Not Blogging Equals Stress

As I also previously blogged, I haven't been blogging as much recently. And I have been feeling very stressed, and depressed recently. I realized these might be connected. At the beginning of my medical disasters (except my hysterectomy which was 18 months earlier) 9.5 years ago, I started blogging about my medical crap. I was 'expressing my stress' (say that three times fast). I trained myself to vent through my writing. Then I haven't been writing, so I haven't been venting.

Last night I started thinking (which is very dangerous at times) and realized that I really need to start blogging again for the emotional stress release I need.

What is on my mind causing me stress? The bump on my head was a real eye opener to my stress levels. I spent most of last week doing a lot of nothing.

I stayed home all week, not just one day as usual. I went to PT on  Monday and the doctor for my concussion diagnosis on Tuesday and that was it. I physically was not up to doing anything else. I didn't go to the gym at all. When I go three times a week, I get to see a lot of people and chat with some. I think its my one big 'get and see people' event each time I go. I also cancelled my second PT appointment of the week and skipped my knitting group. In not going out, I really isolated myself. Which was very bad. But I did feel so bad the beginning of the week that physically I needed to stay home and rest.

By the end of the week, physically I was feeling better but emotionally I was feeling worse. In addition to not going out, I didn't blog much so I didn't get to vent as I needed.

Saturday I had a craft show and I was very happy that I actually felt good enough to be there all day. This week I plan to be social - go the gym 3 times, PT twice, meet a friend for coffee, go to my rheumatologist, and prep for my next craft show this coming Saturday. I also plan on blogging every day.

Today is Better Than Yesterday

By the end of yesterday, I was beyond stressed. Let's see why was I stressed: I have been feeling like crap because of the bump on my head. I have two friends in hospice care (see yesterday's blog). I have several other medical issues to deal with - my PCP keeps sending me with more blood tests to figure out why I have been so anemic (problem since chemo). My neck hurts from the (stupid) bone spur. My mother ended up in the emergency room yesterday (but she's going home today). I have my first craft show this weekend and need to get ready. I can't remember the rest.

I was so stressed I was ready to call for an prescription of ativan (a/k/a lorazepam). But I survived.

This morning I have taken my time to get ready for my upcoming craft fair. I have also talked to a friend and my mother.  I feel slightly less stressed and am relaxing enough to get things done.

I hate stress. I don't need any more medical issues. My mother needs to get healthier.

That little evil voice

After years of medical crap behind me, I still get those nasty niggling thoughts that something new might actually be wrong with me. What is the reason for that 'new' problem? Is it cancer again? No I can't get cancer again. I have had my share already thanks. My body can't take much more please. 

I admit to having some not so good thoughts about pains in the past few days that are leading me to making new appointments with a couple of doctors. This does not make me happy. But sometimes I have to just calm down that little evil voice that causes me so much stress. But since its a Monday morning I have to wait a bit to call in to make appointments because everyone else in the world is also calling in because they get sick on the weekend too.

Anyway my health management basically consists of quieting the little evil voice whenever it speaks up. Is there special health insurance for that? There should be.

Stress is Bad for My Waistline

This isn't a good week. (I swear I do have good weeks, just not right now.) The reasons why it isn't a good week is that I had an MRI Monday night so I was up way too late - meaning after midnight. Today I have a deep cleaning at the periodontist. This means they will inject Novocaine and then scrape way under my gums. I expect I will have soup or scrambled eggs for dinner. Then tomorrow night I have the sleep lab so I don't expect to get a good night's sleep again. I know I whined blogged about this earlier this week but I want to whine some more.

Yesterday I needed a two hour nap to recover from Monday night. I also needed too many snacks. Today I think I will probably be grumpy. I plan on eating lunch before my appointment which probably means some kind of fast food which is bad. But I think if I have some food in my stomach I will probably handle the teeth scraping better. (My dentist has told me this several times - eat a good meal before dental work. Having food in your system makes a big difference.) Also I probably won't be able to eat for a few hours after between sore gums and numbness.

When I am stressed I find myself stress eating. I know I am doing it and have tried to turn myself towards fruit instead of fattening food. But its just too many categories. When I am extremely stressed (think cancer diagnosis level of stress) I stop eating and actually lose weight. I need to lose weight but I am happy I am not that stressed and am at the whining stage.

I just need to watch what I eat and get through this week. Then I'll stop whining.

So What Does RA Feel Like?

There is a big difference between rheumatoid arthritis and osteoarthritis. Osteoarthritis is the kind from overuse that causes your knee/elbow/hand to hurt when you over use it, or maybe even when you aren't using it. Rheumatoid arthritis is systemic and starts with your little joints - like your feet and hands. The joints become achy and bulge and more.

This article explains better than anything else I have seen on what RA really feels like:

Like the fatigue and exhaustion after climbing a mountain or running a marathon.
Like the aches and pains after a significant fall or being in a car accident.
Like the full body aches and pains of a bad case of the flu.
And the stress as you wait for a flare to happen and make all the aches and pains start again.

"However, in order to truly understand, you must envision your injury, the flu, and the exhaustion all occurring at the same time. You must accept that your body would not heal in a few days, you would not be refreshed after a night of good sleep, and your ‘normal' would forever be compromised. But like all RA patients, in time you would learn to adjust. Having Rheumatoid Arthritis is not the end of the world it's just another way of living in it."

Not only that you can't forget the mental confusion sort of like chemo brain.

This is part of my life. And add in all my other health issues and I am the picture of health.

A Post for Sick People

As a follow up to my earlier post for Friends of Sick People, here's a post for my advice for people who are sick.

As a patient with an icky medical diagnosis, you need to remember the most important person you need to take care of is you. I know you love your children, spouse/partner, and other people close to you but you need to focus on you for a bit. You will need more rest and care than usual. You will spend a lot more time at doctors and other appointments. Any time when you are not at work you will probably be focused on your (lack of ) health. Nap time!

You may find the need to set some rules and requests for other people. You are not being rude, you are letting other people know how they can best help you. You need to rest and take care of yourself, go to doctor appointments (and then recover from them).

Personally I decided I needed to limit social visits and phone calls. Newly diagnosed with cancer, and a cascade of additional medical issues, I decided I was not going to answer a thousand phone calls, texts, and emails asking the same (damn) questions and decided I would provide information for others in my blog. If anyone wanted to know how I was doing, they need to read my blog (unless you are my parents, they are allowed to ask me questions or my husband who went with me to all important appointments). If people wanted to come over, their visit had to be short.

People often want to be helpful but are unsure how they can help. If someone says anything about any kind of help, you can give them concrete ideas on what you need. A casserole for dinner? Help with laundry? Do you need someone to help get your children to school on some days or maybe even getting you to the doctor?

And its not just the physical issues but also your emotional self. At my second cancer diagnosis I decided I needed emotional support and joined a support group before my second surgery. I wasn't going to let cancer suck any more enjoyment out of my life.

If you feel you need more emotional support, start with your doctor or a social worker at your local hospital. They will have access to information on where you can find help. In addition, look for local support groups through your church or local support centers. And the stress? I'm not going there.

It is important to remember that the most important person, emotionally and physically,  is the one with the ailment.  Don't forget!

Exercise for Memory???? Or Cancer Causes Stress.

A new study (because we all new more studies) says that exercise can boost memory for breast cancer patients. What? I exercise and my memory is shot, getting worse every day. I don't believe it.

The theory is that exercise alleviates stress and benefits women psychologically which improves their memory.

"A surprising finding is memory problems appear to be related to the high stress load cancer survivors experience, and may not be specific to chemotherapy or radiation treatments."

That's surprising? To me this is even more important than figuring out that exercise improves memory. Seriously, I could have told you that a cancer diagnosis causes incredible stress. It just amazes me how many people do not get that part. Obviously they haven't been diagnosed with cancer. 

I Am Feeling Stressed

I didn't blog yesterday and am a little late today because I hadn't really decided what was going on with me. Finally (call me slow if you want) I decided I am feeling stressed. And I am beginning to figure out why I am so stressed. I have a lot going on. Nothing major medically but just too much stress for me.

Last month, in the spirit of doing something good, I decided to convince my husband we need to adopt a third cat. As soon as I asked about where are the good local shelters someone offered me her two cats that she needed to get rid of (because her son was moving home with his dog who didn't get along with the cats). [Maybe the son shouldn't have been allowed to bring his dog home.... but its not my house so I kept my mouth shut.]

We waited until we got back from vacation and picked them up a week ago Sunday. When we went to pick them up my husband said 'you are making a mistake' but I still thought I was doing something good.

They were two incredibly obese orange tabbies that had been locked into an unfinished room in the basement without windows for 'several weeks'. They were not in good shape. I still thought I was doing something good.

We brought them home and put them into a separate room and I put them on diet food. Except Sunday afternoon we had two cats. Monday we only had two cats for a brief period of time in the afternoon. Tuesday afternoon we had two cats for about 5 minutes. This Sunday morning, after reporting a lost cat to animal control, we then had two cats again at about 4 am. We also had two cats for about 30 seconds at 5 am this morning. One of them (I think its Jake not Ginger), can jump over the baby gate we have keeping them in a separate room. He keeps hiding in the basement (we think).

This morning I found someone had pooped on the laundry room floor and someone else had tossed their cookies on the rug in the finished part of the basement. I decided that's it. They have to go back. We took them conditionally - if WW III broke out in our house, they had to go back. Right now we have four cats who keep hissing and growling at us and each other. I can't take it.

Ginger (or whichever is not lost living in the basement) meows all the time when he is hungry - which is all the time because he is on a diet. He keeps me up. (Who names a boy cat Ginger anyway?) If I close the door to either his room or our room, I can still hear him meow. I don't sleep well because of my pain levels and other health issues anyway. And if one cat is not meowing, another one is, or growling, or hissing at each other and having a 'conversation' that keeps me awake.

I really wanted to do a good thing but I can't do this one. I need to take them back asap. Like this afternoon. I am getting rid of one today around 6pm. I just have to find the other one so I can take them both back.

I do feel guilt. But I also believe that I need to take better care of myself. I felt my stress level go down after I made the decision. I called my husband and he is okay with my decision (and is probably telling me that I was making a mistake in the first place.

I am not in the position to do good deeds until I am in a better place with my place (in a few thousand light years).

Managing All That Bad News

Recently the news has been dominated by all sorts of horrible headlines on all these tragedies (and politics). It can be very hard to take for everyone. I admit there have been so many events that every day on the news you hear about another one and you begin to wonder 'that really can't be another one, it must be the same one I already heard about'. Sometimes the media becomes a blur of blood, bias, guns, and gore. 

I recently found an article that discusses how to cope with all this bad news. The gist of it was 'turn off the news' which I find to be sound advice, especially if you want to preserve your sanity. 

"This constant churn of harrowing news is physically and psychologically unhealthy, and you don't need to be directly involved in a tragedy to feel its effects. To the concerned viewer, this pain can feel unavoidable or even necessary. It might be a little bit of both. The truth is, in an age of unfettered access to the worst of humanity, we have to act as our own gatekeepers if we want to stay sane."

It made me think that as a patient, I get a lot of bad news directed at me. And I often get the question 'how do you cope?'. 

Over the past nine years, I have learned to cope in my own way. When diagnosed with breast cancer, I quickly learned that I could not digest all the implications right away. It took time - time for the latest to sink into my brain. 

I started trying to learn all about my cancer and treatment options. I immediately went into information overload and my brain fizzled out. So I basically turned off my brain for anything past the stage of treatment I was in. I couldn't handle any more. While I was coping with surgery, I learned about surgery, post surgery, potential issues including lymphedema. Once I was through surgery, I learned about chemotherapy. I took it in stages so my brain could cope.

A big part of the trauma of cancer is coping emotionally. And that coping extends to outside issues as well. I can't live in the world of  'all bad health all the time' or 'all cancer all the time'. No one should live in the 'all bad news, all the time' mode. We can't keep our sanity and deal with all the doom and gloom. So turn off the news, go outside and smell the roses for a while.

Changing Stressors

As life goes on, my stressors have changed. Or maybe just the list gets rearranged. When I first started blogging, breast cancer was my primary concern. But then my health started to fall apart and things have changed.

At my breast cancer diagnosis, I quickly prepared myself to cope with breast cancer and I came up with a plan - support groups, etc. And I dealt with it. 

Then I got gall stones and had my gall bladder out. Then I found out I should be seeing an endocrinologist about my thyroid cancer which made it harder for me to ignore it. When I went to one she sent me for an ultrasound which found some thing on the thyroid bed which we had to follow and it stressed me out for a while. Then my back started hurting. then I was diagnosed with fibromyalgia and rheumatoid... Somewhere in there I got a root canal too....

Where am I going with this? I had lunch with two breast cancer friends this week. One of them has  multiple other current health issues. We were talking about them and she said that breast cancer was the last thing on her mind these days. She needs to get the rest of them fixed so she can back to worrying about breast cancer.

For me, my stressors now revolve between what is my current worst (usually health) problem. It can change daily. I sort of hang on during my roller coaster ride. 

So how do I cope? I have created my own little support world. I burn off stress by going to the gym three times each week. I have a therapist I see monthly. I have a meds therapist (with the good drugs) to keep me sane. I have a weekly knitting group at a local cancer center. We all are coping with cancer. I also get together with my other 'unhealthy' friends and we hang out and talk bitch about our health concerns.

Since I can't be healthy, I just try to keep my sanity. If at all possible.

Warning: A Cynical Post

They, the infamous, all-knowing 'them', say that after a cancer diagnosis, in one year you will reach your 'new normal'. As I have said before, the whole new normal thing is bogus and not worth seeking because it doesn't exist.

And its not after a year either. That year concept is wrong. First of all, your treatment may not end in a year. You are forever changed and even if your body returns to something resembling your previous body, your mind has been irreparably scarred. At every doctor appointment or test or scan for the rest of your life there is that evil little voice that says 'what if....'. It also shows up in the middle of the night when you can't sleep, or it wakes you up.

Also there are the people, like me, who find that after that cancer diagnosis, your body continues to rebel and send you down the never ending medical spiral of more ailments. While in chemo, in addition to growing a benign breast tumor, my gall bladder developed gall stones (a completely separate ailment) which led to surgery. Other people I know have developed cardio issues and other treatment side effects. And the women who chose reconstruction face additional surgeries. Never mind all the people who suffer from significant side effects from treatment and surgeries.

I am lying in bed this morning, waiting to take the (damn) cats to the (damn) vet. They are sleeping peacefully next to me but I know at the first sign of the dreaded carriers, I will be faced with the game of 'chase' with me chasing them so I can stuff them in their carriers. Full carriers are hard for me to pick up and carry to the car. When I arrive at the vet it will take two trips to get them inside. But they need their physicals and shots and exams (which they will hate). When we come home they will hate me. And my back will be killing me.

And I hate it that my body no longer allows me to do all the basic things in life that I used to be able to do. I am frustrated with my pudgy body that makes that is difficult to lose weight.

Yesterday I finally finished the latest request for information for my SS Disability application which includes asking me about how my ailments have changed my life from before when I was sort of healthy to after when I can only when I can watch everything I used to like or that used to be easy for me that are now a struggle. I really do not need reminders of the things that I can no longer do.

Pause. Deep breath.

Sometimes my inner cynical b*tch comes through and needs to vent. Maybe this is why I need therapy to cope.

Trauma and Ailments

One of my many ailments is fibromyalgia. How fun. NOT! This is from Web MD.

"Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals."

Yes, fibromyalgia amplifies pain. It makes life so much fun. I don't get a little twinge, I get ripples of pain across parts of my body.

"Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event."

Could a second cancer diagnosis be considered 'a physical trauma, surgery, infection or significant psychological stress'? Do we remember those studies that associate cancer with PTSD? Yes. So is that how I ended up with it and rheumatoid arthritis? RA does run in my family. But no one else has had fibromyalgia.

"Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression." 

Depression? From cancer twice? Maybe. And add in my other health crap. And the best part is always the last.

"While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help."

So could the trauma of my health disasters pre-2012 have triggered my fibromyalgia? One of those little medical mysteries I need to learn to live with. Along with why I got cancer twice before 50 and why my body then decided to fall apart. I'll work on sucking it up for now because I don't see much choice in the matter.

Would you get a dog?

I am a cat person but after reading this article about dogs who sniff out cancer, I briefly considered getting a dog. I am not a dog person. Its not that I don't like dogs, I do. I think for a pet they are a lot of work. You have to make sure you are home to walk them etc.

However, if my dog could sniff out any cancer in me before it could be found by a scan or test, I would be very happy with a dog. It would save me a lot of stress and anxiety.

Like all other cancer people, I have more concerns about another cancer than the average person. There is only so much kale and greens eating, green tea drinking, alcohol avoiding, and exercising that a person can do. We get examined, tested, lectured, and any other things our doctors tell us we should and shouldn't do often.

But we still have those 'what if' moments in the middle of the night. So if when one of those moments occurred and we had a cancer sniffing dog sleeping next to the bed who was not concerned about any cancer scents coming from us, we would be reassured that there was no need to concern and more easily go back to sleep.

So I will follow this research and consider getting a dog. I'll have to ask our cats about this as well.

Patient vs Doctor

I often write about what its like to be a patient. Well, not just often, more like all the time. Why? Because I am a patient who is a frequent flyer at the local hospital. Sometimes I know more about the hospital than its employees.

As patients we go through our medical adventures and misadventures and move on. That nasty test is over. The bad results are digested and a treatment plan comes along. We have our emotional highs and lows and we keep on going.

We hear about the potential risks and problems at each treatment. We hope for the best and sometimes cope with the worst. We develop ways to cope and move on and grow.

But what about the doctors and nurses and other medical professionals? I have never really stopped to think about them and how they cope.

First of all in their jobs, every day is like Groundhog Day. They must deliver good and bad news, administer tests and watch their patients react. They help cure and heal some patients, and are forced to watch others slip away. That must be incredibly difficult. It must represent a failure for those who took the oath to 'do no harm'.

They work hard to help their patients and then some they can't help. So what is your job? Engineer, cook, parent, soldier, butcher, baker, candlestick maker? What if what you make is a total flop? How does that make you feel? But what if its not just a flop but someone loses their life?

And what about the further burden of a patient who follows their advice to a T and still doesn't make it?

The emotional toll must be incredible. I could not imagine. And I had never ever thought about it until I read this article on a doctor who writes prose and poetry as an emotional outlet to cope. That's not that much different from being a patient.

How strong is that 'little voice'

Tomorrow I have a doctor appointment. Its not a big deal, just a follow up with my rheumatologist, including a discussion of my blood work last week. On the surface its not big deal. I don't expect any big news. Maybe a little tweak in my medications at the most.

But there is always a little (tiny cancer 'what if') voice in the back of my head at every doctor appointment. The question is always 'what if' something isn't right that leads to more testing that leads to something else which finds something 'bad'.

I can't help it. That little voice is an evil thing. Learning how to balance that evil voice is a lifelong journey after cancer. It never goes away. Keeping it quiet is the challenge.

When I had my hysterectomy before breast cancer, nearly 25 years after thyroid cancer, I was compelled to ask my surgeon if there was any chance of cancer there. I couldn't stop myself from asking. She assured me that they would 'slice and dice' to make sure there was none.

And there was none.

After breast cancer, that evil little voice reared grew in volume again. With a vengeance. Its only been over 8 years but that voice tends to sneak into the back of my brain. It tries to tell me that some ache or pain could only be 'really bad'. I can't let it run my life.

But I will go to the doctor tomorrow and tell that stupid little voice to keep quiet. I hope. Maybe if I could leave it behind that would be better.

Not a good start

Its early and today is not off to a good start. I can't find my damn glasses and am wearing an old pair which will give me a headache soon. I am exhausted and I have to go to work for a few hours. (My replacement quit and I said I would go in and clear up any disasters for a few hours.) I would skip work but if I do, I don't think I can get there for a week due to my schedule.

I would prefer to stay in bed for the morning and not go anywhere. This is why I 'retired' so I wouldn't have to work when exhausted.

What I need to do right now is to get up and look for my glasses. I think I probably fell asleep wearing them and they are wrapped up in the blankets somewhere. This means I need to take the bed apart and see if I can find them (before I get a headache). This is not conducive to resting. Grrr....

Now I can relax

The past few weeks have been horribly stressful for me. I have been sick basically since mid-December. We did not really celebrate Christmas and New Years. And the move was very stressful as well between the lawyers, realtors, and bankers and numerous delays. Anything that could have gone wrong seems to have. Finally we got moved into to our new house.

Before his big adventure

But we were short one cat. Our cat, Boots, got out while at the cat sitter last week. I have looked for him numerous times, put up signs, notified animal control, shelters and rescue league. This morning I had a few minutes and was near our old house and wanted to see if maybe he had made his way back there. But the new owners were having appliances delivered in big trucks which would scare him too much so I left.

Then I had a doctor appointment and decided to make one more trip down to the cat sitter's neighborhood. I called Boots and he came running. I grabbed him and put him in the car. I had a can of cat food and the cat carrier with me so I could feed him if I found him. I also gave him water.

After his big adventure

He is skinny. He is a little more skittish. And he is exhausted. I need to check his paws to make sure they are okay but otherwise he seems fine.

I was extremely stressed about him being gone. I did not want to give up on him but was also concerned about what if we never found him. I could not forgive myself for that.

Stress is hard on me. I can't sleep when stressed. I have enough problems sleeping with insomnia and pain I had started skipping meals because of stress. I am happy to lose a few pounds but that's not a good way to do it.

Now I can relax and focus on unpacking and taking care of me again. I know I just posted this all on FB so if you read it there already you can ignore this whole post. This just shows how stressed I was.

Twenty Four Seven Medical Care

It has always aggravated me that if you get sick on a weekend you either wait until Monday to see a doctor or end up at the Emergency Room which is the wrong place to be unless it is a true emergency. And the horror stories of the surgical errors over the weekends because the only surgeon on call was two hours away.... I will admit that this has improved in recent years with the advent of more walk in clinics and longer hospital hours. But, we get sick and stay sick 24/7/365.

And the worst is having to wait all weekend for test results. Why can't someone read the damn test results and tell us on Saturday instead of making us wait until Monday for an answer? Any cancer person is familiar with this issue

Forbes Magazine wrote an article recently on New Year's Resolutions The Key Players in Healthcare Should Make. This issue shows up on the third page, after recommendations for doctors to improve their practices and synching electronic medical records.

So why do hospitals essentially close down on weekends? I completely understand administrative offices working a five day work week and the convenience of having all the staff available at the same time for better communication, yada, yada, yada. But why do medical staff also work only Monday-Friday? We don't just get sick between 8 and 5 on Mondays to Fridays?

There is always the complaint about too many patients coming in. But what if the hospital hours for medical care were stretched over seven days instead of five? The staff could still work the same number of hours but just over a longer period of time. And if you get a medical test, you don't need to wait for someone to read the damn report. If you were admitted over the weekend, you don't need to wait until Monday for surgery to be scheduled. I can go on.

'Bankers hours' medical care should be a thing of the past. The only people who benefit from being hospitalized over the weekend is the hospital - they get to bill the insurance companies for more nights' stays. Wouldn't it be better for the patient to be operated on over the weekend and then get out of the hospital?

What if hospitals were open for care half the time instead of a quarter (five nine hour days = 45 hours/week or 26.7%) of the time? What if hospitals were open 7am-7pm Monday - Sunday? Waits for appointments would be shorter. More patients could be treated. Patients who work full time could see doctor's at more convenient times. This is only 50% of the time, not 24/7/365 but its a big step toward more access.

I know this would require more staff but then hospitals would have less down time and would operate more efficiently and their expensive testing and surgical equipment would get used more and therefore be more profitable. And the patient's would be better treated and less stressed - quicker access to care and more information on their conditions.

Just an idea... I'm just a professional patient who hates waiting to find out the answers.

Connect the Mind with the Body

The 'all-powerful' insurance companies have been mandated by law to cover mental and behavioral issues the same as physical ones since 2008. But just because the law says so, doesn't mean this really happens. (Didn't I just blog about this? I did, yesterday. And then today's Boston Globe has an article on this very subject.)

The new way of health care payments, the global payment system, may actually lead to better care for the emotional side of treatment. The payments are made per patient and not per treatment and an emotionally healthy patient is probably better at managing their medical treatments.

"The hope is that global payments are providing incentives for insurers and providers to finally raze the longstanding wall between mental and physical health care, since reimbursements are based on patient outcomes. Potential benefits are obvious — people suffering from both diabetes and depression, for example, would be more likely to consult a doctor for diabetes treatment if their mental outlook improved. Conversely, depression might ebb in patients who keep their diabetes under control."

For anyone who went through chemo, didn't you just have some days where you were too tired and too sick and too sick of being sick to want to go through chemo and someone had to persuade you to go?

So maybe with this global payment system,which is not yet perfect and shows some gaps for some patients, will help with this. At this point, I am happy that I am not the only one who cares about the emotional side of being sick.

The Big Gap in Treatment for All

Someone said something the other day that hit a nerve for me. 'How well do you think the emotional needs of patients are met?' And I started thinking.

When I was diagnosed with thyroid cancer, my emotional needs were not mentioned. At all. When I first destroyed my knee skiing, no mention was made of the changes I faced in my life. That was when I first needed to give up some of my favorite sports - skiing was never the same again. When I had hysterectomy, I was given the advice by friends to go to hystersisters.com to answer a lot of emotional questions and the long term impact of the surgery. I do not think my doctor gave me any advice. I mean I may have been given a pamphlet but that was it.

When I was diagnosed with breast cancer, I was definitely given a folder of information on resources - support groups, lymphedema, hair loss, Look Good, Feel Better programs. But I was the one who said I am going to a support group, asked for a therapist, and all that. My emotional needs were sometimes asked about but I felt I was the one raising the issue of how I was coping.

When I was diagnosed with fibromyalgia and rheumatoid arthritis, my emotional needs were not mentioned. these diagnoses are not minor, they are pretty much life changing. And doctors didn't think my emotions were an issue.

No matter what the doctor tells you, how often do they stop and ask you how you are doing emotionally? Somethings are minor - you get the flu, sprain your wrist, etc - you will heal and go back to normal. But after a diagnosis of RA, MS, fibromyalgia, heart attack, stroke, or anything else with a significant long term impact on your health that will change you forever, shouldn't the doctor and the rest of your medical team consider your emotional health as much as your physical health?