BROKEN DING-DONGS, HEARING AIDS, AND ONE MORE REASON TO HATE OUR GOVERNMENT

Hey everybody! It’s been a while. I thought it would be good to post again.

I’ve got a little time; I’m on a medical leave right now to take care of a sudden and troublesome condition. I’m hoping to return to work in January. So, I’m using the time for research and writing. Good time for a new post.

My time as a Medical Assistant has not been terribly long, but I have learned a few things. The world of healthcare is full of drama, intrigue, gossip, strong emotions, and downright assault. They didn’t exactly prepare me for that in school. But, many veterans of the industry are a bit burned out these days, so I joined the ranks just in time for the rampant profanity and frayed nerves. Good times!

But, all that’s for another time. Today, I’d like to write about broken male genitalia, hearing aids, and a federal government that just continues to annoy the crap out of me.

Okay, bear with me, because this is sort of round-about.

Older males can develop a condition called Peyronie’s Disease. Simply put, this a pronounced curvature of the ding-dong when it becomes ready for the old hoo-hoo cha cha with a nice lady. Many illnesses and conditions in medicine are eponymous; that is, they are named after the scientist or physician that first identified them. I have done no research, nor do I wish to, of who Peyronie was, and why he chose this area of study. Well, I suppose someone had to do it?

Anyway, this curvature of the little fella can be quite debilitating, preventing regular sexual intercourse. Please, please, please do not follow this link:

https://www.google.com/search?q=real+pictures+of+peyronie%27s+disease&tbm=isch&ved=2ahUKEwj6w5GU2v_zAhWLATQIHWN1AbAQ2-cCegQIABAA&oq=peyronie%27s+disease+pictures&gs_lcp=CgNpbWcQARgCMgcIIxDvAxAnMgQIABAeMgYIABAIEB4yBggAEAgQHjIGCAAQCBAeMgYIABAIEB4yBAgAEBhQAFgAYLQiaABwAHgAgAF0iAF0kgEDMC4xmAEAqgELZ3dzLXdpei1pbWfAAQE&sclient=img&ei=p1eEYbrUMYuD0PEP4-qFgAs&bih=757&biw=1600&rlz=1C1CHBF_enUS897US897

I warned you. Anyhoo, Peyronie’s Disease is generally caused by a buildup of scar tissue and plaque in Mr. Johnson. This is typically due to a number of various medical conditions, but most often due to penile trauma. What happens is, the old timer really, really wants to do the bang-bang dance with the pretty lady friend. However, along with age can often come another unfortunate condition, erectile dysfunction. ED, as it’s known, can be varied in its severity. If it is not too bad, the gentleman will do his darnedest to guide the not-so-stiffy into the nice lady’s fun zone. This invariably does not work, and is probably not all that fun for the female partner. I’m guessing. But, this continued practice will cause physical trauma, damage, to Mr. Johnson. This often results in Peyronie’s Disease. Oh, the tragedies of man…

But wait! Hope abounds! Modern modern medicine triumphs! There is a medication known as Xiaflex (triumphant music sounds) that can cure this condition!

Xiaflex is a medication that breaks down the plaque buildup in a shlong with Peyronie’s Disease.

https://en.wikipedia.org/wiki/Collagenase_clostridium_histolyticum

It is injected directly into the affected area of the penis. You are reading that correctly. A needle, made of metal, is inserted right into a crooked penis. In my practice as a Medical Assistant, I have seen Peyronie’s Disease, and I have seen it corrected by an injection of Xiaflex into the affected area of the male member. It cannot be unseen. I am different now.

Xiaflex is not inexpensive. Depending on the severity of the Peyronie’s Disease, it can take up to 12 injections of the medication. Each administration of Xiaflex costs roughly $3000.

Okay, so my 87 year old mother, who I love dearly, is nearly deaf. I know that there was no segue there, but bear with me. This all comes around. Nevertheless, I hope my Mom is not reading this.

Charlsia Schall is still very sharp mentally, and I inherited her wicked sense of humor. Physically, she’s doing okay for someone who is 87, but she needs to use a walker and she desperately needs hearing aids.

You can still speak with her, but it is usually best to speak directly in front of her, in a louder, clearer voice. Being that her cognitive acumen is still strong, it is easy to carry on a conversation with her. At her age of 87, I am truly lucky. Not many people have such a luxury. Again, I hope you’re not reading this, but I love you, Mom.

My mother and late father, through living frugally and saving as much as they could, did okay for themselves. You know, living within your means and saving as much money as you can. Like you’re supposed to do. Sheesh. Old people, wise with their money… I tell you… Anyway, though she could definitely afford it, Mom is not keen on making large purchases. On some level, I don’t blame her at all. Hearing aids are profoundly expensive, with decent ones starting at at least 4-5 thousand dollars. As my Mother is not entirely deaf, this is an economic button she is just not comfortable pushing.

Social Security was signed into law by President Franklin D. Roosevelt in 1935. Again, I got no segue here, but trust me, this is all going to come together. Hopefully. If this is a good day. Anyway, Social Security was part of the rescue package intended to mitigate the Great Depression. Apparently, economies occasionally need medication and therapy as well. The Great Depression had ravaged the United States. A recap of history is not needed here.

The government, at all levels, has always taken a strong interest in the American healthcare system. This can be a good thing, as government oversight can ensure the safety of patients and the efficacy of treatments, strengthening out healthcare system. (How we go about paying for this masterpiece is another story entirely). Federal agencies exist to oversee healthcare at all levels, ostensibly to protect the American patient: the FDA, the CDC, the DEA, the Joint Commission, etc. Occasionally, these departments can become weaponized for political reasons, as we are human, all of us flawed, and humans run the government.

My education and professional experience is in medicine. I dislike talking politics, as people can easily get all yelly-shouty-pissy. I know only the basics of our political system, and I hold opinions based on what I see. There is a branch of philosophy (I have dabbled, but am not educated) known as epistemology. This school of thought seeks to differentiate between what is fact and what is opinion. In today’s era of social media, it is quite easy for anyone, from any ideological camp, to loudly shout an opinion, with scarce facts backing it up, until, in this era of blatantly partisan media, their opinions are reinforced enough to become, in their world, facts. A nice twist of logic. It is difficult to speak of politics these days, as we live in a largely binary political belief system, with inflexible, unyielding opinions (not facts), and people quickly get emotional and confrontational. You cannot have a rational discussion with someone in that state. Hence, I avoid politics.

Anyway: back to politics nonetheless, the federal government, and Social Security. Over the years, the government has changed, tweaked, and adjusted Social Security, but the basics of the original intention still stand. All taxpaying Americans pay into it, and our senior citizens can enjoy an easier way of life, as medical bills mount with age. Be that as it may, there are certain things Social Security still will not pay for.

My beloved mother could really use those hearing aids. Hearing aids are not covered by Social Security.

Xiaflex, the medication that treats Peyronie’s disease, is covered by Social Security.

Let that sink in for a moment.

Hearing aids? Up to $7,000 or $8,000 dollars.

Xiaflex? Up to $36,000 dollars.

Yup. No hearing aids, no new glasses, no covered dental work for my Mom.

Bent weener? No problem. Got you covered.

I was a little stunned when I heard about this. Surely, I thought, the powers that be in Congress would have rectified this by now. An RN I was working with at the time gave me his opinion:

RN: Andrick, who do you think makes the laws in the Senate?

Me: Uhh… Well, for the most part, mostly older white males.

RN: And who do you think they have staffing their offices?

Me: Usually insanely hot 35 year-old women.

RN: Okay then, do the math.

Me: Aw, crap!

Joe Biden and the slim majority of Democrats in Congress have recently tried to stabilize the country and give long-needed help to the working class. Again, I hate speaking politics, but two of his Republican predecessors did the same thing. But, because half the country believes Joe Biden lost (dude… people… really?), the opposition is suddenly concerned about all this money we’ve been throwing around.

Initially, Biden’s rather largish spending plan included adding hearing aids, vision, and dental to Social Security recipients. Sounds like the right thing to do. But people balked at it. Biden has scaled his ambitions back. Recently, Congress at least passed an infrastructure spending bill. There is more work to be done. Biden and the Democrats are still trying to pass legislation that would help the needy. After much yelling, the plan was scaled back, as far as Social Security benefits go. Vision and dental are out, but hearing aids would be included. At least my Mom could finally hear again.

However, the opposition is again balking at this one. Along with them are two Democratic obstructionist Senators. One is a cranky old man, with an 85 year old body and 500 year old face,a Republican dressed as a Democrat, who doesn’t like spending money at all. He wears sensible shoes. He represents the state of Virginia. I had to Google Virginia; evidently it’s a suburb of West Virginia or something. East Virginia was infamously destroyed by the Cloverfield monster. The other Democratic obstructionist Senator is a woman from Arizona, who’s really pulling off the naughty-behind-closed-doors school librarian look. I’ve been to Arizona. Head south to the deserts of SoCal, go east, and stop where all the retired people are. Anyway, this Senator is rather hard to read. She doesn’t seem to stand for anything, and dislikes speaking to reporters, her constituents, or the clerk who asks paper or plastic. Maybe she’s just there collecting a paycheck. She certainly does not need the Viaflex. So, there is a good chance that the aid package that includes hearing aids in Social Security will not pass.

So, there you have it. Penny-pinching senior citizens can’t rely on Social Security for hearing aids, but senior citizen males, no matter what their station, can afford Xiaflex to fix their bent ding-dongs. Makes perfect sense to me!

Well, until next time! Thank you for reading!

FROM HELL’S HEART I STAB AT THEE

I work in healthcare. I am a Certified Medical Assistant. Children hate me. They can’t see my big, goofy smile through my surgical mask. That matters little. They know who I am. I am the man who keeps Mr. Pain in his pocket.

Millions and millions of Americans hate going to see the Doctor. There are a lot of valid reasons for this. One is primarily economic. American healthcare can be extremely expensive. We are the only industrialized nation that has not figured this out, and there is plenty of debate concerning this; however, that argument is for another time. Millions of Americans also hate going to see the Doctor because they refuse to believe they are sick or in need of treatment. That’s all well and good, you hardy lumberjack, you; but many diseases and illnesses have no symptoms, until the affliction decides to kill you. Millions of Americans hate going to the Doctor because they think that all Doctors are quacks, and are just going to take your money. Well, sorry you feel that way, but I’ll probably be the one taking your vitals when the cancer kicks in that could have been avoided had you seen the Doctor sooner to prevent your illness. Millions of Americans hate going to see the Doctor because they believe Western medicine is impure and inherently harmful. There is nothing wrong with yoga, meditation, or tai chi; in fact, Western medicine has embraced these practices. To a degree; I’m really not sure that chamomile tea and ginger root paste is going to cure your diabetes. Just sayin’. But I posit this: Millions of Americans are afraid to go to the Doctor for one simple reason: they are afraid of needles.

Trypanophobia is the fear of medical procedures, especially needles. This is distinguished from aichmophobia, the fear of sharp things. Also, this is not to be confused with iatrophobia, the fear of Doctors, the White Coat syndrome, why your blood pressure goes up in the exam room even though hypertension has never been a problem for you. But back to the fear of needles. There can be good reasons for this. With an injection or a blood draw, metal is entering your flesh, and you may see blood. On an instinctual level, that’s not supposed to happen; even though on a rational level, it may be necessary treatment for an illness. It’s really as simple as that. But please allow me to elaborate.

In 1995, Dr. J. G. Hamilton, a smart man with a no-nonsense name, published a paper on this topic: (https://pubmed.ncbi.nlm.nih.gov/7636457/). He suggested that the fear of needles has an ancient genetic basis in evolution. Our pre-history ancestors were well aware that sharp cuts or bites could very well be a death sentence. There were no antibiotics; if the wound were to become badly infected, it could kill the injured. There was no healthcare to speak of, save the shaman or medicine man who may try to perform rituals to appease the deity the tribe believed in, as the injured had angered this god, bringing the affliction upon the wounded.

Another evolutionary theory by Stefan Bracha, MD, suggests that one might faint from an injury to demonstrate that a fallen combatant is no threat, and is taken out of the violent melee over the hunting grounds of contention at hand. (https://www.sciencedirect.com/science/article/abs/pii/S0278584606000091?via%3Dihub) You know, I’m still not really sure if possums actually do that. But I digress. Possums are cool.

The truth is, however, you really don’t need to go that far back in our evolutionary history to paint a simple picture of a grown adult’s fear of needles. All of us, when we were toddlers, received several vaccines. The Centers for Disease Control and Prevention has a schedule that healthcare providers follow:

This itinerary is only to 6 years. There are several vaccinations and inoculations after that, and many into adulthood. Many of the diseases listed in this chart have been all but eradicated due to immunizations. However, healthcare deeply respects patient autonomy. There are many parents out there who, for whatever reason, distrust vaccines (anti-vaxxers is the pejorative term) and refuse to get their children vaccinated, because there is a 0.000007% chance the vaccine will cause their child to grow a second head. On a serious note, this philosophy is why measles and mumps have not been completely eradicated, and, sadly, it is often the children who suffer and die.

But regarding a young child getting their shots: I posit a train of thought, a somewhat obvious one, that if one follows, it is quite easy to see why many of us hate needles. You are probably familiar with psychologist Erik Erikson’s eight stages of human development. Of course, unless you are a Scientologist, there is no perfect model for human psychology. Nevertheless, Erikson’s model has been studied and reworked by various schools of human development and psychology. Marysville Universtiy has a great article on this model, as well as others: (https://online.maryville.edu/online-bachelors-degrees/human-development-and-family-studies/stages-of-human-development/). In a healthy environment, trust and autonomy will foster in the growing human in the formative years. These healthy traits are directly opposed at the Doctor’s office.

When we are infants, toddlers, we are coddled, fussed over, and, in a healthy and nurturing environment, we are loved. Our needs are met. We have no responsibilities. Or course, there is discipline and punishment when we don’t get our way, but; again, in a healthy environment, this is for our protection. But. eventually, we are taken to the Doctor. Toddlers in particular, at some level, understand these visits, as much as they are places of potential pain.

When we are administered the vaccinations above, we certainly do not have the mental capacity to understand why we are being hurt by the scary man in scrubs. We are restrained, which is terror enough. Then, a sharp blast of pain appears on the body, usually, in the case of a toddler, on the thigh. This can be quite the traumatic experience for the youngster. I was holding down the legs of a 3 year-old once, while another Medical Assistant was giving him his shot. The young man was quite vocal in his opposition to all this. He really filled the room. And I tell you, a tiny human like that can really summon precocious strength. I didn’t like it, but I really had to hold him down. Generally, the parents are off to the side, although some assist in restraining the child, and all of them usually say things like: “It’s okay sweetie. You’re doing fine.” In the child’s head, nothing is okay, and nothing is fine. These are our formative years. We remember these events, at some level of consciousness. It is quite easy to see, then, why we carry this fear of Doctors, and specifically needles, well into adulthood.

There is a physiological process behind all of this. Most of us are familiar with the concept of fight or flight. This human (and animal) phenomenon is older than the theories of ancient man outlined above. It is ingrained into the very survival instinct off all human beings. It has been with us since we first banged the rocks together, and it continues today, when we go to the Doctor to get poked with a needle.

You have a nervous system, commanded by your brain. The nervous system carries out commands to different parts of your body to tell them what to go do with themselves. The main nervous system, the central nervous system, is divided into several sub-systems. The parasympathetic nervous system is responsible for resting the body when you are relaxed, resting, or feeding. The sympathetic nervous system, on the other hand, ramps your body up when danger is perceived, kicking in the fight or flight reflex. Our ancient ancestors had to do things like run from bears (this would the ‘flight’ portion of fight or flight). When this system kicks in, blood and oxygen and sent to the lungs, and the body is filled with adrenalin, to prepare ourselves to get the hell out of there. This reflex is with us today, although it can be associated with actual, physical danger (car crash, mean dog, airplane turbulence) or societal danger (the boss wants to see you, the principal called, collections just sent you a letter). When this happens, and one is expected to hold still, sitting in the phlebotomist’s chair, blood and oxygen leave the brain, our thinking becomes clouded, and many people either have an intense reaction of fear, or, even the big tough guys, experience vasovagal syncope, a fancy term for passing out. I’ve seen it happen.

But you know, the bottom line is this: it could be a lot worse. Depending on the skill of the healthcare provider, and the type of injection, getting a shot in the shoulder or getting a needle in the arm for a blood draw is pretty low on the pain scale. Needles today are designed to cause as little pain and discomfort as possible.

This is a fantastic article: (https://medicine.uq.edu.au/blog/2018/12/history-syringes-and-needles) The first needles were used in the second century, CE, with disastrous results, and by that I mean fatal. It wasn’t until the mid-19th century that modern needles began to take shape. But I don’t imagine those needles were all that easy to take, let alone sanitary.

Let me wrap it up this way: Have you ever been stung by a bee? That hurts! That’s because it’s designed to hurt. All of us have jabbed one our fingers with a staple before. That hurts! Those are things that are piercing our flesh. Modern needle design, with the hypodermic wielded by a skilled healthcare practitioner, really: Does. Not. Hurt. Sure, it stings a little, but it’s over in a few seconds, your arm may be a little sore afterwards, but trust me, you are probably going to be okay. When I am practicing in a clinic, I am forbidden from giving any kind of assurances, but here on this blog, I’m pretty sure you’re going to survive your shot.

Most of the injections I give are either in the shoulder, the thigh, or, rarely, the back of the upper arm. I occasionally give small injections on the inside of your forearm. Once in a while, the buttocks. I know what I’m doing. There are tips are tricks that I paid a lot of tuition money to learn. I’ll make it east on you. But, not to scare you, there is the occasional injection, rarely given, that are handled by Registered Nurses or Doctors: intraosseous, into the bone. Intrathecal: into the spine. Intracerebral: into the brain. These all sound fun, right? But these are rare, and are administered carefully and with anesthesia by a highly skilled practitioner. There is also, of course, an amniocentesis, which expectant mothers may be familiar with. But there is also cardiocentesis, when a needle punctures the heart. These are just a bit above my paygrade.

So the bottom line is: it’s perfectly okay to be afraid of needles, but it really doesn’t hurt too bad. On the second day of my externship, I have to give a vaccine to a 7 year-old child. She was frightened, scared, and crying. I did not patronize her; I told her it would hurt a tiny bit for just a few seconds, that it was okay to be scared, it was okay to cry, and it would be over quickly. She relaxed a bit. As soon as I injected her, she immediately perked up. “Oh!” she said. “That really doesn’t hurt too bad!” I happily affirmed her, was done in a couple seconds, and withdrew the needle. My mentor said she had never seen a reaction like that from a child. So, I know that needles are scary, and that’s perfectly okay to feel that way, but just remember that 7 year-old girl.

I’ve gotten very good at assessing what kind of patient I have, very quickly. Sometimes, if someone has a healthy outlook on life, but, I can tell, is afraid of injections, I usually try to lighten the mood with a few jokes:

“Well, let’s give this a shot.” “It’s okay not to look; I don’t either.” “I promise you, this won’t hurt me a bit.” “Present: arms!” “Oh… no wonder… that’s the wrong end of the needle…” I’ve got pages of these!

There is one final note to end on, something I neglected to mention. The Dentist. The Dentist uses needles, too. Your gums are much thicker than skin, so the Dentist uses a larger needle. The nonvaccine is very thick, so the needle must remain in gum for a longer time. The Dentist enjoys this. The Dentist is evil. The Dentist enjoys hurting you. The next time you go to the Dentist, bring your holy water, and banish the Dentist back to which they came. I kid! I’ve had some great dentists.

Remember: it doesn’t hurt that bad. Be like that 7 year-old girl! I’ll see you at the clinic!