There was a time when I would've considered the ACA unnecessary. That I would've been annoyed by it. This was also a time where I had little to no interest in politics. It's funny how life has a way of humbling a person and teaching them something new about themselves on a regular basis. This is a story about how I ended up needing the help in order to make myself better.
"Well why didn't you just get a new inhaler?" I felt a sinking pit in my stomach. I was at a follow up visit to my doctor after ending up in the ER a few weeks before because bronchitis had made my asthma worse and I couldn't breathe. The first thing my doctor asked me was where my inhaler was when this had happened. After all, that was in my plan. I tried to explain to her that I only had one inhaler and it had been stolen the week before when I was riding the bus. Somehow, despite my explanation she didn't understand that since I was uninsured at the time, I just couldn't afford a new one. It was only after the ER trip that a friend of mine had pity on me and bought the inhaler for me.
I lost my insurance in April 2012 because I had been working at a call center that had outsourced its customer service department overseas. This was my fourth lay off in about six years. The whole time I had been trying to go back to school but in playing musical jobs I had never managed to do so. I decided to make school my focus and work secondary and deal with it.
Because I have asthma, I've never been able to get insurance without going through my work before. COBRA would've cost me over six hundred a month, and while my state had opened a high risk pool, it was still too expensive. My NP was awesome and made sure I got refills of my medication before I lost my insurance and gave me a list of community services for when I did lose it, because she knew I wouldn't be able to come back afterwards.
I did everything I could to make sure I would be taken care of. I signed up for a prescription plan at a local pharmacy, I found local clinic that was free, run on community donations. Still there are things that free clinics couldn't handle. Waiting all week to see a doctor because you got sick on Sunday and the free clinic is only open on Saturday isn't helpful when you're so sick you can't breathe. The doctors are volunteers so there's no guarantee of continuous care. In fact, the push is to get you into a local public health or community clinic, but they often were not taking new adult patients or were an hour drive away.
It was about a month after I lost my insurance when I found a lump on my right side, along the edge of the breast tissue. The free clinic provided me a referral but when I called the places they suggested I was turned away. I was told I was too young, that the office no longer provided services, or that they were out of funds for the year. I continued to fight to find a way to access services, but without a referral from a PCP I was getting nowhere. I finally took the time to bus out to one of the few clinics taking patients. They contacted a local imaging center attached to a public hospital to get me in. This started in June, I was finally in for imaging in October. In November I would get a biopsy and find out it was benign. It took me six months from start to finish to find out what was there.
It would be another year before I would get insurance again. In that time I ended up in the ER enough times the doctors started to recognize me. There really wasn't anything either of us could do. I couldn't manage my health without being able to afford regular doctor's visits and medication and they couldn't make a solution appear out of thin air. My wisdom teeth got infected and had to be removed but had to wait two months for a dentist who would help. I was on antibiotics so long I ended up with a GI infection. Bronchitis, allergic reaction, a set of second degree burns from how bad at cooking I can be. They got to deal with it all, despite the fact that most of these things were preventable.
All if this changed in January of last year. I live in one of the states that approved the Medicaid expansion and set up their own healthcare exchange. I was there on day one to shake hands with the Governor, tell him my story, and sign up. I stood up with him to others to encourage them to use the exchange as well. It is the only day of class I've missed since I started back.
Because of the Affordable Care Act I was able to get needed blood work that I had not been able to afford. Reliable access to medication. The first thing my PCP did, remembering how just a few months earlier I had ended up in the ER because I didn't have an inhaler was make sure to get me a prescription for one so I had a backup. One thing I know is I appreciate the opportunity more than I could ever express.
I know there are naysayers out there who will tell me that those things are not really free and that someone has to pay for them. One day I'll graduate and that person will be me. I seriously hope that I am paying to make sure someone gets the care they need with the money I pay into the system. It's saner than paying for what happens when they can't. The system we have isn't perfect, but it can only get better if we put effort into it.
eroc, I think we all agree that we could alter our healthcare costs at least to some degree with better diet and exercise, but I'm pretty sure that information is already out there. Beyond the education that already exists, what else should be done? How should it relate to health insurance?
First the education is bad. Beyond that, I can't cram years of knowledge and practice into a post. It is not easy solved. And the "majority rules", will always be a sad reality. Even when people spread mistruths, if enough people agree "it has to be true"….screw real science, it's EBP. WHich is not science, it is a tool of science that can be greatly skewed.
So you're in favor of single payer then? I'm not sure if you realize it, but you can read other people's post's, including ones that respond to your posts and you can then respond back.
So who of the three that you listed do you think had even the slightest knowledge of where you need to begin? The doctor and nurse that has had ONE elementary level class of nutrition? Even listing a doctor or nurse as a person to listen to about diet and exercise shows where you are starting from. Doctor have such a huge liability they are not going to give you anything more than one-size-fits-all advice, the same as the nutritionist. You either have to pay for detailed advice OR learn it for yourself.
I can only base what your starting point is once you list me your daily choices of food everyday for the past month. That includes snacks, drinks with ingredients beyond water, what your DAILY exercise consists of on a regular basis.
AND this is where people tend to give the response…….as to why I won't get rich giving advice. Society truly believes that everything should be easy from the very beginning. My easy may be different than your easy because of the years it has taken me to acquire the knowledge. With time and a lot of effort it becomes easy. Same as anything in life if your work hard at it.
For exercise, my biggest tip is that once you stop being sore (musculoskeletal) your are no longer progressing. And nutrition is key to performance, leading to better health. Anyone that tells you different lacks knowledge, personal trainers included. PT's are there to make money, I've been one, it is disgusting what goes on in that industry.
I have not gained my knowledge from classes, I gained my knowledge through years of practicing what I preach. I took classes to become a RN, but did understand what it takes to be one until I began to practice being a RN. And I say again, if anyone the responds with an excuse I bet money you lack the knowledge.
So diet and exercise counseling from a Doctor, a nurse, even a nutritionist is not reliable, you're suggesting to instead utilize a random person on the internet?
In the hierarchy of reliable information sources on nutrition, I'm not sure that a random-internet-poster is above a nutritionist, although I will agree that many view it that way, which I would argue is more of our problem than the solution.
So who of the three that you listed do you think had even the slightest knowledge of where you need to begin? The doctor and nurse that has had ONE elementary level class of nutrition? Even listing a doctor or nurse as a person to listen to about diet and exercise shows where you are starting from. Doctor have such a huge liability they are not going to give you anything more than one-size-fits-all advice, the same as the nutritionist. You either have to pay for detailed advice OR learn it for yourself.
So my doctor, who knows my health history and how it affects my nutrition isn't a good resource? My nurse, who is the one who monitors my progress isn't a good resource? And my nutritionist, who works in the same practice and builds a collaborative care plan for me can't help me? You're under the impression that my clinic happens to be a McDoctor clinic or something? I've lost weight with their help. That's better than I've ever managed before, especially "internet research" through "Doctor Google."
The last 3 people I would go to for nutritional advice are my dr (limit eggs to 3/week? GTFU). A nutritionist that insists Pop Tarts offer nutrition because they're fortified or the hospital nutritionist who never considered how to feed a Celiac and had no answers when asked. All older examples but they're hardly cutting edge resources, just canned responses based on outdated/flawed studies.
And nurses? In general, forget about it. I have a nurse patient with new dx of biopsy confirmed celiac, she had no idea where to start. And 64% of our nurses are seriously overweight. I have more knowledgeable discussions with my son who is deeply into diet and fitness, I'm not exaggerating.
Now if your diet is based on crap, then all 3 and my mother could offer improvement.
I guess the difference may be where I live Libby. I live in a city that's pretty well known for being a bunch of health nut crazy to the extreme. Sometimes to the extra crunchy extreme. Bright side is that it's really easy to find things for a good low glycemic diet here. If I was to go back home, I would expect to run into trouble with getting nutritional support there. For that matter, it took me moving here to get any help at all. My doctor's office is a collaborative team that includes MDs, a DO, an NP, behaviorial health, nutritionists, and case managers. They work well for me.
I am struck by the puritanical and self-congratulatory tone of the anti-fat posts here and elsewhere on the site. They bear a certain resemblance to the "drug seeker stories" so prevalent in rant threads. However, I think a debate on our cultural inability to deal with human physicality is beside the original point of the thread.
I would like to echo Muno's question and ask how the ACA should be changed to better address the effects of lifestyle on health.
I guess the difference may be where I live Libby. I live in a city that's pretty well known for being a bunch of health nut crazy to the extreme. Sometimes to the extra crunchy extreme. Bright side is that it's really easy to find things for a good low glycemic diet here. If I was to go back home, I would expect to run into trouble with getting nutritional support there. For that matter, it took me moving here to get any help at all. My doctor's office is a collaborative team that includes MDs, a DO, an NP, behaviorial health, nutritionists, and case managers. They work well for me.
I would assume there are such practices in Sacramento but we don't have anything like that in my area, we might be like your home town. It is great that you have a team that you're happy with.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
It is not wrong. What is wrong is telling everyone it is not their fault. And you simplifying my statements is like me stating I am a nurse…my job is to pass meds and start IV's…it is multi variable well beyond your excuses listed.
But what do I know, I was birthed inside of a single wide trailer in a trailer park (not a hospital) and a 9th grade high school drop out until the age of 35. SO I have no idea, right??
And I grew up on a farm with no plumbing or electricity . . . I know poor, too. But the thing is -- and I had to move to the east coast and work in a ghetto to "get it" -- country poor (a trailer park or a farm) is different from city poor. I always had plenty to eat and because we only ate what we could grow (or shoot or catch), it was a pretty healthy diet. Farm work is good exercise, too.
I'm not in favor of telling everyone it's not their fault they're obese. However, sometimes it really ISN'T their fault that they cannot lose the weight after they've gained it. It's far easier not to gain the weight than it is to lose it once you've gained it. There are multiple factors that can deter people from losing weight. It's really NOT as simple as "eat less and exercise more" once you're over forty or so. Yes, that works when you're younger -- mostly -- but those of us who have been around a few decades have learned that it really is not always that easy. If it were, I'd be a bathing suit model.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Because you lack knowledge, based on your posts. I am not stating anything but facts. Not judging or being mean. I am saddened by the lack of knowledge of so many here posting, but it is the norm in our society….it's just worse that so many nurses know so little about nutrition and exercise.
And yet your last two posts have come across as mean and judgemental.
I am 39 yo, and have lost over 50lbs at times. And can do it again and again from the knowledge I gained as a competitive bodybuilder. As have many of the people I know, well past their forties It's easy based on mindset, not physicality. (For me) But I do agree the longer one abusing their body by not eating clean and exercising the harder it is to recover from the damage inflicted throughout those decades.
I have never lived on a farm, btw. Have you lived in a trailer park?
I have offered no nutritional advice. But I absolutely know how many experts are far from that.
And because I know what I know I can spot lack of understanding in people comments. Just the same as being as nurse describing functions in details to people that do not have the same level of comprehensive understanding.
What I do know is there are millions that believe that doctors and nurses understand nutrition because of credentials alone and that is ignorance to a high level.
eroc
218 Posts
First the education is bad. Beyond that, I can't cram years of knowledge and practice into a post. It is not easy solved. And the "majority rules", will always be a sad reality. Even when people spread mistruths, if enough people agree "it has to be true"….screw real science, it's EBP. WHich is not science, it is a tool of science that can be greatly skewed.