really quite unpleasant if not treated promptly. Another pest that is more likely to affect people this year is the tiger mosquito. Native to Asia, the tiger mosquito was first found in the USA in 1985.  It's smaller than most mosquitoes, but its bite causes more irritation than most and, unlike the mosquitoes we are used to around here, it dines throughout the day, not just at night. The tiger mosquito is capable of transmitting a variety of diseases including the potentially fatal West Nile virus.

Somehow, I think people are far more likely to be bitten by a mosquito or a tick than by a rabid bat or raccoon! It's also more likely that you would seek medical help if bitten by a raccoon or a bat, so, nasty as rabies is, to my mind the tick and the mosquito are significantly more dangerous.

Score one for the US medical system

UK expats often have a lot to say about the differences between the National Health Service and the lack of a national health service here in the US. Although there are many criticisms to make of the NHS, at least you know you won't go bankrupt in the UK because you need medical treatment. I'm lucky in that my husband's employers are Europeans and they have made it a priority to make sure their employees have decent health insurance.

I discovered recently that the American system has a small advantage over the NHS, that I have never heard anyone mention before. It is the idea that a patient's medical records belong to the patient and that the patient is entitled to copies of them. I've had a couple of MRIs done recently (actually four) and the staff at the MRI center are quite happy to give me a copy of the MRI CD as soon as the notes regarding the findings have been transcribed - so I can actually know what was found (or not) BEFORE my appointment with my doctor to discuss the results. My sister commented in a recent email to me "in the UK doctors are really secretive about results of tests - they seem to think that a little knowledge can be very dangerous."

I recently asked for a referral to a specialist, and he asked for copies of my records from the other doctors I had already seen, including my opthalmologist, to be faxed or fedexed to him before he would even make an appointment with me. I assumed the other doctors would send the notes directly to the specialist, but in almost every case their office staff told me I could pick the records up myself. One of the doctors I've seen recently said that he always writes his patient notes with the expectation that at some point the patient will see them. One specialist sent me a copy of the report that he sent to my primary care physician/GP without me even asking for it. Another dictated the notes before I left the room "so you'll know what I'm telling your primary care doc. and you have a chance to correct me if I make a mistake."

It was interesting to see what gets included in the reports.There were entertaining comments such as:

"Denies recent illness. Denies sore throat, cough or nasal congestion."
"well developed and nourished; appropriately groomed; in no apparent distress."
"Communicates appropriately for age"  

Then there's all the detail about my health of course, most of it understandable, but I did have to look some words up: apparently I have no diploplia, dysdiadochokinesia, ataxia or dysmetria - and that's a good thing! If it sounds like I've had a lot of doctor's appointments recently, yes, I have and there are more to come. Despite the way it may sound, I do not have a life-threatening condition and am not even feeling ill. I do have an immense gratitude to my husband's employer for not going with a high deductible health insurance plan, and I have a cool new photo I can use for my Facebook profile for Halloween!

Never mind the London buses . . .

. . . check out this ambulance!



I believe bikes are used in a few towns as rapid response vehicles because they can get through the traffic faster than a car.

Bugs and meds

I didn't miss the US on our recent trip to the UK, except when we needed an open pharmacy at 8 on a Sunday evening when my son had a strong allergic reaction to the local biting insects and began to look very puffy. My mother was sure the 24 hour Tescos would be open, but '24 hours' means 10 a.m. till 4 p.m. on Sundays. Should you ever be in a similar situation, do not bother trying to find out which is the 'duty chemist' in town. They won't be open either, as their hours are likely to be something like 11 a.m. till 1 p.m. According to Late Night Chemist, Boots claims that they now have a 24 hour pharmacy within a thirty mile drive of most of the UK population, but we had a hospital much closer than that which was a better bet. We were lucky enough that we knew all we needed for DS was over-the-counter antihistamines. The hospital has a truly 24 hour pharmacy which sells OTC meds, and we got in and out fast enough that we weren't even charged the 2 pound parking fee and didn't have to deal with anyone asking us for either NHS cards or (worse) credit cards!

Make sure you know the generic name for any OTC meds you may need when travelling. We wanted Claritin - and found Clarityn was the same thing - loratadine. I would be wary however that similar brand names might not always mean similar products, and sometimes the names are so different that telling the pharmacist what you want will not immediately get you what you need.

Of course, we should have had some loratadine with us. I had my asthma inhaler and never needed it, though had I forgotten it I would have certainly needed it! I was glad I'd remembered the imodium when I was not well on our return flight - especially as we ended up sitting in the plane on the ground at Heathrow for 2 hours after our scheduled departure time! Although I've had a flight attendant offer me meds for an upset stomach in the past, I learned from that experience that the imodium pills are so tiny it's always worth having some with you when you travel. Loratadine now gets added to my packing list, but who knew that bug repellent with DEET would have been a good idea for a trip to the UK? Aiee - not that it would have done anything to ward off the wasps that were everywhere this year . . .

Wordless Wednesday

Of EOBs, lying dentists and cheap insurance companies

We never used to hear from our health insurance company, but now they send me mail regularly. Apparently it's now state law that every time they refuse to pay 100% of what the doc bills them for, they have to send an Explanation of Benefits (EOB) to me so that I can see what the original amount billed was versus how much they actually paid. When the health insurance does that I simply file the paper in the trash (after recovering from being gobsmacked that the doc charged $132 for putting some freezy stuff on DS's verruca/plantar wart - a 10 second item that suddenly turned into outpatient surgery on the bill!) However, when the dental insurance company sends me an EOB, I pay closer attention because in that case I have to pay the difference between the amount originally billed and what the insurance paid :-(

I lived for years in the US without dental insurance. Many employers simply don't offer it, or it is so expensive it's not worth it. When I finally had a job that offered dental insurance and decided to sign us up for it, I was advised to look for a dentist that was already cooperating with that insurance plan, or to find one who was prepared to do so. If we go to a 'plan dentist', routine visits are covered 100%. If we go to a non-plan dentist, routine visits are covered 100%. So what's the difference? Either way, the insurance reimburses the dentist what they believe to be reasonable rates for the service. Unfortunately, that is usually significantly less than the dentist actually charges. (Hmm - can you spell NHS?) If you see a plan dentist, they have agreed not to bill you for the difference. A non-plan dentist, on the other hand will bill you for whatever they don't get from the insurance company. And if you need any treatment other than routine checkups and cleanings, the non-plan dentist's work is only partially covered.

My dentist back then would not sign up with the insurance company we had because their reimbursement rates are too low. (Just like the dentist I used to see in the UK, who no longer does any NHS work!) I continued to go there because I liked the dentist. I called once to make an appointment because I had a lump on the inside of my cheek. Although usually it takes months to get appointments, the dentist agreed to see me the same day. In fact he gave me the last appointment of the day - at 8 o'clock in the evening! I was there until after 9 o'clock even though it turned out to be a minor problem that the dentist was able to resolve quite easily. When he told me what the cost was, I almost fainted! As he was a non-plan dentist, I would be responsible for 50% of the charge. I pointed out that had I gone to see my doctor instead and been referred to an oral surgeon, it would have cost me a lot less. His solution: to bill the insurance company for a more involved procedure, let me make just the $10 copay I would have made to my doctor, and so long as the insurance company paid him a specific dollar amount he guaranteed he would not bill me for the difference! Although I was grateful, I was really rather taken aback that he was so quick to offer to lie!

We are currently receiving mail on a regular basis from both our medical and dental insurance companies. The children's routine dental care is covered by our medical insurance, and fillings and so on are covered (at least partially) by the dental insurance. Right now the two companies are arguing about who is the 'primary' insurer, and who's going to pay what. Fortunately, before I got too worked up about it, I noticed that the letters I've been getting are actually only cc'd to me, and it is up to the dentist's office to sort it all out. I suppose that's part of what their insane charges are supposed to cover in the first place so I'm going to let them earn their money!

When it comes time to deal with the orthodontist I'm sure it'll be easier. That's because the coverage for orthodonture is, and probably always will be, simple to calculate no matter which dentist we see - ZERO!

BTW, unless something remarkable happens this year to inspire me, you'll have to consider this my Halloween post, as I've already blogged about Halloween here, here and here.

Chocolate in my cupboard

Yes, there is too much chocolate in my house. In addition to all the chocolate in the photo in my last post, there is a ten POUND bar of chocolate in the basement . . . The good news (for my hips) is that that very large bar of chocolate, which was a present from some relatives at least 3 years ago is still untouched. Well, it's not dark chocolate, so what's the point? You'll notice that all the chocolate on 'my' shelves in the cupboard is dark chocolate. (The top shelf is DH's and I truly would not dream of taking any of his chocolate. The shelf in the other cupboard with the chips/crisps is another matter!)

The bad news is that since we got married I have put on just over 30 pounds. When I got pregnant with DS, I weighed 5 pounds more than I do now. However, this time last year (when I hated my job and was on antidepressants to make it through each day) I weighed 20 pounds less than I do now. I could blame my weight gain on DH's wonderful cooking, but it's simply a case of too many calories and too little exercise. When I was in my twenties I worked at a boarding school where I was actually paid to do an hour's exercise every day!

Much as I would hate to be working the kind of hours I put in back then, the idea of being paid, indeed being required, to exercise is rather nice. It seems so hard now with a husband and kids and a full-time job to find time to work out. I specifically remember running five miles one Friday afternoon with the kids (which for me was a very long run) and deciding I wasn't done yet, so I headed off to an hour-long Jazzercize class. I was very aware of the effect it had not only on my weight, but also on my health. My cholesterol dropped from 350 to 240 without medication, I was much less moody, and I had no trouble at all keeping my weight down. For a very brief period I was an American size 5, but fortunately for me my love of food outweighed my love of exercise as a size 5 is not a healthy size for me to be.

I thought I was being so American back then, so conscious of my fitness and my weight. I went to an aerobics class when I was back in the UK and was not impressed - they actually stood still between the songs, whereas in Jazzercize we never stopped moving. Now I'm the other kind of American - the overweight kind :-(

I made a small move in the right direction last weekend - I bought a bike. I wouldn't ride my bike on the roads around here, but we have a nice park nearby where I could ride my bike with the kids and there are some rail trails not too far away too. DH has a bike rack for his car, but I may need to get one for mine too. Unfortunately that will entail getting a towing hitch installed and, having just bought the bike, my budget is shot for now!


I also need to make more use of my YMCA membership than just walking around in the small, warm, pool when we take the kids swimming on a Sunday morning. DD had a swimming class last Saturday and I swam in the lane next to her. After 4 lengths of the pool I was out of breath and feeling, quite frankly, knackered. I made myself keep going though, figuring that so long as I was moving it was better than sitting on the side of the pool watching her. By the time her lesson was over, I was actually sorry to get out. Unfortunately, that was her last class until the fall and without the incentive of swimming alongside her during class I probably won't swim very much over the summer.

I 'only' have 30 or 35 pounds to lose. Having been reading some other blogs recently where people are documenting their efforts to lose over 100 it made me realize that if they can do that (and many have, and kept it off) then surely I can lose a mere 30?! Thanks to bloggers like Sharon for motivating me to get started again - now I have to get on with it.

Wordless Wednesday - daily meds

Mad cows

I'm not allowed to give blood here in the United States because, despite being resident in the US for so long, I have spent long enough in the UK since 1980 that the health authorities worry that I may be carrying Mad Cow disease. A sensible precaution really, given that it is not something that they can test for.

I suppose I should be reassured by the fact that there is a far lower incidence of CJD in the USA than in the UK, but today's news of a beef recall makes me wonder. How can they be sure that the beef supply in the United States really is free of mad cow disease when quite clearly there are meatpackers who ignore potential symptoms of BSE in the animals they are slaughtering? I know there are supposedly 'other safeguards' in place - but who knows if those are being ignored too? I'm not a conspiracy theorist, but this will certainly strengthen the argument of those who think BSE is more prevalent in the US than the USDA would like us to think. I'm just glad that I only eat beef once or twice a year, when our friend Theo makes his wonderfully yummy teriyaki beef.