Trading in the 500 for a 200 OK
At last, after a week or two of 500 server errors, we're back into 200 OK land. Turns out a WordPress plugin (wp-cache) was acting up causing php.cgi to time out. I have no idea why it happened, no changes were made to plugin or backend software. Non-deterministic errors for the lose, I guess.
So…
I hope to start writing again soon. I've been absolutely mired in economics lately such that my time behind the pharmacy counter has been purely spent on auto-pilot. Truth be told, I'm not sure what to write about. Silly people aren't very interesting anymore, and there are other bloggers that do it better. Therapeutic stuff is interesting, but I haven't been thinking about anything interesting or controversial lately, and it's bad form to just make things up, so we'll have to see what comes down the line.
And really, I'd rather not bore you with economics talk, even though we are on the cusp of a nice little recession, and I could ramble for pages.
However LIBOR and TED are moving back in the direction of Sanity, which means the credit markets will continue to thaw, but that doesn't mean the rest of the economy isn't sputtering, and it'll take more than a non-stratospheric TED spread to get the real economy back chugging again.
Healthcare, of course, will continue to be relatively safe — if uninteresting — so long as your profit centers are relatively inelastic, and it's ultimately going to be green technology that really drives the market in the next ten years. Well, that's assuming that petroleum prices go back up to something like their true price, not their currently-low, market-determined price. I'm probably in the minority of people who wants to see gas prices go back up so we keep our eye on the renewable energy ball.
Pigovian tax for the long-run economic win!
My Doc smells…
…That's why we bathe him regularly. 
We adopted Doc — a name given to him by his previous owners — about 2.5 months ago from the local animal shelter. He's 8 years old, which is about middle age for a Beagle, and if I told you he barely makes a peep, you probably wouldn't believe me. But it's true — he only blows his horn when someone walks by outside with a dog, and not even then when I take him down to the city where that sort of thing is common.
He does have an irritating habit of trying to mount every female he encounters, however, but he makes up for it by making an excellent vacuum cleaner where food is involved. 
Bits and bobs
So it's been a little while since I've written anything, though traffic has gone up during this time for reasons I am unclear on. I can only imagine what it would be like if I'd continued writing steadily.
Back in January, I changed pharmacies — same chain, just a different location. I worked OT for ~10-15 hours a week for the entire month of January just to get the pharmacy under control. I probably sent back ~$50-60,000 worth of overstock — most of it in topicals. Spent a bunch of time creating a brain-dead easy supply chart so we don't load up the back room with unnecessary supplies. We've gone from overflowing shelves (of everything) and an overflowing supply area down to inventory that's more manageable. It was worth the extra effort. Anyone that's ever worked in a pharmacy with an inventory problem can attest to that.
I've always known — and taken for granted — that the easiest way to get people to do what you want is to make it easier for them to do the right thing than it is to do the wrong thing. In terms of the little stuff, like supplies, it means making the open boxes more accessible, and having them clearly labelled as to what they are so we don't have 6 open boxes of the same thing. You know, stuff that is so STUPIDLY easy that no one does it.
I can't help but think that if we were an independent store with an actual owner where every extra box of 40/60 dram easy-open caps and the extra 15 boxes of Taclonex came out of a real person's pocket, this would never have happened.
I hate wasteful anything. It gets under my skin in a way that dragging fingernails down a chalkboard bothers everyone else.
Personally speaking, I've been quite healthy in the last two months, which is a nice change from the end of 2007. I've identified the main food-based trigger that aggravates my gastritis — ice cream. (*sob*)
I won't bother to link my "about me" page again, because it largely talks about personal failures of mine that I don't care to revisit, but I think I've *finally* figured out what I think I'd really excel at studying formally. This has been difficult, because over the years I've had professors take me aside and tell me that I should "seriously consider" studying the following: physics, computer science, English, mathematics, and medicine. (As though my ego has ever needed any outside help.)
The trouble comes in that I've always been *terrible* at finishing anything. Start with a bang, get bored, and jump to the next interesting thing. The other trouble is that I've never really found any discipline that marries all of my (diverse) interests and skills. Math is beautiful when I can get into it; computing (and programming) knowledge has always been helpful — and occasionally studying it has been fun; before I got a computer, I checked out every physics book the public library had and read them all; medicine is, and always will be, fascinating; and writing is just something I've always done in the background — though I once discounted it as a useless skill.
You can see — I'm all over the map. What to do?
It hit me one day while I was browsing the web, as I am wont to do. I was looking through the course offerings at my state university, seeing what was interesting so that I could take some classes. I found myself avoiding the hard sciences because I could probably recite all of the degree programs and their requirements, and instead I focused elsewhere.
Where I stumbled upon Economics.
…and knew almost immediately that this was it. I looked over the requirements, looked at my transferred credits, and concluded that it should take me about a year to finish with a modest bit of effort. Having 160 undergraduate and professional credits really helps there. I think the main reason it really spoke to me was because basic economics principles are the basis of, well, everything.
From there… who knows. I'd like to finish pharmacy, since it's where I fell in love with clinical science, something I'll always have, regardless of where I end up. And there's nothing wrong with a PharmD and a license to practice pharmacy to fall back on. I guess the main practical thing is that it will open doors that are currently closed to me. That stupid piece of paper is really very important to everyone on the planet, it seems. Interesting that personal merit and skill are meaningless until you have that piece of paper, and then mean everything afterwards.
But then I guess it's as good a minimum barrier to entry as any.
Alright that's enough personal bullshit for now. I've got a couple of posts that have been brewing that are actually pharmacy-related…
When you've had more coffee than usual and…
You know how when you've had more caffeine than usual, and you're just barely past the edge of high-performance into the realm of "Hmm maybe I've had too much coffee"?
And then you get some unexpected, bad news out of left field that would make you feel pretty shitty without that extra stimulation, but because you've had more coffee than normal your baseline sympathetic tone is already elevated, and all of a sudden you've got skeletal muscle tremors and you can't sit still to save your life or focus on any one thing for more than 4 seconds and your hands are cold and clammy and your knee is going a mile a minute and you have to piss every 20 minutes which smells like the Kilimandjaro dark roast you just had?
Yeah, that's where I am right now.
On the list of things I expected to hear today, this was not near the top
I'm was a little upset this evening, but I'm getting more comfortable now.
I called my GI doc three days ago to discuss my ongoing issues, and I was able to get an appointment for this afternoon(!). The nurse that did the preliminary vitals and whatnot stuff was unfamiliar to me. She told me that the GI folks were borrowing her for the day from Cardiology downstairs. For some reason she decided to listen to my heart… and she took a really long time doing so. I don't remember anyone listening to my heart before except at my PCP's, and never for so long.
"Hmm," she said.
"'Hmm'? What does 'hmm' mean?" I asked.
"I think you have a heart murmur… has anyone ever told you this before?"
"Uh, no. No one's told me that before."
"I see… let me listen again."
Another long pause while she listens.
"Yep, sounds like you have a murmur. Let me tell [Dr GI] so he can have a listen."
We then go on to have a five minute discussion about drugs, psychopharmacology, clinical pharmacy, and people with entitlement issues. (WTF)
My doc comes in, says hello, we talk about a great many things like we always do (last time we talked about the ins and outs of the laws governing anesthesia and CRNAs in the state of Massachusetts and this time we talked about Thanksgiving, travel, and energy efficiency and how it relates to electrical engineering. I love my GI doc — he's great.)
I was substantially less freaked out at this point, and we both almost forgot the murmur. He listens with me sitting up and lying down. He confirms it, suspects PVCs — something I've suspected I've had for about four years now — and we talk cardiologists. Turns out, one of the guys downstairs is an arrhythmia specialist, and does a lot of work with people my age.
–
I've been having mental battles with myself over the last couple of weeks whether I'm merely a hypochondriac, or if there's a real problem with whatever body part is letting me know it's there. I don't like to diagnose myself; I don't like to be one of those people. But I know that 1) I don't like going to the doctor every other week 2) I don't like taking pills and 3) I do my damnest not to be one of the people who taxes the system. I think that sort of rules out hypochondriasis.
Dropping a diagnosis on someone can be very disconcerting, even something relatively benign (most likely) like arrhythmia. Intellectually, I know that heart arrhythmia aren't a huge deal. I know millions of people have some kind of arrhythmia. I also know that most people have PVCs at some point during their life, and that rare is the person who has never had a skipped or extra beat. I have suspected that I have had some kind of heart trouble since the first time I walked up some stairs and I couldn't get my heart rate to drop for about five minutes.
I thought it was just the amphetamines I was taking at the time for ADHD. I'm certain those didn't help.
Since then, I've had four EKGs, and had my heart listened to by four doctors and countless nurses. They've all told me that I'm fine; there's nothing wrong. I heard it so many times, I believed it. I chalked it up to mere anxiety.
I'd just like to tell the world that I'm fucking tired of people ruling out something *actually* being wrong simply because I'm young. Delve deeper. Refer, if you must. Sitting here in my chair, sipping my decaf Columbian, this revelation explains a few things that I noticed were different about myself since since first grade.
I was always a pretty strong long-distance runner, but I suspect that's simply because walking was never (mentally) an option. I DID notice (and other parents noticed) that it took me longer to recover than the other kids. Where I might run a mile in 7 minutes or so, it would take me 45 minutes to an hour to get my breathing under control where other kids would be fine in 10 or 15 minutes.
Being in first grade, I thought nothing of it the first time someone said something to me about it. My chronic ear infections and multiple cases of severe poison ivy tended to be more pressing.
In junior high and early high school, I had a paper route, and despite biking 5-10 miles every day loaded down with newspapers, my CV endurance never really got beyond a certain point. When I played lacrosse in high school, my heart felt like it was going to explode pretty regularly. Moreso than the other kids.
More recently, while at the gym, I've hated cardio. There are days where I can run for 45 minutes to an hour and be fine, except for the very long recovery time afterwards. Other days, as soon as I move past a walk, I can feel my heart skipping beats. If I continue on, I get lightheaded and have to sit down. (Otherwise I'll fall down.) The more regular I am with cardio, the worse this problem is. It doesn't get better, it gets worse. Oh, and there's also the fact that about 10% of the time that I take a deep breath, my heart skips. (This is why deep breathing doesn't work for me when it comes to managing panic attacks.)
Of course, there's nothing wrong with me. I'm too young to have anything wrong with me. 19? 21? 25? Fuck it, it's all in your head. Maybe these R tards should read Groopman's book and try to take some of the principles to heart.
So while I was a little upset today at being informed that I have a heart murmur, I am somewhat comforted to know that I'm not mentally defective (at least not in that way ), and that perhaps I have an answer. At last. Yes, I know murmurs come and go. They're not always present while the provider is listening. But a Holter monitor was never discussed. Maybe I should have been more pushy. But like I said, I didn't want to be one of those people.
–
Back to diagnosis dropping before I close. Knowing something in your mind and reconciling it with the emotional reaction you have to this input are two completely different animals. In fact, logical reconciliation doesn't come until later, if at all.
I have been guilty of being somewhat dismissive when someone tells me something that's obviously bothering them. If I know it's trivial, or a problem that's easily managed, you tend to not think of it as a terribly big deal. Familiarity with and exposure to a disease state causes a recalibration of Normal. Perhaps even indifference.
But nothing is trivial, even if it's not serious or life-threatening. Not to the person receiving the news. Nothing. (Unless they're drugged out of their mind, like I was when they said "Hey dude you have Crohn's." I just didn't give a fuck at that point.)
Oh, and what takes the cake is that when I got home from work tonight, and informed my family of this revelation, my mom laughs and says "Oh yeah, I have a murmur, too." and my grandmother pipes up and tells me she's got one, too. What the fuck, people. TELL ME THESE THINGS so when I'm asked if there's any history of illness in my family I can give the correct answer. I know my grandfather died of a heart attack, but I always thought he was an isolated case and it was because he was a lifelong smoker and alcoholic. :rolleyes: But no, apparently most of my grandmother's brothers and sisters and my own aunts and uncles have murmurs, too.
The mind boggles. Apparently this information is trivial.
I wish I could replace my plumbing
Might be going away for a while. No, not to jail. :p Will know more tomorrow.
It sucks that we can augment breasts and tighten up faces, but we can't fix internal plumbing. Bits and pieces can be removed, but not fixed. Not in my case, anyway. I've got two problems right now. 1) My Crohn's is kicking my ass out the window and 2) I have some sort of testicular issue that's not probably not epididymitis. I've been taking diclofenac for #2 (thinking it was epididymitis), and I think it might be aggravating #1, despite the Crohn's being located in my ileum, and not my duodenum or stomach. Apparently diclofenac is considered a contraindication in Crohn's patients (just found this out). We will have to see. SSRIs play havok with my GI tract — I appear to be very sensitive to just about every psych med in the book. (Except benzodiazepines. :rolleyes: ) Not that diclofenac is a psych med.
Ironically, I'd probably have found this out quicker if I was healthy — feeling terrible makes it difficult to step outside yourself and look and think objectively about what is going on.
I think stress is playing a role here, too. I could really use a vacation. Somewhere quiet with a lot of alone time and some good books. However the finances do not allow it.
The prospect of drinking another liter of liquid chalk barium doesn't particularly thrill me, either.
I feel pretty horrible, and it shows in my crappy writing of late. 
[tags]Crohn's disease[/tags]