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New Dueling prognoses
Pessimist: The glass is half empty.
Optimist: The glass is half full.
Engineer: The glass is twice as big as it needs to be.

We returned Wednesday from a lightning trip to the Southland, where we lingered just long enough for Lina to have her “staples” removed (she was rather dreading the procedure, which proved in the event, she reports, no more painful than eyebrow-plucking—I wouldn’t know), her fifth and presumably penultimate dose of chemo, and followup consultations with young Dr. P, her oncologist, and old(er) Dr. M, her surgeon. The two men had discernibly and interestingly different takes on the patient’s status.

The operation a month ago went, as previously reported, very well. Once the surgical team opened her up, they could see that the foe had been dealt a thorough beat-down in previous months by the forces of modern chemistry, and that of the growths formerly spreading their tentacles along the peritoneum there was barely a residue: “We could see where the tumors were, but no trace of where they are,” as Dr. M put it at the time. All to the good. Liver, lungs and gastrointestinal tract, at one time occasioning various levels of concern, proved clean as a whistle, as three whistles. The entire reproductive apparatus was extracted, along with a few lymph nodes, and sent to the lab for analysis. It is reported that the cancer was uterine in origin (better news, apparently, than had the ovaries been the seedbed) and that the lymph nodes were clean (excellent news, because the lymphatic system typically serves the forces of the disease as a kind of Ho Chi Minh trail, a reference that will be lost on some of our younger readers). So the news, as previously conveyed from North Hollywood, was all to the good, and Lina was beginning to describe herself as “cancer free.”

“Not so fast,” (figuratively) said apologetic Dr. P on Monday in the course of his consultation. He reminded Lina that he’d said all along that the objective of the treatment was to send her into remission and delay the inevitable return of the disease for as long as possible. He outlined a programme of quarterly bloodwork and MRI scans to monitor her status. As I’ve previously had occasion to observe, the guy has a good “bedside manner,” for all that he looks like a college sophomore, and I’ve always appreciated that he’s never attempted to sugarcoat the situation. Still, Lina left the meeting feeling a bit deflated.

Then, Tuesday, for staples, chemo and a chinwag with Dr. M. It bears mentioning here that when Lina first brought up the possibility of incorporating HIPEC (interesting aside: my old freshman roomie from 1970, who went on to make his living as a medical radiologist at the University of Colorado, was the first to suggest that we look into “hyperthermic” therapies), Dr. P was lukewarm, heh-heh. “It’s gone in and out of medical fashion,” he said. “Lately it’s out.” Enter Dr. M, who aligns himself with a dissident faction of the medical establishment, believing that HIPEC has up until now not been deployed effectively: generally it’s used as a last-ditch delaying tactic against the final onslaught once remission lapses. Nein, says the Doc, you want to hit it early, not wait until the Red Army is shelling Berlin. HIPEC delivers the same cancer-thrashing chemicals that are administered in conventional therapy, but cuts the circulatory system, as intermediary, out of the action and takes the fight directly to the foe in conjunction with heat (109°F), and cancer hates heat. The idea, if I may be permitted again to switch martial metaphors, is not to permit the Taliban to retire to its mountain redoubts to regroup, but rather to bathe all the affected surfaces with scalding poison and take out any stragglers before they can go forth and multiply. His take on Dr. P’s gloomy prognosis was in the way of a spirited dissent, in effect—I am of course taking some dramatic liberties here, not having been present for the actual consultation—“Who you gonna trust, some snotnosed punk fresh outta residency who’s merely like, felt you up, or the ol’ trouper here, who has got up close and personal with more abdominal cavities’n you could shake a scalpel at, including, let’s not forget, your own? I say we’ve killed the fucker, and you’re gonna get through this, and to hell with Doctor Bringdown.” Well, you know, conflicting takes and confirmation bias, and I’m sure Doc M’s pep talk was expressed more delicately than I have rendered it here, but we’re both in sunnier spirits following this second take. It’s nice to think, based on reasonable authority and not on wishful thinking alone, that there remain grounds for hope.

It is sobering to reflect that if Lina does survive this, it will owe entirely to her opting for Cedars-Sinai over CaesarCare, which explicitly (indeed, “vehemently” was the word the CaesarCare oncologist used) refused to consider HIPEC: ice cold rather than lukewarm. They pretty much planned to put her on a “palliative care”/hospice path. This appears to be, at the moment, the conventional thinking about this flavor of cancer, and who knows but that Doc Feelgood might be over his skis—but I give Cedars points for its willingness to depart from the fatalistic orthodoxy regarding which CaesarCare, to all appearances, was rigidly aligned and unwilling to brook any deviation therefrom. And of course, thank the FSM and Saint Franklin for Medicare parts A and B, and for the supplemental insurance Lina purchased last year. The present ordeal would have beggared us ten years ago, whereas our out-of-pocket outlay to Cedars thus far has been—wait for it—about thirty dollars at their pharmacy.

cordially,
New cutter vs medicine chucker? always two different viewpoints but glad things are looking up
since I am likely a few months away from medicare part b and all of the rest of the alphabet it is good to know about that part.
"Science is the belief in the ignorance of the experts" – Richard Feynman
New Think thrice about “Medicare Advantage”
CaesarCare has been pestering us for years to sign up for “Medicare Advantage.” Yeah, right: advantage CaesarCare. It would have locked us into their system, and Cedars-Sinai, rather than being underwritten on Medicares A and B, would have been entirely on our dime, and by now I’d be typing this entry from a residential hotel room in the San Francisco Tenderloin with our socks drying on the radiator, since we’d have had to sell The Crumbling Manse™ to meet the expenses.

cordially,
New thank you for that. Im in no rush and will confer with my doc's billing office for
best practices as well as the specialists I use from time to time. Have had part A for a couple of years and since I am still nose to the grindstone I am covered at work so have some planning time
"Science is the belief in the ignorance of the experts" – Richard Feynman
New With Medicare A and B . . .
The bill for the main work on my heart attack was $171,718.01. My out of pocket was $1,556.00.

I should have Medicare D starting on 1 Jan 2023, which is important because Dr. Toshikkor added another expensive (no generic) prescription. The "Physician Samples" he gave me will hold me until then.
New The Washington Post agrees.
WaPo Opinion: Medicare Advantage? More like Medicare Disadvantage.
--

   Christian R. Conrad
The Man Who Apparently Still Knows Fucking Everything


Mail: Same username as at the top left of this post, at iki.fi
New looked at my 2023 medicare guide
Part A and B service anywhere is the US where it is accepted
advantage plan? Locked into their area of service with huge costs if elsewhere, looks like I am sticking with A & B. Thanks for the link
"Science is the belief in the ignorance of the experts" – Richard Feynman
New Also - 'deny until they die' - gotta make that profit somehow
New There are good threads at Balloon-Juice on medical insurance.
David Anderson is the front pager there that talks about it clearly and with lots of facts. Lots of good comments on his threads. One woman makes the point that if you're in an Advantage plan, there are severe constraints if you later decide that regular Medicare works better.

E.g. this comment by Ohio Mom.

Personally, I start suspicious when for-profit outfits advertise insurance on TV. TV ads cost money, and that money has to come from somewhere... So, while Medicare Advantage may work, one has to verify it with one's own work based on one's own circumstances.

We're a few years away from signing up for Medicare, but we dread the process.

David makes the point that picking insurance is complicated and there are too many variables to make an "optimum" choice. The best you can hope for is to not make a bad choice, and keep an eye on annual changes.

Good luck!!

Cheers,
Scott.
New And they have an incentive to make you choose the plan that's best for them
I try to do the math and figure what we're going to need each year. But they have better actuarial tables, and they know what hospitals are actually going to charge.
--

Drew
New I am so, so pleased to not have to deal with all that bullshit
I know there are variances in quality of care and outcomes. But holy shit, from where I’m sitting, it’s worth it.
New Seconded. Thank Bog for the pinko commie Nordic Welfare State.
New Overall, great news!
But, keep on checking that there is no regression.
Alex

"There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge."

-- Isaac Asimov
New Sounds promising either way!
Continued better health to her.
Regards,
-scott
Welcome to Rivendell, Mr. Anderson.
New Don't sell the crumbling manse
I wouldn't sell my house and leave my wife homeless. Don't you do the same.

I got a tiny little broken pinky. Nothing compared to the real issues you're dealing with. Just this wimpy little pinky. But I could easily see it turning into $100,000 worth of surgery. F*** that. Let's limp along with this broken pinky for the next 20 years. I can handle that.

I'm dreading the moment the doctors say we have an issue. We got insurance for the year. I have an insurance. Had no insurance for 10 years and now I have it this year because I whine to my wife that I'm fragile so she decided to go get it. My pinky does not qualify. My fragility is internal and I'm just fine right now. Thank you very much. So she's pissed that I'm not spending a whole bunch of money on doctors. Because we have insurance for the moment.
New Excellent to hear, and may Dr M's view turn out victorious.
Not to forget, of course, that Dr P is also fighting on your side, his "loss" to Dr M(abuse?) being, AIUI, just one of over-caution.

And super-congratulations on having so successfully navigated the thickets of the US health insurance jungle.

Fingers crossed, etc, for the continued well-being of all parties involved.
--

   Christian R. Conrad
The Man Who Apparently Still Knows Fucking Everything


Mail: Same username as at the top left of this post, at iki.fi
New No disrespect to Doctor P
We’ve been greatly impressed with him all along, even though I have grandnephews close to his apparent age. He’s given us his best evaluation of L’s situation from where he sees it, and although he was initially skeptical as to the efficacy of early HIPEC, he heard out Doctor M and was persuaded to incorporate it in the course of treatment. Particularly because he’s fairly young, I expect that should M’s approach yield the outcome we all hope for, he’ll not assume the stance of “this is how we’ve always done it”—CaesarCare’s attitude,* which would have slotted the wife on a highway to hospice care—and will countenance or even recommend early HIPEC into patients’ regimens going forward.

Doctor M, who is very confident that he and his medical faction have hit upon what amounts to a cure for L’s condition, hopes to cite her successful outcome as he lobbies for the wider adoption of this approach. Me, I hope that one of these years he name-checks her as he makes a speech in Stockholm.

cordially,

*I may have mentioned this before: CaesarCare absolutely (“vehemently” in the oncologist’s words) refused to contemplate HIPEC in their course of treatment. They were not prepared to deviate from SOP to give L a chance of surviving what they assumed by default to be a terminal condition. Fuck ’em.
New :-) I hope he's right too! Best of luck and best wishes.
New Re: Dueling prognoses
Cringers fossed for a fortuitous outcome!
     Dueling prognoses - (rcareaga) - (18)
         cutter vs medicine chucker? always two different viewpoints but glad things are looking up - (boxley) - (10)
             Think thrice about “Medicare Advantage” - (rcareaga) - (9)
                 thank you for that. Im in no rush and will confer with my doc's billing office for - (boxley) - (1)
                     With Medicare A and B . . . - (Andrew Grygus)
                 The Washington Post agrees. - (CRConrad) - (6)
                     looked at my 2023 medicare guide - (boxley) - (5)
                         Also - 'deny until they die' - gotta make that profit somehow -NT - (scoenye)
                         There are good threads at Balloon-Juice on medical insurance. - (Another Scott) - (3)
                             And they have an incentive to make you choose the plan that's best for them - (drook) - (2)
                                 I am so, so pleased to not have to deal with all that bullshit - (pwhysall) - (1)
                                     Seconded. Thank Bog for the pinko commie Nordic Welfare State. -NT - (CRConrad)
         Overall, great news! - (a6l6e6x)
         Sounds promising either way! - (malraux)
         Don't sell the crumbling manse - (crazy)
         Excellent to hear, and may Dr M's view turn out victorious. - (CRConrad) - (2)
             No disrespect to Doctor P - (rcareaga) - (1)
                 :-) I hope he's right too! Best of luck and best wishes. -NT - (Another Scott)
         Re: Dueling prognoses - (pwhysall)

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