H1N1 Flu- (Last Post)

http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm#UnderCounting#UnderCounting

CDC Estimates of 2009 H1N1 Influenza Cases,
Hospitalizations and Deaths in the United States,
April 2009 – January 16, 2010

February 12, 2010 1:00 PM ET

April – December 12, 2009 Estimates
April – November 14, 2009 Estimates
April – October 17, 2009 Estimates

On this Page:

• Background
• The Numbers
• Table: CDC Cumulative Estimates of 2009 H1N1 Cases and Related Hospitalizations and Deaths from April 2009 - January 16, 2010
• Method to Estimate 2009 H1N1 Cases, Hospitalizations and Deaths
• Background Emerging Infections Program
• Seasonal Influenza-Associated Hospitalizations in the United States
• Seasonal Influenza-Associated Deaths
• Under-Counting of Flu-Related Deaths
• Related Links

Background

Estimating the number of individual flu cases in the United States is very challenging because many people with flu don’t seek medical care and only a small number of those that do seek care are tested. More people who are hospitalized or die of flu-related causes are tested and reported, but under-reporting of hospitalizations and deaths occurs as well. For this reason CDC monitors influenza activity levels and trends and virus characteristics through a nationwide surveillance system and uses statistical modeling to estimate the burden of flu illness (including hospitalizations and deaths) in the United States.

When the 2009 H1N1 flu outbreak began in April 2009, CDC began tracking and reporting the number of laboratory-confirmed 2009 H1N1 cases, hospitalizations and deaths as reported by states to CDC. These initial case counts (which were discontinued on July 24, 2009), and subsequent ongoing laboratory-confirmed reports of hospitalizations and deaths, are thought to represent a significant undercount of the actual number of 2009 H1N1 flu cases in the United States. A paper in Emerging Infectious Diseases authored by CDC staff entitled “Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009” reported on a study to estimate the prevalence of 2009 H1N1 based on the number of laboratory-confirmed cases reported to CDC. Correcting for under-ascertainment, the study found that every case of 2009 H1N1 reported from April – July represented an estimated 79 total cases, and every hospitalized case reported may have represented an average of 2.7 total hospitalized people. CDC then began working on a way to estimate, in an ongoing way, the impact of the 2009 H1N1 pandemic on the U.S. in terms of 2009 H1N1 cases, hospitalizations and deaths. CDC developed a method to provide an estimated range of the total number of 2009 H1N1 cases, hospitalizations and deaths in the United States by age group using data on flu associated hospitalizations collected through CDC’s Emerging Infections Program.[e1]

The Numbers

(Print table )

On November 12, 2009 CDC provided the first set of estimates on the numbers of 2009 H1N1 cases and related hospitalizations and deaths in the United States between April and October 17, 2009.

Estimates from April – October 17, 2009:

• CDC estimated that between 14 million and 34 million cases of 2009 H1N1 occurred between April and October 17, 2009. The mid-level in this range was about 22 million people infected with 2009 H1N1.
• CDC estimated that between about 63,000 and 153,000 2009 H1N1-related hospitalizations occurred between April and October 17, 2009. The mid-level in this range was about 98,000 H1N1-related hospitalizations.
• CDC estimated that between about 2,500 and 6,000 2009 H1N1-related deaths occurred between April and October 17, 2009. The mid-level in this range was about 3,900 2009 H1N1-related deaths.

Updated Estimates from April – November 14, 2009

Using the same methodology CDC updated the estimates to include the time period from April through November 14, 2009 on December 10, 2009.

• CDC estimated that between 34 million and 67 million cases of 2009 H1N1 occurred between April and November 14, 2009. The mid-level in this range was about 47 million people infected with 2009 H1N1.
• CDC estimated that between about 154,000 and 303,000 2009 H1N1-related hospitalizations occurred between April and November 14, 2009. The mid-level in this range was about 213,000 H1N1-related hospitalizations.
• CDC estimated that between about 7,070 and 13,930 2009 H1N1-related deaths occurred between April and November 14, 2009. The mid-level in this range was about 9,820 2009 H1N1-related deaths.

Updated Estimates from April – December 12, 2009

Using the same methodology CDC has updated the estimates to include the time period from April through December 12, 2009.

• CDC estimates that between 39 million and 80 million cases of 2009 H1N1 occurred between April and December 12, 2009. The mid-level in this range is about 55 million people infected with 2009 H1N1.
• CDC estimates that between about 173,000 and 362,000 2009 H1N1-related hospitalizations occurred between April and December 12, 2009. The mid-level in this range is about 246,000 H1N1-related hospitalizations.
• CDC estimates that between about 7,880 and 16,460 2009 H1N1-related deaths occurred between April and December 12, 2009. The mid-level in this range is about 11,160 2009 H1N1-related deaths.

Updated Estimates from April 2009 – January 16, 2010

Using the same methodology CDC has again updated the estimates to include the time period from April 2009 through January 16, 2010 on February 12, 2010.

• CDC estimates that between 41 million and 84 million cases of 2009 H1N1 occurred between April 2009 and January 16, 2010. The mid-level in this range is about 57 million people infected with 2009 H1N1.
• CDC estimates that between about 183,000 and 378,000 H1N1-related hospitalizations occurred between April 2009 and January 16, 2010. The mid-level in this range is about 257,000 2009 H1N1-related hospitalizations.
• CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths.

 

Note: Less than 5% of increases in the estimates from one reporting date to the next are the result of delayed reporting in cases, hospitalizations and deaths.

CDC Estimates of 2009 H1N1 Cases and Related Hospitalizations and Deaths from April 2009 - January 16, 2010, By Age Group

2009 H1N1	Mid-Level Range*	Estimated Range *
Cases
0-17 years	~19 million	~13 million to ~27 million
18-64 years	~33 million	~24 million to ~49 million
65 years and older	~5 million	~4 million to ~8 million
Cases Total	~57 million	~41 million to ~84 million
Hospitalizations
0-17 years	~82,000	~58,000 to ~120,000
18-64 years	~150,000	~107,000 to ~221,000
65 years and older	~25,000	~18,000 to ~37,000
Hospitalizations Total	~257,000	~183,000 to ~378,000
Deaths
0-17 years	~1,230	~880 to ~1,810
18-64 years	~8,980	~6,390 to ~13, 170
65 years and older	~1,480	~1,060 to ~2,180
Deaths Total	~11,690	~8,330 to ~17,160

* Deaths have been rounded to the nearest ten. Hospitalizations have been rounded to the nearest thousand and cases have been rounded to the nearest million. Exact numbers also are available.

The latest estimates released on February 12, 2010 incorporate an additional 5 weeks of flu data (from December 13, 2009 through January 16, 2010) from the previous estimates released on January 15, 2010.

The latest estimates through January 16, 2010 show a relatively small increase in the total number of 2009 H1N1 cases, hospitalizations and deaths since the previous estimates posted on January 15, 2010. The additional five weeks of flu activity data added to the get these updated estimates correlate with a five week period of generally low flu activity in the United States.

The United States experienced its first wave of 2009 H1N1 pandemic activity in the spring of 2009, followed by a second wave of 2009 H1N1 activity in the fall. Activity peaked during the second week in October and then declined quickly to below baseline levels in January. The early rise in flu activity in October is in contrast to non-pandemic influenza seasons. Influenza activity usually peaks in January, February or March. (See graph of peak influenza activity by month in the United States from 1976-2009.) Because 2009 H1N1 activity peaked in late October, the greatest increase in the number of estimated 2009 H1N1 cases, hospitalizations and deaths occurred during the period of April through November 14, 2009. The estimates provided for the subsequent 4 weeks (through December 12, 2009) showed a modest increase in the total number of 2009 H1N1 cases, hospitalizations and deaths and correlated with decreasing but still elevated flu activity nationwide. The most recent estimates updated with data from December 13, 2009 through January 16, 2010, correlate with a five week period of generally low flu activity.

Visits to doctors for influenza-like illness (ILI) in general were low between December 13, 2009 and January 16, 2010 and were either at or near the national baseline during all five weeks. During the week of December 13-19, 2009 (week 50), ILI was at the national baseline of 2.4%. It rose slightly during the week of December 20-26, 2009 (week 51) to 3.2%, decreased slightly, but stayed just above the national baseline at 2.4% during the week of December 27, 2009-January 2, 2010 (week 52), but then fell the next two weeks to below the national baseline at 1.9% during the week of January 3-9, 2010 (week 1) and 1.8% during January 10-16, 2010 (week 2). Similarly, the number of states reporting widespread flu activity declined throughout this time from a high of 7 states reporting widespread activity during the week of December 13-19, 2009 (week 50) to 4 states reporting widespread activity from December 20-26 (week 51), to one state reporting widespread activity the week of December 27, 2009-January 2, 2010 (week 52). For the weeks of January 3-9 and January 10-16, 2010 (week 1 and 2 respectively), no states reported widespread flu activity.

While activity so far this season peaked in October and then declined quickly to below baseline levels in January, there are still uncertainties surrounding the rest of this flu season, including the possibility of increases in circulation of seasonal influenza viruses and increases in circulation of 2009 H1N1 viruses.  In past pandemics, flu activity has occurred in waves and it’s possible that the United States could experience another wave of flu activity. In addition, sporadic cases of influenza may also be detected in the summer.

The data by age provided in the updated estimates continues to confirm that people younger than 65 years of age are more severely affected by this disease relative to people 65 and older compared with seasonal flu. With seasonal influenza, about 60 percent of seasonal flu-related hospitalizations and 90 percent of flu-related deaths occur in people 65 years and older. With 2009 H1N1, approximately 90% of estimated hospitalizations and 87% of estimated deaths from April through January 16, 2009 occurred in people younger than 65 years old. CDC is continuing to recommend vaccination against 2009 H1N1 at this time for all people 6 months and older, including those people 65 years of age and older because severe illness and deaths have occurred in this age group.

This methodology and the resulting estimates continue to underscore the substantial under-reporting that occurs when laboratory-confirmed outcomes are the sole method used to capture hospitalizations and deaths. CDC has maintained since the beginning of this outbreak that laboratory-confirmed data on hospitalizations and deaths reported to CDC is an underestimation of the true number that have occurred because of incomplete testing, inaccurate test results, or diagnosis that attribute hospitalizations and deaths to other causes, for example, secondary complications to influenza. (Information about surveillance and reporting for 2009 H1N1 is available at Questions and Answers: Monitoring Influenza Activity, Including 2009 H1N1.)

The estimates derived from this methodology provide the public, public health officials and policy makers a sense of the health impact of the 2009 H1N1 pandemic. While these numbers are an estimate, CDC feels that they present a fuller picture of the burden of 2009 H1N1 disease on the United States.

CDC will continue to use weekly data from systems that comprise the National Influenza Surveillance System to monitor geographic, temporal and virologic trends in influenza in the nation.

Method to Estimate 2009 H1N1 Cases, Hospitalizations and Deaths

CDC has developed a method to provide an estimated range of the total number of 2009 H1N1 cases, hospitalizations and deaths in the United States since April, 2009, as well as a breakdown of these estimates by age groups. This method uses data on influenza-associated hospitalizations collected through CDC’s Emerging Infections Program (EIP), which conducts surveillance for laboratory-confirmed influenza-related hospitalizations in children and adults in 62 counties covering 13 metropolitan areas of 10 states. To determine an estimated number of 2009 H1N1 hospitalizations nationwide, the EIP hospitalization data are extrapolated to the entire U.S. population and then corrected for factors that may result in under-reporting using a multiplier from “Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009.”.   The lower and upper hospitalization estimates also are calculated using the EIP hospitalization data. The national hospitalization estimates are then used to calculate deaths and cases. Deaths are calculated by using the proportion of laboratory-confirmed deaths to hospitalizations reported through CDC’s web-based Aggregate Hospitalization and Death Reporting Activity (AHDRA).
Cases are estimated using multipliers derived from “Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009.” 
The lower and upper end of the ranges for deaths and cases are derived from the lower and upper hospitalization estimates. The methods used to estimate impact may be modified as more information becomes available. More information about this methodology is available.

Throughout the remainder of the 2009 H1N1 pandemic CDC will update the range of estimated 2009 H1N1 cases, hospitalizations and deaths every three or four weeks. While EIP data is reported weekly during influenza season, because the system is based on reviews of patients medical charts there are sometimes delays in reporting and it can take some time for all the data to fill in. CDC will continue to provide weekly reports of influenza activity each Friday in FluView and will update the 2009 H1N1 Situation Update each Friday as well.

The estimated ranges of cases, hospitalizations and deaths generated by this method provide a sense of scale in terms of the burden of disease caused by 2009 H1N1. It may never be possible to validate the accuracy of these figures. The true number of cases, hospitalizations and deaths may lie within the range provided or it’s also possible that it may lie outside the range. The underlying assumption in this method is that the level of influenza activity (based on hospitalization rates) in EIP sites matches the level of influenza like illness (ILI) activity across the states.

This methodology is not a predictive tool and cannot be used to forecast the number of cases, hospitalizations and deaths that will occur going forward over the course of the pandemic because they are based on actual surveillance data.

Background Emerging Infections Program

The Emerging Infections Program (EIP) Influenza Project conducts surveillance for laboratory-confirmed influenza-related hospitalizations in children and adults in 62 counties covering 13 metropolitan areas of 10 states. (This includes San Francisco, CA; Denver, CO; New Haven, CT; Atlanta, GA; Baltimore, MD; Minneapolis/St. Paul, MN; Albuquerque, NM; Santa Fe, NM, Las Cruces, NM; Albany, NY; Rochester, NY; Portland, OR; and Nashville, TN.) Cases are identified by reviewing hospital laboratory and admission databases and infection control logs for children and adults with a documented positive influenza test conducted as a part of routine patient care. EIP estimated hospitalization rates are reported every week during the flu season. More information about the Emerging Infections Program is available.

Seasonal Influenza-Associated Hospitalizations in the United States

An average estimated 200,000 flu-related hospitalizations occur in the United States each year, with about 60 percent of these hospitalizations occurring in people 65 years and older.

Background: A study conducted by CDC and published in the Journal of American Medical Association (JAMA) in September 2004 provided information on the number of people in the United States that are hospitalized from seasonal influenza-related complications each year. The study concluded that, on average, more than 200,000 people in the United States are hospitalized each year for respiratory and heart conditions illnesses associated with seasonal influenza virus infections. The study looked at hospital records from 1979 to 2001. In 1979, there were 120,929 flu-related hospitalizations. The number was lower in some years after that, but there was an overall upward trend. During the 1990s, the average number of people hospitalized was more than 200,000 but individual seasons ranged from a low of 157,911 in 1990-91 to a high of 430,960 in 1997-98. 

More information about seasonal flu-related hospitalizations is available.

Seasonal Influenza-Associated Deaths

Flu-associated mortality varies by season because flu seasons often fluctuate in length and severity. CDC estimates that about 36,000 people died of flu-related causes each year, on average, during the 1990s in the United States with 90 percent of these deaths occurring in people 65 years and older. This includes people dying from secondary complications of the flu.

Background: This estimate came from a 2003 Journal of the American Medical Association (JAMA) study, which looked at the 1990-91 through the 1998-99 flu seasons and is based on the number of people whose underlying cause of death on their death certificate was listed as a respiratory or circulatory disease. During these years, the number of estimated deaths ranged from 17,000 to 52,000. This number was corroborated in 2009, when a CDC-authored study was published in the journal Influenza and Other Respiratory Viruses. This study estimated seasonal flu-related deaths comparing different methods, including the methods used in the 2003 JAMA study but using more recent data. Results from this study showed that during this time period, 36,171 flu-related deaths occurred per year, on average.
More information about how CDC estimates seasonal flu-related deaths is available.

Under-Counting of Flu-Related Deaths

CDC does not know exactly how many people die from seasonal flu each year. There are several reasons for this:

• First, states are not required to report individual seasonal flu cases or deaths of people older than 18 years of age to CDC.
• Second, seasonal influenza is infrequently listed on death certificates of people who die from flu-related complications.
• Third, many seasonal flu-related deaths occur one or two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection (such as a staph infection) or because seasonal influenza can aggravate an existing chronic illness (such as congestive heart failure or chronic obstructive pulmonary disease).
• Also, most people who die from seasonal flu-related complications are not tested for flu, or they seek medical care later in their illness when seasonal influenza can no longer be detected from respiratory samples. Influenza tests are most likely to detect influenza if performed soon after onset of illness. In addition, some patients may be tested for influenza using rapid tests that are only moderately sensitive and result in some false-negative results.
• For these reasons, many flu-related deaths may not be recorded on death certificates.

These are some of the reasons that CDC and other public health agencies in the United States and other countries use statistical models to estimate the annual number of seasonal flu-related deaths. (Flu deaths in children were made a nationally notifiable condition in 2004, and since then, states have reported flu-related child deaths in the United States through the Influenza Associated Pediatric Mortality Surveillance System).

Related Links

• Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009 
  
  
• Questions and Answers: EID article "Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April-July 2009"
  
  
• Mortality Associated With Influenza and Respiratory Syncytial Virus in the United States, Journal of American Medical Association. 2003;289:179-186.
  
  
• Questions & Answers: Estimating Deaths from Seasonal Influenza in the United States
  
  
• Influenza-Associated Hospitalizations in the United States 1979 Through the 2000-2001 Respiratory Seasons, Journal of American Medical Association. 2004; volume 292, no. 11.
  
  
• Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009, New England Journal of Medicine.
  
  
• Questions and Answers: NEJM article "Hospitalized Patients with 2009 H1N1 Influenza in the United States- April-June 2009"
  
  
• Public Health Surveillance in the United States, Epidemiologic Reviews. 1988; volume 10: 164-190

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Photo from CDC on Flickr. © All rights reserved.
Caption reads: This negative stained transmission electron micrograph (TEM) shows recreated 1918 influenza virions that were collected from supernatants of 1918-infected Madin-Darby Canine Kidney (MDCK) cells cultures 18 hours after infection."

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Unless something very odd happens, I believe this will be my last post on this terrible flu.
It has been so very interesting to watch this all unfold.
Have you known anyone? Lost anyone? Were you vaccinated?
I know a few people that did get this flu- And fortunately did live through it.
My heart goes out to those of you that have lost someone, or are still suffering.

God Bless.

XOXO
Anne

Thinking Cap$ on Please. (I Need Your Help).

Good Evening...
I am (almost) lost for words.
(I owe you BIGTIME if you can even get through the whole sordid mess)!

I know a lady that goes to the same pain center that Casey and I do.
She is a very nice lady. Well, unless you cross her. hehehe
(I really HAD to include that- As a show of deep respect and admiration).

She went in yesterday to get her prescriptions renewed for another month.

* Note:
If you have never gone to a pain management specialist doctor, you must go in every 30 days to have your pain meds refilled.
Upon your arrival to the clinic, they have a questionnaire for you to fill out, about 5 pages of different stuff.
You MUST fill every page completely.
I respect that they have you do this- Not for their own culpability, but to refresh the patients mind also.

One of the pages states something to the effect of, "I know it is harmful & dangerous to abruptly discontinue the use of these medications without doctor recommendation, supervision and guidance." 

You must check each box that you have read it each time. 
You must sign every page etc etc etc.

Thus begins her visit... Normal so far. hehehe

* Another Note:
She does not see her regular NP, rather an extra they have. New perhaps?

She indicates how much pain she has still been having- She is on extended~release morphine, in addition to something else for her breakthrough pain. I believe it is either oxycodone or vicoden.

This NP "ups" the morphine claiming that it "is less addictive" than her other pill that she takes for breakthrough pain; that when she hurts more, she should take an extra morphine pill instead of the other.

I really am at a loss to explain that to her. Hearing this makes no sense to me... But surely they know better than I do?
SO I remain mute. hehehe Really I do.
(Know that I will look it up for her- there has to be something online).
 
Since she had enough medications to last for exactly 30 days, she has none left. Keep in mind that going off either of these narcotics "cold turkey" as they say, will be dangerous to do.

She takes her 30 day refills prescriptions with her, and off to her pharmacy.
She has gotten these same meds refilled for a long time already, and at the same pharmacy.
They know her on sight, by name, and tell her the meds will be ready for pickup in about 20 minutes.

When she returns, she is told that her insurance will not pay for these medications. 
One is $319.+. Another is $250.+, the third is $112.+

She asks, "Why not"
Stating, "They have always done so in the past?"

The pharmacy explains she must contact her doctor and her insurance company, and straighten this out. That they have no idea.

She contacts both places; leaving a message at the doctors office, and being put on hold at the insurance company 3 times for an extended period of time. So the insurance company is basically unreachable. (She was on hold 20 minutes at one point).
The doctors office calls her back. They agree to do any/all interceding on her behalf.

Later, the doctors office calls again, saying that it is all handled and that she will have her meds by that night.

She calls the pharmacy.
Nothing was ready. Nor had it even been approved with the insurance! 
She tells them to "please run it again" because she already knows it is approved.

Thinking that she will be fine until morning, she calls back the next day.
Her prescriptions have not been processed, approved, or filled.

Many "pass-the-buck" phone calls later, this is what she knows"

1. The doctor tells her that it is in the pharmacy's hands.
2. The pharmacy tells her it is in the insurance company's hands.
3. The insurance company now tells her it is not a covered drug. (She will not be put through to a supervisor either).
   
   • She has received these same meds many times and they were ALWAYS covered.
     
     
   wtf!, Right?
   

Wow.
Again, I am at a loss for words.

She has been going to this pharmacy for her entire life. The pharmacy knows her. They have always gotten their money from her and/or her insurance.
This is a medicare advantage policy by the way.
Medicare Advantage policies are NOT Medicare. They are only a supplemental policy TO Medicare, and have nothing to do with the government.
This insurance company is on the east coast. With another phone call she learns that they apparently have not processed anything for 3 days, and are trying to catch up- The snowstorm put everything back, and they had been closed for those 3 days.

She cannot wait 3 days for her medications! To do so would jeopardize not only her pain, and her well being, but would add some very physical and nasty withdrawals to it.

She asks the pharmacy to please give her enough meds to cover those 3 business days, that she would pay for them herself.
No can do. It's all or nothing.
WHAT?!?

So... Who the hell is lying, and why?

Please know this is not Casey; although she has had her own problems with this clinic- Not ever with the doctor himself, but more specifically with the NP's (Nurse Practitioners). Lord knows the damned doctor doesn't have any time to spend with his patients to be able to piss them off in the 1st place.

Is your mind boggled yet?

This lady is also Native American- Choosing to use CVS instead of the clinic pharmacy because it is much closer to her home.

She calls the tribal pharmacy- Do they have these meds in stock?
Yes.
She calls CVS and asks for her written and signed scripts back, telling them when she would be there to pick them up.

She picks them up- One is written on, (the one she is already sick from withdrawing from), but they have attached a note for the Native Pharmacy to call them.

All is well.
She has her medications. (With a big smile from the pharmacist too)!

• CVS has lost a very loyal customer. Her monthly medications are over $8800.00 annually. Now add in a sickness, or stitches, or a broken bone to that.
  
  • In addition to herself, lose her parents, her children, and grandchildren to add that lo$$ for CVS.
    
    
• My guess is that the pain clinic will lose her also.
  
  • They lied to each other, one telling the other that it was all taken care of and covered.
    
    

• She will also change her secondary insurance at the end of the year.

Do these insurance companys actually make people withdraw from their meds? Is that even legal?
Or like the one gal said to her, "well lady, we are not doctors!"

Somethings not right!

What's YOUR take?
Whose mess is this?
Is that NP correct about morphine being less addictive than the others?

Know that you are not permitted to be at a loss for words since I already am.
~<;-)

XOXO
Me

Life goes on...
I should not have said "all is well." But she DOES at least have her prescriptions, and that is a relief to her.
It will take some time for these drugs to actually help her again.

"Hint, Hint"

Good Morning All;
We are home. Have been since late Tuesday. And it was an awful drive through "Snowstorm Doug"...

Our 'trip', (and what a road trip it was!), began nice enough-
And I was quite happy to see this sign.
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Oh yeah, Baby!
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I-94 was not bad at all; especially given the fact that Minneapolis had been under a storm warning for 2 days already- We were quite effectively snowed in, in that hotel.

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Smooth sailing on I-94 eastbound
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Almost as soon as I'd thought "well this isn't so bad" the road became downright crappy.
Worse than anything were the underpasses.
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Each and every one of them on our way home had this splotch of ice underneath. 
I slid the 1st few times thinking wth? I have put many, many, miles on driving in winter weather, and have never, ever, seen this phenomenon before.

Every time we went under the overpass, the car/truck slid a bit. Just enough to throw Casey's and my blood pressure up a few notches, and live on adrenalin.
I remain unimpressed.
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Of a sudden, our 4 lane highway turned to 2 lanes...
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Kinda...
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The 2 lane road came and went. When worst comes to worst, you can always drive on the graveled shoulder of the road. (If you can find it without going in the ditch). hehehe

For some reason, with God as our witness, ALL of the darn snowplows were heading west.
Had they been eastbound, then sooner or later one would catch up to them. It didn't happen.
Oh and yes, our road would have been plowed! duh.
Casey and I remarked on their absence more than once.

In some counties there was salt on the shoulders. In others, there was sand spread around between the lanes.
I hadn't wanted to stop.  Drives like this leave me with a very bad case of tunnel vision. I know I want to be home. I know the roads are very bad, and deteriorating with each mile, and no matter how much pain I am in.
I go slow, like the turtle, and thus far it has always paid off. Reasonable speed being the only practical way to drive, adding many silent prayers.
Casey's insides, and Punks bladder (and my own), would not allow for me to drive straight through.

We stopped to feed the girl, and to get gas twice- (That gasoline, just to keep as much weight in the car as was possible). It makes no never mind to me if I have 4~wheel drive. 
* I see LOTS of 4~wheel drives in the ditch and in the snowbanks in Winter. They simply cannot function on ice either.

Put snow over that ice, and you have problems.

Then add more snow...

And finally, a county snowplow in front of us!

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Add lots of wind, and a snowplow in the left lane...
Whenever he hit those drifts it was a complete whiteout in front of me for about 10 precious seconds. We were completely blinded, even staying back the requisite 200 feet.
Since there was NO passing him safely, he remained in front of me until he used an exit lane...
So much for asking for a snowplow.

Highway 29 became this 2 tracking road. I knew the 2nd lane was there, somewhere, I had some room for error..
Some cars passed me. Many 18 wheelers too, yet most remained happily behind me.
Why is it that the smaller the vehicle the faster they go? I will never understand that one.
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The closer we got to home, the more disappearing acts the road did...
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Finally going through Pulaski, and we were on County B.
Say Yay!
Only two nasty hills to deal with. These hills do not bother me overmuch- Maybe because I am close to home; and maybe because as long as the other cars know how to drive then all is well.
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Joy! The snowplow on this county road had gone our way! hehehe
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But that same snowplow, and the snow, had also obscured my driveways.
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Oops, but never mind- (Please refer to the fact that I have 4 wheel drive).
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A little extra push on the gas pedal, and little swing at the end of that driveway, and we were HOME!
And SAFE!
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The tire tracks were from Miss Kelli stopping by earlier to make sure the house was warm for our arrival.
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We weren't home for an hour and a half and Jim pulled in with his snowplow. Thank God for Jim!
I hadn't planned on calling him until Wednesday, but his wife Sarah had driven by on her way home from work and had seen the lights on.
And it was a godsend that he did come because then at least we could get in/out if we needed to.
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I swear my hands are STILL deep red and bruised from holding that steering wheel.

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Casey stayed here until Wednesday evening- Too risky for Greg to have driven out that night.

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Miss Punk, and a very noisy (and indignant) Mr. Sputnik were reunited.
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.
I have just checked the weather forecast:

"A WINTER STORM WARNING REMAINS IN EFFECT UNTIL 6 PM CST THIS
EVENING.
THE SNOW WILL QUICKLY SPREAD EASTWARD FRIDAY MORNING...
AND IS EXPECTED TO TAPER OFF FROM WEST TO EAST LATE FRIDAY
AFTERNOON. AT THIS TIME...IT APPEARS THAT SNOW ACCUMULATION OF
THREE TO FIVE INCHES WILL BE POSSIBLE IN THE WARNED AREA."

Oh wait! ~That's the forecast for Prattville, Alabama! hehehe

I sure hope William sends me more pictures, (like this one from last year).
Hint, Hint, William...
.
.
 
That's my Lawrence! (March/2009).
He will be 10 on the 17th. Time flies.
.
.
Texas already received their snow.
I have zero pictures of Isaiah or Wyatt in the snow.
Hint, Hint, Jenne.

"Hint, Hint" for Chuck, (and Katie, and Kristen, as well) !  hehehe

Uncle Chum called two days ago- He said he is doing well! (Sault Ste Marie, MI) and was going to be calling my Aunt Marlene that night.
She lives in Philadelphia, PA. They have gotten so much snow in the past ten days that it seems to be never ending. Breaking all records...

I'd better close for now, and get on with my day.

Hope you all have heat, electricity and are safe. (And once those things are taken care of then please get out and play in it)! I would love to see you take a picture of your own snow angel.

My love to all

XOXO
Me

Good Tuesday- Good Grief.

Good Morning Everyone-
As we watched the TV on Sunday night, clicking between Titanic and the game, I suddenly felt this awful shooting pain in my back. Not sure what it was- (I hadn't even moved at that point). But it sure took my breath away. I for one can surely think of more pleasant ways to have my breath taken away.

When I awoke yesterday it was obvious that although she was suffering, Casey was in better shape than I was.
I could barely even walk.
A quick phone call to the front desk ensured that Punk would be brought out to relive herself anyway. (Thank the powers that be that they all love this dog of mine)!
As the day progressed, slowly but surely I was able to get around a bit better.
We have been watching the snow fall...




 um, What IS this ?!?!
.
.
Seeing the poor little pup, curled up...
.
.

-and so obviously bored;
.
Casey decided to do something about that boredom.
.
.
It was time for a little fun for Casey... and a "pawdicure" for Punk
.
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.
.
Just to help with the chapping, and with those rough edges under the claws.
.
.
 
A little Vaseline, a little moisturizer with aloe and cucumber too.
And a whole lot of foot massage action!

Afterward, Punk was still bored...
.
.

She is hard to please every now and then,
(but most especially in a little hotel room when she is used to running in the fields).
.
.
.
Then, a siren, which seemed very close.
And not one of those phony ones on the TV.

Casey and Punk to the window to investigate...
.
.


.
Yes, it was still snowing! hehehe.
..


.
.
.
But the siren WAS very close...
.
.
 
At the front door of the hotel as a matter of fact.
I do not know what happened, but about 10 minutes later they left with a lady.
No sirens or lights, which is a good thing. (Yes, we did see her move).
.
.
.

.
 
The Moos Tower at night, in the snowfall.
.
.
.

Anyone wanna hold hands and sit for a while? hehehe
.
.
.
.
 
And this, my friends, is how fast my baby girl heals!
(They even gave her an extra dimple)! hehehe
.
.
.
Rumor has it that in addition to the snowfall we have gotten here, we will be getting home to another foot of snow as well, whenever that will be.
I suppose there are not two ways around that in February.
(Or maybe Canada is just covering all of her bases)?! hehehe
Yes, I love picking on my Canadian friends!

For now, I must get moving around a bit.
My back did improve yesterday, and up until I went to bed it was quite manageable. I wish to keep it that way.  I am also very happy that I didn't have to drive home yesterday with my back like that.
The forecast today for Green Bay reads as follows:
" 'Dynamic' snow system could bring 10 inches to Green Bay.
Snowfall expected to begin Monday and continue until Wednesday could dump six to 10 inches in and around Green Bay, the National Weather Service said."


Hope all is well, (and cozy), in your little corner of the world!

Love to all

XOXO
Me



Oh and again I ask, what IS this?
Take your best shot. hehehe

The Happy Business of Living...

Good Morning All;
(It will be by the time you read this anyway)! hehehe

Does everyone have plans for The Super Bowl?
And who are ya rootin' for?
Since I will root for the underdog, I will be cheering for The Saints.


Speaking of dogs... (Was too). hehehe


On Friday, Punk caught me nibbling on a potato chip...

She 'sneaks' up to watch, (and to beg for just a little one).
She thinks I don't see her?!?
.
.
.
 

She watches as I nibble... Using my two front teeth, because I swear all the rest are hurtin' big time. I understand now how people can grab a pliers and pull their own teeth out. (Just that I didn't pack any pliers)...
.
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Then Punk has this doggie~stare~down with the TGI~Fridays bag.
Bacon and cheddar 'flavored'- (Tastes like neither by the way).
.
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.

.
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I give her one.
I say "wait".
.
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.
 
So she waits. 
*Such a good dog!
.
.
After there are no more chips, she sits by the door...
One eye staring at her leash.
The other eye watching me very closely so I do not leave her behind when I go up to the hospital.
.
.
.
 
"Please take me with you?"

She was SO good at the hospital on Thursday that she can definitely go back...
.
.
As I got to the hospital, I made her wait in the car.
(I told her to 'be very good'- She was)!

For being so good she receives an extra~special treat!
.
Scroll down please...
.
.
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.

.
.
keep scrolling...
.
.

.
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.

a little more...
.
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.
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.
.
Yes, alright. This is a HUGE treat for all of us! 
hehehe 
...And WOOT~WOOT too!
.
.
Just know that whatever you do, do NOT ask Punk if we should bring Casey back to the hospital...
.
..

.
.
 
She loses her puppy sense of humor, and will NOT even listen to such a thing!  
hehehe
.
.
.

Yes! Casey is out of the hospital! Being released earlier than the 11~14 days we had been told!
(Go Casey)!!!

As always Dr. Sutherland wants us to stick around in case anything goes awry in this first week or so. Understandable.

Today was good for Casey. (For me too, not having to go up there)!
And oh, I hope it stays that way!

She has an appointment back to see Dr. S. next week.

A little prayer maybe that we can get home after that, and get on with this happy business of living?!

Have a SUPER Sunday!!!  And may the best team win!
Time for me to hit the hay... G'Night All.

XOXO
Me

Hypocrisy Defined.

http://www.politifact.com/truth-o-meter/statements/2010/feb/05/barack-obama/obama-criticizes-republicans-who-opposed-stimulus-/
Alaska. Kentucky. Pennsylvania. Georgia. No. Carolina. (So far).

PolitiFact | http://www.politifact.com

Obama criticizes Republicans who opposed stimulus, then claim credit for projects it funded

*****

Some Republicans who voted against the stimulus "have been all too happy to claim credit for Recovery Act projects and the jobs those projects have produced. They come to the ribbon cuttings."

Barack Obama on Tuesday, February 2nd, 2010 in a town meeting in New Hampshire

Obama criticizes Republicans who opposed stimulus, then claim credit for projects it funded

Twice recently, President Barack Obama has slammed congressional Republicans for voting against his economic stimulus bill in February 2009 but later touting provisions of the bill that benefited their own constituents.

During his Jan. 29, 2010, question-and-answer session with House Republican lawmakers in Baltimore, Obama brought up the American Recovery and Reinvestment Act, as the stimulus is officially known:

"There was an interesting headline in CNN today: 'Americans disapprove of stimulus, but like every policy in it.' And there was a poll that showed that if you broke it down into its component parts, 80 percent approved of the tax cuts, 80 percent approved of the infrastructure, 80 percent approved of the assistance to the unemployed. Well, that's what the Recovery Act was. And let's face it, some of you have been at the ribbon-cuttings for some of these important projects in your communities."

Then, on Feb. 2, 2010, Obama riffed on the same theme during a town hall event in New Hampshire:

"I have to point out, though, that some of the very same folks in Congress who opposed the Recovery Act -- and claim that it hasn’t worked -- have been all too happy to claim credit for Recovery Act projects and the jobs those projects have produced. (Applause.) They come to the ribbon-cuttings and ... (laughter). They found a way to have their cake and vote against it, too. (Laughter.)"

We decided that a claim that bold, repeated in two high-profile events within a week's time, was worth a fact-check.
 
As it turns out, we found several cases in which lawmakers voted against the measure but later claimed credit for provisions or projects stemming from the stimulus bill.

• Rep. Don Young of Alaska.

Young, who has served in Congress since 1973, sent out two press releases on Feb. 13, 2009, the day the House passed the final version of the stimulus bill.
 
One was headlined, "Rep. Young Votes NO On Democrats’ Massive Spending Bill." It quotes Young saying, "This bill was not a stimulus bill, it was a vehicle for pet projects, and that’s wrong."
 
Young's second release of the day was headlined, "Rep. Young Wins Victory For Alaska Small Business." It explains how Young, after lobbying by the Alaska Federation of Natives, targeted a provision from the stimulus bill that would have required competitive bidding for stimulus grants and contracts. The Alaska Natives group said the provision could have hurt its members' ability to benefit from Small Business Administration programs. Young, the release said, "worked with Members on the other side of the aisle to make the case for these programs, and was able to get the provision pulled from the bill."
 
In the release, Young said that “no matter if I supported this bill or not, I would make sure [Alaska Natives] were not hurt by it."
 

• Rep. Geoff Davis of Kentucky.

Davis, a three-term congressman, issued a news release on Jan. 28, 2009, the day of the first House vote on the stimulus, in which he was quoted saying that "this so-called ‘stimulus’ legislation is full of pet spending projects that will do very little to restore confidence in our economy or create jobs."
 
But 11 months later, on Dec. 16, 2009, Davis sent out a release announcing the awarding of a $1 million-plus grant for the Carroll County School District. "Congressman Geoff Davis is pleased to announce that the Carroll County School District has been awarded $1,044,140 in funding through the American Recovery and Reinvestment Act of 2009 (ARRA) Early Head Start Expansion Program," the release stated. It goes on to say, "In these difficult economic times, it is critical to ensure that vulnerable populations in Kentucky have access to important support services like those provided by the Early Head Start program. This important grant will allow Carroll County School District to expand their ability to provide needed assistance to local low-income families and children. I am very proud of the work that the Carroll County School District is doing to strengthen their community, and I am pleased that our office was able to assist them in obtaining these funds.”
 
As it happened, on the very same day, Davis sent out a separate release in which he referred to the "failed trillion-dollar 'stimulus' bill."
 

• Rep. Bill Shuster of Pennsylvania.

Shuster, elected in 2001, is a member of the House Transportation and Infrastructure Committee. During the stimulus debate, he advocated for targeting the measure more directly toward infrastructure spending. A Jan. 28, 2009, news release from his office said that "President Obama told the American people that he would stimulate our economy by rejuvenating our infrastructure. As a long time advocate of improving our nation’s infrastructure, Shuster was encouraged by this announcement. Unfortunately, the Democrats in Congress, led by Speaker [Nancy] Pelosi, squandered this historic opportunity to create jobs and strengthen the backbone of our economy in order to fund 40 years of pent-up liberal pet projects."
 
In November, the Blairsville (Pa.) Dispatch reported that Shuster attended a ceremonial groundbreaking for a new facility at a sewage treatment plant in Blairsville. According to the newspaper, the $12.1 million project was funded in part by federal stimulus money.
 

• Rep. Phil Gingrey of Georgia.

In a Feb. 13, 2009, news release, Gingrey, a four-term congressman, explained his vote by saying that "this ‘stimulus’ bill only perpetuates the dangerous myth that government spending will fix this economy. ... The truth is government spending will only bury future generations in more debt."
 
In October, a photograph in the Cedartown (Ga.) Standard showed Gingrey handing over a giant, ceremonial check for $625,000 in stimulus money to municipal leaders. The money was to pay for "new sidewalks, landscaping and other improvements to the downtown area," according to the newspaper. A Gingrey spokeswoman told the Standard that because the project qualified for federal stimulus funds as "shovel-ready," Gingrey "presented the proposal at the federal level."
 
City commissioner Scott Tillery described Gingrey to the newspaper as "our point man when we need action from the federal government. His staff is always interested and involved in local concerns, and the congressman will use his influence to make a case for his constituents."
 

• Sen. Richard Burr of North Carolina.

Burr voted against the stimulus yet appeared in person to present a $2 million-plus stimulus grant to help build a fire station to house the Bethlehem Community Volunteer Fire Department.
 
"This is a great thing for this county," Burr said, according to the Hickory (N.C.) Daily Record. "We're not accustomed to federal dollars in that magnitude finding their way to North Carolina."
 
A spokesman for Burr told the Associated Press in October that he wasn't taking credit for the money. "Sen. Burr was invited to the grant presentation by the Alexander County commissioners and was happy to be there to recognize the community and the fire department for their work in securing this highly competitive grant,'' the spokesman said.
 
In an interview with Politico, Burr added, “Just because I voted against the stimulus doesn’t mean I shouldn’t recognize the merit achievement of an entity.”
 
None of the four House members cited above responded to a query from PolitiFact. But the spokesman for one senior Republican lawmaker -- House Minority Whip Eric Cantor of Virginia -- did return our call. He argued that the Democratic criticism is overblown.
 
Cantor, a leading stimulus opponent, has taken heat from Democrats for organizing a job fair whose participating employers benefited from stimulus funding, as well as for helping local officials lobby for stimulus money to support a high-speed rail link between Washington, D.C., and Richmond, Va.
 
Brad Dayspring, Cantor's spokesman, defended both efforts, saying that, in the first case, the congressman was simply trying to help his unemployed constituents get back to work, and, in the second case, he was continuing his longstanding efforts to boost high-speed rail. Cantor's advocacy on the rail issue dates back a decade, to his tenure in the Virginia legislature.
 
On the broader question of why Cantor opted not to support the bill, Dayspring said that the congressman made his decision based on his opposition to the vast majority of the bill's provisions. "The bill was so flawed, he voted against it despite his overwhelming support" for the rail provision, Dayspring said. "If you support 1 percent of a bill and oppose 99 percent, are you expected to vote for it?"
 

Let's return to Obama's claim.

The president said that Republicans who voted against the stimulus "have been all too happy to claim credit for Recovery Act projects and the jobs those projects have produced."

We found at least two lawmakers -- Young and Davis -- who aggressively criticized the stimulus bill yet sent out a news release touting their own role in helping constituents benefit from the bill.

In the meantime, Obama also said that some opponents of the stimulus have "come to the ribbon cuttings" for projects funded by the bill. Shuster, Gingrey and Burr clearly attended such ceremonies.

To us, five clear cases are enough to validate the president's assertion that some stimulus opponents have "found a way to have their cake and vote against it, too."

We rate Obama's statement True.

Imagine that! Hypocrisy among the chosen GOP.
Fascinating, isn't it?

Hopefully these states' voters will be able to see these cheaters and charmers for what they are, and vote them out.
Are YOUR Reps next on this list???

XOXO
Me

Chocolate?

So cute!

Good Morning All;
It has been a busy few days- Sorry for not posting more, but hard to manage my time these days.

I have a few pictures of course. And just a few words to describe our days...

Before Casey can eat, they have to make sure she has bowel sounds- (even though she is left with only a puny little bowel).
.
.
.

 
Nurse Kim listens...
To hear only faint little noises.

(But even with the faintest of sound, they increased her diet anyway).

I went up to the hospital late Tuesday evening- She was coloring-
.
.
 
Almost impossible for her to read given the fact that the IV dilauded messes Coloring is much easier.

We opted to go for a walk...
She stopped at the 6th floor sign...
.
.
.

Unit 6D. (They say "Delta", we say "DeGrave"). hehehe
.
.
Wednesday was her rough day.

But yesterday was not bad at all.

Just as I got up there yesterday morning, she had gotten her central line out. They now give her the dilauded by mouth since she has been managing well enough with putting a bit of food in her face.
.
.
.
 
Line OUT!  (Say YAY)!
.
.
.
.
.
.

Casey has been running a low grade fever on and off for 2+ days now.
Unsure of what might be causing this, the nurse decided to cut the end of the line and send it down to be checked out. Maybe there is an infection coming from that?
We have not yet gotten those results...

The nurse asked Casey if she wanted her central line for a souvenir?
.
.


 
 But of course she did!  (No one but Casey)!  hehehe
.
.
We took another walk...
.
.

.
 
Please CLICK HERE. (Unit 6D Transplant Team).
.
.
With her central line out, she is now able to go up to a full diet!

Nausea or not, if this was yourself, and if you hadn't eaten anything of substance for a week, what would YOU want?
.
.
.
 
How does Chocolate Layered Cake sound?!?  hehehe
No, she didn't finish it, but she did LOVE what she nibbled on!

I went back up last night again.
.
.
 
Punk hates her harness, but it is a necessity if she is to visit Casey!
.
.
.
.
 
There was love all around!
.
.
Casey had gotten dressed and we took Punk for a walk outside.
Kind of slick out there... It has been snowing on and off for over 2 days now.
.
.
.
 
As long as these 2 were together, they were both quite happy.

And so was I
.
.
.
 
.
.
.
I'd better close and get moving already.
Later start, even though I have been awake since 3. (All of 3 and a half hours of sleep).
My back is godawful.

Hope all is well with all of you!
Have a "wunnaful" weekend!

Love to all

XOXO
Me

.

AIG. (Again). Seriously?

http://pol.moveon.org/pac/aigagain/letter.html
http://pol.moveon.org/pac/aigagain/letter.html

Here's a brief letter you can {forward, share, repost, or} send to your email circle. Please send it along right away, but please only contact people who know you personally. Spam hurts our campaign.

cut and paste

the text below into an email message:

Subject: Help stop AIG's outrageous bonuses Hi, The people at AIG who are most responsible for the severity of the financial crisis should be in jail. But instead, they're slated to get another $100 million in bonuses--on top of the $450 million they got last year. Unbelievable, right? I signed a petition telling Congress that it's long past time to take real action to stop companies from giving out taxpayer dollars in bonuses. Can you join me at the link below? http://pol.moveon.org/aigagain/?r_by=&rc=paste Thanks! XOXO Anne

The final step:

Donate: Can you make a financial contribution to support this campaign?

Volunteer: We need your help. If you have some time to give, press here.

Privacy policy

Escaping To England For Affordable Health

http://www.npr.org/templates/story/story.php?storyId=123210644&ps=cprs
From National Public Radio.

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization.

(iStockphoto from link) Caption reads: 'The high cost of health care in the United States drove Erica Rex to move to England following her breast cancer diagnosis.'

STORY...

I moved to England in September at the age of 53, three days after my student health coverage at Columbia University ran out. Diagnosed with breast cancer last April, I knew I would not be able to buy a plan on the open market, even if I could have afforded it.

I had been struggling to find a full-time job in New York since 2003, following the breakup of my first marriage. It had been grim. Between the economy and the state of my profession – I'd been working as a journalist for many years – I hadn't been able to land full-time work. After yet another promising job melted into "we've had our requisition pulled so now we can't hire you," it occurred to me that a journalism degree might help. So in the fall of 2008, I returned to school for a mid-career masters degree at Columbia Journalism School.

Six weeks from finishing school, already deeply in debt from years of underemployment and student loans, I learned I had breast cancer—a rather large tumor of 1.6 centimeters that had luckily, not spread. A lumpectomy followed, then two months of radiation therapy.

At the time I was diagnosed, I had been seeing my English partner for less than a year. We had decided we would marry at some point; yet I had hesitated to set a date. I was career-obsessed. The cancer forced my hand. Our only choice – if I intended to continue treatment without going into even more debt – was for me to move to England, and for us to marry as quickly as possible so I could get on the National Health Service.

Lindenhall Surgery ("surgery" is the English term for a general practice, every NHS patient's first port of call) occupies a rambling house on a quiet, leafy street in Newport, Shropshire, where my husband works, a town about 90 miles northwest of London. I met Dr. Christopher Lisk, the principal general practitioner, after arriving in September and then returned later for his first examination of me. That exam was needed to get a in referral to a breast cancer center for a follow-up appointment with a specialist.

His waiting room windows overlooked a garden. Pamphlets lay on every available surface, offering guidance on topics from child safety to confidential chlamydia testing.

Then there were poetry pamphlets. I picked one up.

"To wake the soul by tender strokes of art,

To raise the genius and to mend the heart..."

- Alexander Pope

Poetry in the Waiting Room (PitWR) was the brainchild of a poet who discovered many of his friends were spending lots of time in NHS waiting rooms. It's funded by the British Arts Council and the NHS and aims, according to a brochure, "to comfort those waiting to see the doctor through poetry." An informational footnote declared that the pamphlets were described "in a House of Lords debate as the most widely read national poetry publication."

I tried to picture Orrin Hatch, Richard Lugar and Robert Byrd debating poetry on the floor of the Senate. I drew a blank.

Dr. Lisk called me to his consulting room over an intercom. He's a tall, sixtyish man with thinning blond hair, clad in a smart three-piece navy pinstripe suit. Scores of millefiori paperweights decorated his desk. A folding wood partition separated the examining space from his consulting office. Dr. Lisk's practice has a full-time staff of six general practitioners, a clutch of nurse practitioners and a harried office staff who cater to the medical needs of a substantial catchment area in Shropshire.

What I really notice about the health care providers in England is that they seem to have more than half a second for me – and they actually listen.

Dr. Lisk asked me how I'm doing on Tamoxifen, a breast cancer drug he prescribed in September. I explained to him that I was worried about my six-month mammogram, which I had not yet undergone. The chances that I'll make it to 12 months or two years improve if I haven't suffered a recurrence by six months. Breast cancer is a numbers game.

"First things first," said Dr. Lisk. "Take off everything but your panties and have a seat on the bed." I undressed behind the partition. There were no gowns. I sat on the examining table in my underpants, hugging my arms over my chest. The room was freezing.

He came in, washed his hands, and reached for a sphygmomanometer, to take my blood pressure. It was like those I remember from childhood: a rubber bulb squeezed to inflate the cuff, a vertical column of mercury encased in glass. He held the cold disk against my skin, and listened as the air hisses out of the valve.

Then he palpated my breasts, then my armpits. "How many lymph nodes did they remove?"

"Six," I replied. He listened to my chest. Then, vertebra by vertebra, he examined my back.

As his fingers probed, he was looking into space, his head cocked to one side, as though he was listening for some furtive whispered message. He was like a talented pianist, meticulously pressing the piano keys, discovering nuances of the music even as he plays. He probed more – my neck, then my groin, searching for the elusive lymph node that would divulge a tale of metastasis.

"Aches? Pains? Other complaints?"

Besides weight gain, night sweats and attacks of gas which he apologetically attributed to the Tamoxifen, I couldn't think of any.

"Get dressed then," he said, "and come sit down."

Putting on my clothes, I concluded it's impossible to characterize the difference between health care in Britain and the United States in a few sentences.

Every feature of U.S. health care, from insurance company to doctor's office to drug company, exists as a separate for-profit enterprise. Here, health care is part of the social fabric. Prevention isn't just a matter of common sense, it's public policy. Cigarette packages have the words "Smoking Kills" emblazoned on them in huge black letters. Tobacco is taxed at a figure approaching 100 percent.

Erica Rex is a journalist currently living in the United Kingdom.

For me, though, what's critical is knowing that if I have to have more surgery, I won't find out, after the fact, that I owe hospital copayment charges of $4,000 — and this, after my surgeon forgives $6,000 of his $12,000 fee. (It turned out he wasn't in my insurer's preferred provider network.) My prescription drugs, now that I'm on the NHS, are free.

Shortly before I left New York, I had drinks with a South African friend. He asked me how I felt about the move.

"I wonder whether I'll ever get past the feeling that the bottom could fall out any minute, even once I'm on the National Health Service," I said.

We agreed survival anxiety probably accounts for a lot in the American character. Our edginess, perhaps. Unless, of course, you're Bill Gates. In the U.S., money really is everything.

Sometimes my husband Roger gripes about what he calls the British "nanny state." So much is done for the English, he maintains, they can't think for themselves anymore. Showers, for instance, are statutorily equipped with automatic shut-off valves on the thermostats. In case the water gets too hot. I remind him that the opposite of the nanny state is me in the U.S. with breast cancer and no steady job and insurance.

I had some wonderful doctors in New York, caring and helpful. But I also had to fight with my hospital there to get the tests I needed, and several of the specialists were so difficult to deal with I chose medical protocols to avoid them—no matter what the best option for treatment was. What I really notice about the health care providers in England is that they seem to have more than half a second for me – and they actually listen.

At his desk, Dr. Lisk scribbled notes on a pad. He said that he was referring me to a breast center at Rowley Hall Hospital in Stafford. The building, he told me with some amusement, used to house a reformatory for wayward girls, until the NHS bought it.

"They'll send you a letter with an appointment," he explained.

"When?" I asked.

"Within a fortnight, I should think. Ring me if you haven't heard from them by the end of next week."

I stood to go. I thanked him. He walked over from behind the desk and clasped my right hand in both of his.

"Try not to worry. They'll take good care of you at the breast center. It's a very good one." His face had the same slightly abstracted look it did while he examined me.

Then he changed tense; he changed pronouns. "I'll see to it myself you're taken care of. I personally will take responsibility for your care."

*****

It's still a damn shame that in this day and age, America the beautiful still ignores her sick and dying people.
Perhaps you mistakenly believe that everyone can just up and move to another country?
When will it matter to you?
Or will it take having to watch a loved one die a horrible, painful, and completely AVOIDABLE, death?

XOXO
Me

For more articles from NPR, do the CLICK here
"President Obama is asking Congress to find a way to extend coverage to every American."
http://www.npr.org/templates/story/story.php?storyId=106180134