Seniors lounge (over 50) come on in.
- Thread starter Vanhalen
- Start date
atatu
Legend
I'm just frustrated that it's been a long time, not a week or so, more like 2 months. I don't have a problem with the PA, it's just tough to ever get an appointment with my doctor. I really feel like an MRI would help but apparently that's not possible.
movdqa
Talk Tennis Guru
A guy comes into my office to talk about his knee issues. I've given him advice on it for 15 years. Lately I've told him to go down to New England Baptist hospital in Boston. They have one of the best orthopedics departments in the world. Does he go? No. He'd rather complain and ask me for advice. Mainly because I've solved my knee issues without doctors. But I put some effort into it. I don't get the reluctance to see doctors.
A lot of folks ask medical questions here thinking that some random person on the internet will be better than people that treat conditions for a living.
A lot of folks ask medical questions here thinking that some random person on the internet will be better than people that treat conditions for a living.
Dartagnan64
G.O.A.T.
Why doesn't these injuries work this way:
If I have a bad muscle/tendon injury ... I go straight to MRI without doc or insurance permission. Who is going to pay $150 copay for fun ... fake it. Why in the hell should I have to go to the primary, an ortho, PT until I know what I am dealing with. I should be able to get a MRI on my own, and the results without the preliminary office visit. Sometimes there is a wait to get in to see the doc ... injuries shouldn't wait.
Yeah ... what I said.
Your belief in the abilities of MRI/radiologist to accurately make soft tissue diagnoses is quaint. There are a few injuries it's quite useful for and a whole bunch its pointless or misleading for. Knowing which is which is the doctor's job. That and giving the radiologist a heads up as to what he should be looking for rather than reading an image in a vacuum.
No perfect tests in this world. All have significant false positive and negative results especially when applied indiscriminantly.
Tests are adjuncts to the physician's clinical assessment and are always most accurate when clinical context is applied appropriately.
ByeByePoly
G.O.A.T.
Thanks doc I will respond soon ... sitting next to court taking a break on ball machine session. I haven’t hit for 3 weeks and it shows.
My idea of going straight to imaging was to avoid any pointless primary doc visit (don’t like pointless forced primary doc gatekeeper function). I assumed a ortho type imaging center would have expertise on hand beyond the radiologist. Typically I see too much of 1) have to see primary first 2) then have to see specialist because beyond primary’s expertise since we already knew 3) then get imaging.
Chat soon my 2hbh looks quaint at the moment.
I will respond soon ... sitting next to court taking a break on ball machine session. I haven’t hit for 3 weeks and it shows. My idea of going straight to imaging was to avoid any pointless primary doc visit (don’t like pointless forced primary doc gatekeeper function). I assumed a ortho type imaging center would have expertise on hand beyond the radiologist. Typically I see too much of 1) have to see primary first 2) then have to see specialist because beyond primary’s expertise since we already knew 3) then get imaging.
Chat soon
my 2hbh looks quaint at the moment.
ChaelAZ
G.O.A.T.
I can retire in just a few years and I have it in my mind I'll take a year off to just play tennis and drive around the US before starting up a new company or doing something different. But I know injury prevention will also be part of that. It is a helluva thing that we waste all our youth on working instead of playing so that when we can retire, we are older and can't play nearly as much.
movdqa
Talk Tennis Guru
I'm planning on going out on disability in December or retiring.
ByeByePoly
G.O.A.T.
ByeByePoly
G.O.A.T.
@BounceHitBounceHit
Back from ball machine session .... only part I liked my results on was the poor man's ros practice (my ball machine doesn't cut it for ros) ... which is whack ... because ros is my most current troublesome 2hbh learning curve.
OK ... I will let @Vanhalen police this OT old guy lounge discussion. Van ... just let me know and I can move the discussion to the health forum. I like having it here, because we are obviously the smartest, wisest, best looking of ttw ... and we have at two docs here ... one US and one Canadian. Also systems guys (Mov, BBP), OP from the industry, etc. What's not to like?
Doc ... Docs ... interested fellow old guys ... what I'm really interested in is not what I know or don't know (quaint false notions), but what the best system for us injured tennis players would look like, regardless of cost, ideology or legacy systems.
So if we were starting at the white board designing the system for INJURED TENNIS PLAYER (obviously using that a small example of the overall healthcare system) ... we would have some initial requirements:
1) injured tennis player gets injury checked out immediately
2) the "checking out" varies per injury ... sometimes to primary doc first, sometimes to imaging first, sometimes just rest, sometimes ER, etc, sometimes primary doc can guide imaging center without patient primary doc appt, etc).
3) yada yada yada
So from the start, we know the requirements will be different per injury ... you just follow each to their logical requirements. If that always ends up as either 1) ER ... or 2) primary doc ... so be it. The idea that all would either be a trip to the ER or a trip to the primary doc would be rejected pretty quickly I would think. You also have a conflict between "injured getting checked out quick" and "when a doc can see you". Judging by my primary doc's office, it's a huge bottleneck in the system. If you take a slot with an appointment that should have been straight to ortho or imaging center or other more optimum system ... then you take a slot from someone who really needs that primary doc appt quickly (say senior with flu, norovirus, chest pain, etc.)
That's what I would like to see first as a systems guy .... lay out the best system (play it as it lies) first, and then come back and factor in legacy systems, cost, ideology, etc. Oh ... and an honest presentation of the current legacy system, like insurance company setting rules that everyone must follow regardless of the quality of the system ... and where the costs are (pie chart maybe) in the legacy system. You would need that in order to make decisions about any replacement systems and costs.
We got none of that in our Obamacare debate... we started with "freedom, keep your doc, no one gets between you and your doc except of course your insurance company" vs "cover the 30-40 million without insurance, and get rid of medical BK". Of course it's a massively complex system ... legacy or replacement, but escapes me how you can start from anywhere but the white board if you are seriously debating the topic.
I'm such a dreamer ... lol.
Edit: btw ... I would love to be able to discuss healthcare with you for a month non-stop. I have an awesome primary doc ... but can not discuss this with him because of appt time constraints and "other" reasons.
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ByeByePoly
G.O.A.T.
You will probably develop the next Facebook from your home.
If you do, you have to promise not to be a p.r.i.c.k like F.u.c.kerberg.In my post above, the example of what I would like to see would be Sir Movdqa given access to top doctors, orho, imagery personnel, PT, maybe surgeons but you hate to taint the pool
, ZERO insurance company representation, also let's skip the hospitals first round ... and have you design the most efficient player injury software system (P.I.S.S). We will piggyback off your design to replace the US healthcare system. No pressure.
movdqa
Talk Tennis Guru
You will probably develop the next Facebook from your home.
In my post above, the example of what I would like to see would be Sir Movdqa given access to top doctors, orho, imagery personnel, PT, maybe surgeons but you hate to taint the pool
United Healthcare was my insurance company and they took care of about $600K in costs.
There was one case where I had to make a bunch of phone calls to deal with an ambulance subcontractor.
I had some issues with a mail-order pharmacy but I got through those.
In general, UNH has been fine with approving things. Their coverage network is unreal (I think that I could basically go to anywhere in New England and probably the entire country. My expenses were $2,000 per year (my deductible). When healthcare works, it's very, very impressive.
Dartagnan64
G.O.A.T.
Thanks doc
My idea of going straight to imaging was to avoid any pointless primary doc visit (don’t like pointless forced primary doc gatekeeper function). I assumed a ortho type imaging center would have expertise on hand beyond the radiologist. Typically I see too much of 1) have to see primary first 2) then have to see specialist because beyond primary’s expertise since we already knew 3) then get imaging.
Chat soon
All primary docs can give the RICE formula which is helpful for 99% of initial mild sports injuries. Most serious sports injuries are going straight to the ER. Getting an early sports injury specialist appointment is nice but probably unnecessary for a lot of minor injuries that heal on their own. It's likely not cost effective to take their time for these cases. Again the role of a PCP is to triage these things. Getting an MRI should really come after an assessment by a qualified sports injury specialist who can properly direct the radiologist for the right type of image.
Case in point, I'm seeing a patient today for right leg weakness and reading through the chart he most likely has a lumbar plexopathy. But did the PCP or ortho who saw him first order an MRI of his lumbar plexus? No. They ordered an MRI of his back. So now I'm going to have to order the right MRI and he's already had an XRay, CT scan and MRI of the wrong areas. Thank goodness they didn't find something and start chasing the red herring.
ByeByePoly
G.O.A.T.
My suggestion we start with "systems" was not anti-insurance ... it was to figure out what a "best" system should be. Only then could you grade the insurance companies. I don't think we should outsource (from government) the kinds of decisions the insurance companies make in our lives, but that is a separate issue from grading/evaluating their systems imo.
ByeByePoly
G.O.A.T.
Good point ... any "best system" is going to limit misguided / wasted tests. A systems developer would drill down and find out how often that had to be a 1) doc in person 2) doc reviewing/participating remotely 3) doesn't require doc judgement, just follow protocol.
Let's use my hamstring injury (first one) as an example. I could hobble off the court on my own, but didn't walk normal for a couple of weeks. What short of a MRI tells me what I am dealing with ... how bad is the tear inside? It seems to be it's highly educated guessing vs actually knowing (that is assuming a MRI gives you a clear answer). This could be an example where 1) best system is MRI ALWAYS ... 2) that is deemed cost prohibitive for a hobbling hamstring injury but not for the tendon is rolled into a ball near my butt (sorry Pete).
I want to be able to MRI-equivalent with my iPhone ... upload to the hosed-hamstring cloud ... and then get my marching
orders.I thought you were a cancer doc at a cancer center. Not sure why I came to that conclusion.
Dartagnan64
G.O.A.T.
I'm a neuro-oncologist at a cancer center. You are partially correct. I wear a few hats.
ByeByePoly
G.O.A.T.
Dartagnan64
G.O.A.T.
Few more years. I'll have the financial stability to do it at age 60 but it will come down to whether I'm ready to give it up or not.
But then I plan to play tennis Tues, Thurs and weekends and golf on Mon, Wed, Fri. Cross training FTW.
movdqa
Talk Tennis Guru
Anything on the horizon to fix neuropathy from platinum based chemo?
OnTheLine
Hall of Fame
So question for the over-50 crowd ..... Heat tolerance is it better as we age?
Played this morning for 2 hours and by the end (10:30 am) it had already crossed 100F with an intense sun and no breeze.
Played with a group of about 10 on 3 courts, 2 courts of dubs and 1 court of singles .... the youngsters (who were playing doubles bless their hearts) were the ones dropping out early and complaining about the heat ... those of us over 50, including the two of us playing singles were all going along just fine.
Small group to use as a case study but in general I find that the younger players complain more about the heat than those that are a bit more mature.
Is it just that we are more stoic so whine less?
Played this morning for 2 hours and by the end (10:30 am) it had already crossed 100F with an intense sun and no breeze.
Played with a group of about 10 on 3 courts, 2 courts of dubs and 1 court of singles .... the youngsters (who were playing doubles bless their hearts) were the ones dropping out early and complaining about the heat ... those of us over 50, including the two of us playing singles were all going along just fine.
Small group to use as a case study but in general I find that the younger players complain more about the heat than those that are a bit more mature.
Is it just that we are more stoic so whine less?
ByeByePoly
G.O.A.T.
GeoffHYL
Professional
Maybe we just exert ourselves less as we get older, so we don't wear ourselves out in the heat.
ByeByePoly
G.O.A.T.
nvr2old
Hall of Fame
The above docs have clarified this exquisitely. 99+ percent of theses things are non serious soft tissue injuries that heal with time. As we get older the “time” increases almost it feels like exponentially in my opinion. I see pts all the time with sports related injuries. Many think an MRI is the be all end all diagnostic tool when that is really a history and physical by a qualified provider, even a PA who has umpteen more training than other people a possibly loads of real world experience. IMO you should be glad and appreciative the PA ruled out a hernia and had you drop trow as one that is incarcerated causes bowel ischemia and is VERY serious. Personally going through severe plantar fasciitis that may end my tennis playing days so we all have to quit and move on someday. Good luck though.
Dartagnan64
G.O.A.T.
Yeah, new therapies that don't include platinum-based agents. It's heavy metal poisoning. Only way to prevent it is not take the heavy metal.
Gen X suck it up. Millennials moan and quit. It's a generational thing. The Boomers would whine but they use their influence and power to get the early times.
ChaelAZ
G.O.A.T.
Not for me. Starting last year, I started feeling the heat WAY more, and getting tired a bit quicker, By contrast I was a hard core outdoorsman through my late 30's and people used to call me the camel. I'd go for a whole day on a sip of water and not energy change. Now I go for sips and breaks every 5 minutes of intense activity. And I don't spend a great deal of time outside if I don't need to. AC electric bill can confirm this.
movdqa
Talk Tennis Guru
I think that it just depends on what you're used to. I was in Orlando several weeks ago and it was 95-100 and humid and I walked about five miles outside and five miles inside. I was tired but was able to tolerate the heat. If we had hot and humid all the time; I don't think that it would be an issue.
The other question is can you tolerate the cold?
ChaelAZ
G.O.A.T.
I am still out there when it is well into the 100's and humidity is up. Practiced Saturday 6:30a to around 8a then two of our tema guys wanted to play dubs and we played almost another 2 hours. It was over 100 when we walked off court. was 115 degrees that afternoon.
So I can still do it, but I also took an hour nap and didn't do as much as I would in a day when I was younger. I don't think folks over 50 can build any mor resistance to heat, we just manage ourselves better, or can learn to manage better.
movdqa
Talk Tennis Guru
Well, yeah. I know about the one hour nap. Or two hours.
OnTheLine
Hall of Fame
This Gen X-er is so sick of sucking it up .... what we have done our entire lives, no?
Cold no problem. Still in a skirt and tank at any temp over 45F. Below 45F I put on a long sleeve shirt. Winter coat doesn't come out until sub 30F. Didn't live 15 years in Minnesota for nothing.
Played a league match yesterday at 12 noon. OMG. It was 111F with no breeze. It was tough but made it through. First time I have done a 3rd set breaker where I didn't wish we were doing a full 3rd set. Put down 64oz of liquid during the match ... Glad I brought an icy towel. And for the record: the younger players were the ones complaining the loudest.
GeoffHYL
Professional
I lived in South Florida in my 20's. If I played tennis in the summer I would need to take a nap afterwards. I sweat a lot and the high humidity was rough on me. If I played in the same conditions these days I wouldn't last as long as I used to, and would need a longer nap. Playing in low humidity here in SoCal is not so much an issue unless I play for more than 3 hours.
Isn't it the quintessential seniors game? ))
Sometimes the best answer for medical care complaints is to move. I have to say I haven't had a complaint in years about access. My only dissatisfaction is with the co-pay if I go to the ER, $350, only $85 for specialists and can go direct without referral. I don't often one of the ERs...but did three times during the ten months of intensive stuff (pre-adjuvant chemo, surgery, adjuvant chemo) for emergency IV pain meds/dehydration combo, on PCP's orders. (Couldn't keep a meal down for weeks...on two different occasions. South Wretch Diet, guaranteed.) I can get into the PCP nearly instantly, ER is very good, and I still have the "team" from my big C bit quickly available: I've come to believe my docs will do everything to keep me alive for at least five years. Good for their stats.
The radiological bit is interesting. I have a good friend who's a radiologist, Breast C specialist really. She seems to prefer a PET scan or CT scan with contrast for soft tissue and cancer issues. I've only had one MRI, a ultra-resolution Brain MRI in the first week of C workup. Then a full-neck-and-torso PET scan to look for hotspots. The rest has all been CT w/contrast. A lot of them. I feel great, BTW. No pain. A small amount of peripheral neuropathy that affects no vital activities.
What, have I moved to Miami? We have to stop meeting this way.
movdqa
Talk Tennis Guru
Sounds like me the past two years.
My bills for care came to $600K retail. I paid about $4,000 of it. My out-of-pay max was $2,000/year so I didn't really worry about copays and expenses. I'd basically rack up $2,000 pretty early in the year and then insurance covered everything else. I think that negotiated costs came out to about $250K. This was world-class care in Boston. I went to the ER twice, one for an intestinal blockage and the other for a heart issue that resulted from dehydration.
On access: no issues with access in NH. The intake process at Dana Farber/Brighams and Women was quite a challenge. I found out that they do massive volume and it's assembly line medicine. They have a lot of clients from around the country and from many other countries. Once you get through intake, though, getting appointments is not difficult. I think that they realize that time is of the essence when you're dealing with cancer.
Question for you: did you play tennis through treatment? My latest tennis video was during chemo and radiation and, to my knowledge, it's the only one out there. I've run into some people that slept most of the day on chemo. I've heard of some people running half-marathons through chemo and a lot of people work through chemo but almost everyone has far less energy and stamina and the immune system gets depressed making it dangerous around cold and flu season.
ByeByePoly
G.O.A.T.
You raise a good point. Most of us only experience our local healthcare which includes ERs. Add to that, you only go to ERs rarely (hopefully), so your ER experience is actually pretty narrow. I have been to two in my city. The few times I was at one, there was always obvious non-emergency patients in the lobby waiting to see a doc. I only went to the second ER one time ... wife was having major back pain (which turned out to be nothing to worry about), so we headed to the ER. The waiting room was wall to wall patients (hope to be patients) ... and we waited in the lobby for 3+ hours before she got to go back. I remember some guy in a wheelchair coming into the lobby yelling out in pain ... and they wheeled him right back. Someone next to me said the guy gets bladder stones all the time ... and has learned if he yells and makes a scene in the lobby he gets to go straight in.
Which makes another point ... we don't really have a US healthcare system .... we have local systems. Like public education ... more property tax, better system.
movdqa
Talk Tennis Guru
You raise a good point. Most of us only experience our local healthcare which includes ERs. Add to that, you only go to ERs rarely (hopefully), so your ER experience is actually pretty narrow. I have been to two in my city. The few times I was at one, there was always obvious non-emergency patients in the lobby waiting to see a doc. I only went to the second ER one time ... wife was having major back pain (which turned out to be nothing to worry about), so we headed to the ER. The waiting room was wall to wall patients (hope to be patients) ... and we waited in the lobby for 3+ hours before she got to go back. I remember some guy in a wheelchair coming into the lobby yelling out in pain ... and they wheeled him right back. Someone next to me said the guy gets bladder stones all the time ... and has learned if he yells and makes a scene in the lobby he gets to go straight in.
Which makes another point ... we don't really have a US healthcare system .... we have local systems. Like public education ... more property tax, better system.
When I had the heart issue, they took me right in from the ambulance.
When I had the obstruction, I waited for an hour and then was on the floor throwing up. They took me in but I was just on a stretcher for two hours in the treatment hallway before someone came to see me. The first case I would have died; the second case I wouldn't have - it was just very painful for a long time.
Rattler
Hall of Fame
I retired two years ago...
Wait for it...
...
...
At 51!
I play 3 or 4 times a week...one USTA league match, one friendly competitive standing doubles match (where we work on our smack talking skills as much as our game)
A club singles league...usually in the heat of the day. A city wide randomly paired doubles match’s (3 matches).
ByeByePoly
G.O.A.T.
My friend ... you have been through it. You and @Curiosity ... and you already know cancer has touched my family.
The straight in with the ambulance comes up often with my mother. If we start at an urgent care, and they decide she needs to go to the hospital, they recommend in an ambulance because she goes right in bypassing the lobby. One time the ambulance ride was just to hospital across the street. By right in ... that just means a room where you can still wait for hours. We just spent 11 hours at the ER a month ago for two skin tears and a bump on the head (mom). Went in at 4:00 pm and left at 11:00 pm. Docs, nurses ... would pop in once every couple of hours. Nice people ... bad system imo.
movdqa
Talk Tennis Guru
You win the FIRE award.
movdqa
Talk Tennis Guru
We've done that with my mother too. She received a notice from a social worker who had inspected her house and the social worker told her that a rug was a hazard. A few weeks later she tripped on the rug and fractured her upper arm. We were in the hospital for ten hours while people came in and out to look at her and treat her for pain. They brought in someone who does the adjustment (with a LOT of force) to line the bone sections back again. Then they admitted her for a few days and then she went to the skilled nursing facility for two weeks. I'm an hour away so it's challenging when this stuff happens. I have a sister that's twenty minutes away but it's somewhat not fair that she does everything. Other relatives are on the other side of the country.
Taking care of parents can be a lot of work, particularly when they want to maintain their independence.
These kinds of costs are obscene in my book. Nobody who is not wealthy would be able to pay them without insurance. We get charged about 10x what the rest of the western world pays for same care. Our income is not 10x theirs.
ByeByePoly
G.O.A.T.
South Wretch Diet ... good one.
movdqa
Talk Tennis Guru
They are not obscene. They are to offset the losses that the hospitals incur for Medicare and Medicaid reimbursements below cost and also for those without insurance that skip out on the bills.
My son is employed by the parent of the hospital and I read their financial reports and they haven't done all that well in the past couple of years. They have spent any gains on shoring up their pension funds, now at 102% coverage. This is why Medicare for all won't work - it will bankrupt hospitals.
ByeByePoly
G.O.A.T.
You have to love the part about “negotiated the price down”. Sounds like buying stuff from a street vendor on an island vacation.
PhxRacket
Hall of Fame
I just retired after 30 years teaching...at...53. I am also moving on from a side gig at a local pro shop so that I can play tennis socially and competitively as much as possible.
movdqa
Talk Tennis Guru
Some percent of something is better than 0% of nothing.
I negotiated a $14,000 bill to $8,000 for a relative without insurance a few years ago. If you offer to pay on the spot, they may take off up to 50% off the bill. I'd guess that they get nothing in most cases.
ByeByePoly
G.O.A.T.
“This is why Medicare for all won't work - it will bankrupt hospitals”
You mean with everyone profiting like they are now ... thinking mainly big pharma but surgery bills are obscene also.
I think the current system is bankrupting us ... so hope we figure out one that doesn’t.
movdqa
Talk Tennis Guru
I know a guy that was a physics teacher and was a pro at a nice club during the summer. It was a long drive but he enjoyed the work. He was my stringer for a while too. I haven't been able to get in touch with him so I don't know what happened to him.
Here's a chart of GILD: http://schrts.co/YitnXBuc
Do they look like they're making a ton of money? You'd think that Beyond Meat would be making orders of magnitude more money with their 700% stock rise in the past couple of months.
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