With a mouth like THAT, you kiss your mother?

Making pithy and pissy observations since 2004


Memory Care Information [Public Post]

If you're looking for my public posts on memory care/dementia/Alzheimer's, be aware that I have shifted these posts to a dedicated journal at http://memorycare.dreamwidth.org.

1. General advice and observations ... http://memorycare.dreamwidth.org/344.html

2. How to communicate with a loved one who's memory-impaired ... http://memorycare.dreamwidth.org/724.html
     (A/K/A Compassionate Communication with the Memory Impaired.) 

This entry was originally posted at http://allanh.dreamwidth.org/3159936.html. You may comment here using your LJ ID, or on Dreamwidth using OpenID.


How to Game Kaiser Permanente. [Public Post]

 Kaiser Permanente's HMO has gotten a bad rap over the years for being cheap, bare-bones, minimal medical care. While that may have been true 40 years ago, that's not the case now. 

What KP DOES do is a huge bunch of statistical analysis on medical outcomes, and they can tell you to the third decimal point or better precisely how effective any type of medical treatment is for a given patient population.

Some of KP's answers to common medical problems are surprisingly down to earth. Having persistent sinus infections? Try saline nasal irrigation, which is cheaper than antibiotics and doesn't carry any of the risks of constant antibiotic use.  Bad knee/foot/ankle/shoulder/wrist?  Start by working with a physical therapist before seeing a surgeon.

But KP is, in the end, a HUGE medical system which seems impersonal and imposing to many people.  This was the case when I used Kaiser back in the early '80's, but they've improved the quality of their services immensely since then.

All it takes is knowing how to game the system. It's not difficult. It's not unpleasant. It's not illegal or unethical.

Here's how to work the Kaiser system to your advantage.

Primary Care Physician:

It's super-important to find a PCP that you like working with. Many folks going into KP just pick a person at random or let the system pick a person at random for them, figuring they have no choice in the matter. This is a terrible idea.

KP has a huge number of PCPs, and every single one has a detailed webpage talking about themselves, what their approach to care is, and what their specific strengths are. Browse through the webpages under their "Find a Physician" page, -or- contact KP's member services group, and tell them what you need. This includes whether or not you're comfortable with a specific gender of doctor.

HIV positive? Most KP campuses have HIV specialty PCPs who will be thrilled to work with you. You just need to have the intestinal fortitude to ask member services for specifically what you want.

In my case, I called member services and told them I needed a PCP who was comfortable working with a sexually active, openly gay man.  I happened to strike pay dirt with an excellent PCP who has been exceptionally easy for me to work with, and with whom I have discussed many things that most doctors would never hear from a patient.

Your PCP is also your gateway to all other services at KP, which is why it's important to find someone with whom you can establish a good working rapport.

Decided you don't like your PCP? You can change out your PCP without cost or penalty whenever you want.


You must register separately for each appointment in each department. You will need three things:
  1. Kaiser Permanente member card.
  2. Driver's License or other legal picture ID. 
  3. A big smile.
Hand them the first two items while flashing your beautiful smile.  Also have a credit or debit card or cash ready to pay your copay up front as soon as they look it up.

KP receptionists love working with patients who have their shit together and are ready for them. You will get better service over time simply by having everything ready and approaching them with a big smile.

Sadly, so many patients are unpleasant and whiny to them all day long that you will stand out simply for not being an asshole....and you'll get better service than those other folks.

Specialist Referrals:

If you're coming into KP as a new patient, and you have fears about finding a specialist for one of your medical conditions, start by asking your current non-KP specialist if they can make a referral for you to someone they like at Kaiser. The worst response you can possibly get is "Sorry, I don't know anybody".

In my case, I asked my UCSF hepatologist who would be a good person for me to work with at Kaiser on my post-Hep-C treatment issues, including NAFLD, and she immediately came up with the name of the head of their Hepatology group in Santa Clara, with whom she'd been working on a number of joint Hep-C studies over the last 10 years. (Turns out that KP participates in regional, national, and international medical research just like any other large healthcare system.)

Armed with the name of the KP hepatologist, I asked my (fabulous!) new PCP for a referral to her, and he was happy to oblige.

Website and App:

KP has an excellent and highly functional website, and a mobile app for both iOS and Android. USE THEM.

The website and the mobile apps allow you to send and receive secure email with your doctors, schedule appointments with your PCP and selected other departments, and schedule lab visits. You can also reorder prescriptions or direct them to be delivered. (We'll talk about this later.)

Lab Testing:

KP's lab department is huge and impersonal at first glance. There always seems to be a long wait. However...

There's no wait if you simply make an appointment. Interestingly, this can be done with as little as 15 minutes' notice via the website or the mobile app.

If you have an appointment, you skip the registration queue and go directly to an "Appointments Only" window, and are then sent directly through to one of several reserved blood draw stations.

The longest I've ever waited to get blood drawn with an appointment is three minutes.

So when your doctor tells you they've set up a lab test, immediately after you leave their office, sit down with your phone, pull up the app, and grab a lab appointment online BEFORE proceeding to the lab department...and then walk right in without having to wait.

Seriously. I do this all the time. And the lab people keep telling me how much they appreciate my making an appointment, even if I did it just 10 minutes before. It helps them manage their workflow more efficiently. 

The other thing to be aware of with Kaiser's labs: Saturday mornings are the busiest times, followed by Monday mornings and Friday afternoons. How busy? Twice I have gone to the Santa Clara lab on a Saturday morning at ohdarkhundred, only to find a couple of dozen people waiting in line outside the not-yet-open lab. 

However...Sunday mornings when the lab first opens are amazingly quiet. If you need a fasting blood draw, try to schedule an appointment on a Sunday or (non-Monday) weekday early morning right after the lab opens.

The other nice thing about KP's lab system...results are easily and immediately available to you when ready via the website or the mobile app.


Most of the easily accessible pharmacies at KP are huge, crowded, and noisy.  Kaiser is very good about having multiple pharmacies at every campus. Each medical campus with a hospital also has a 24-hour "discharge pharmacy" which is surprisingly convenient if you can't get to their regular pharmacy during normal hours.

Make a point of visiting every pharmacy on your local KP campus when you first enroll or move into the area. Typically, there will be a hugely busy ground level pharmacy, and one or two alternate pharmacies on higher floors.

Avoid the ground level pharmacies. Use the pharmacies on the upper floors. The higher the floor, the quieter the pharmacy and the faster the fill service will be.

KP pharmacies require you to check in at the counter twice: Once to let them know you're there, and a second time when your Rx is actually ready.

During the check-in, they will make sure that what you need is in stock. If it's not, they'll offer you a number of options. If they don't happen to offer it, ask them if another pharmacy on-campus has what you need, and they'll happily transfer the Rx to the other pharmacy.

After the check-in, you will need to wait until your name flashes up on an announcement board that your Rx is ready. Typically this is anywhere from 5 minutes to 15 minutes. The quieter the pharmacy, the faster they'll fill your Rx...which is why I go to the less popular pharmacy locations that are out of the way.

Your doctor or their nurse can direct your prescription to any KP pharmacy you wish.  This is why you need to know where the pharmacies are. A two minute stairway hike or elevator ride to the third floor pharmacy can easily save you 30 minutes or more in waiting time.

If you have recurring prescriptions, convert them to mail-order using the website or mobile app. KP's mail order pharmacy ships most orders within 24 hours of receipt, 7 days a week. I typically receive refills 2 to 3 business days at most after reordering them online or via the app. 


Kaiser has an amazing number of free or low-cost classes for members. You only have to know to look for them. There are classes on healthy cooking, on weight loss, on preparing for your family's first pregancy, and other topics you wouldn't think would be in a healthcare system, such as yoga or meditation (to relieve stress).

The KP website has classes listed under their "Health and Wellness" link.  Most departments also have specialty-specific classes available on their home pages. 

Weight Loss:

Because they're outcome-focused, KP is pretty good about educating patients in preventive medicine such as weight loss. They offer weight loss classes, healthy cooking classes, nutrition classes, one on one consultations with dieticians, medical weight management (www.kphealthyweight.com), and bariatric surgery.

If you're considering either their medically supervised fasting program (Optifast) or bariatric surgery, KP has free classes that will tell you all of the pros and cons of each program. Take advantage of these classes.

There are probably other topics to add to this, but that's all I can think of for right now.

This entry was originally posted at https://allanh.dreamwidth.org/3469815.html. You may comment here using your LJ ID, or on Dreamwidth using OpenID.

Emily Litella

Doing the necessary things.

I wrote this for my friend hickbear on LiveJournal. This will probably be the introduction to the book my friends are pushing me to write about caring for a parent with dementia or Alzheimer's.


In these situations, we do what we must, and not what we want, because we know deep inside that it's the right thing to do, and that if the roles were reversed, this is how you would have wanted to be taken care of.

Knowing this doesn't make doing the necessary things right, fun, or pleasant; it doesn't bring joy or gladness into our hearts. Knowing that you're doing the necessary things at the necessary times is, perversely, the only reward we get.

The doing of good deeds for others without expectation of recognition, reward, or acknowledgement is, in the Jewish faith, called "making a mitzvah".

Jews don't make mitzvahs because they hope for better treatment after death, for Jews don't have a concept of the afterlife. Jewish culture decrees that mitzvahs should be made to make the present world, in this life, a little bit nicer, a little bit saner, a little bit more polite. Mitzvahs are, in somewhat generalized terms, Judaism's method of fighting entropy. 

Caring for a desperately ill aging parent
 (or other loved one) when dementia or Alzheimer's is involved, is a mega-mitzvah.

Why bother if their mind is going (or gone)?
 Because you don't know that they aren't trapped inside their minds somewhere, watching everything you do, and cheering you on for doing the right thing, no matter what their traitorous mouths may say or their hands may do. 

Even as they externally scream or cry or call you names, there is quite possibly a shade of the loving, intelligent parent inside thanking you for caring enough to do whatever it is you must do for them.

It is for the mere possibility of that isolated, small voice deep inside your parent that you do these things, without question, without hesitation.

This entry was originally posted at http://allanh.dreamwidth.org/3325477.html. You may comment here using your LJ ID, or on Dreamwidth using OpenID.


Dreamwidth offering Seed (lifetime) Accounts NOW for about 24 hours

Once a year or so, DreamWidth offers a limited number of "Seed Accounts" (read: "Permanent Accounts".)

TODAY ONLY, for approximately another 18 hours or so, they're offering Seed Accounts for $200.

If you have a DW or LJ account and you want a permanent home for your journal, this is a good deal.*

As of right now, (6:09 PM Pacific), there are something under 100 "Seed Accounts" left.

Go here: http://www.dreamwidth.org/shop to buy one.

*If you're a LiveJournal user and are fearful of something happening to LJ...be aware that DreamWidth will port over your ENTIRE LJ -- posts, comments, icons, and all --- and since it's an enhanced version of the LJ code, it's pretty much totally compatible with LJ for purposes of LJ clients, etcetera. I've been very pleased with it for the past two years. DreamWidth also has a cross-posting feature that allows you to post once to your DW account...and it'll cross-post automatically to your corresponding LiveJournal. Very slick. That's how I add entries to one of my other LiveJournal accounts, in fact.


*sigh* RIP, Sarah Jane...

Elisabeth Sladen, who played Sarah Jane Smith on the long-running science-fiction series Doctor Who, died on Tuesday at the age 63 from cancer.

I enjoyed both Elisabeth's Doctor Who and post-Doctor-al work, and was quite fond of The Sarah Jane Adventures.

No matter how ridiculous or improbable the script, Elisabeth Sladen always made it work with both humor and dignity.

When the fourth (and obviously final) season of The Sarah Jane Adventures reaches Netflix, I'll probably cry all the way through each episode.


Richard Tuck

Boosting signal for Frank Biafore, regarding the passing of his partner Richard Tuck (the East Bay square dancers, NOT the SF-based caller)
from EarthaFan@aol.com
date Tue, Apr 12, 2011 at 9:50 PM
subject Great Sorrow and Joy

It is with great sorrow and joy that I let you know that Richard Tuck (east bay) passed away this evening at home with Tim and I. For those of you that knew Richard you know how many lives he touched and how incredibly positive and generous he was. It is, I think, for that reason I can't help also look for the joy at this time. I am happy he passed away at home, as he wished, and that Tim & I were able to help him at such a special time. I can honestly say I am a much better man for having known him, loved him and learned from him for the past 17 years. It was also through him that I was introduced to square dancing and thru me that he started dancing again after a lengthy absence. I have missed our many square dance friends and look forward to being able to see many of you again. My visits to clubs and dances has been sparse the past year or two, but I hope that will change in the near future.


Frank (Biafore)

PS. If people could be sure this is sent to the other club email lists I would be grateful.

EDIT: If the embedding works, here's a picture of Richard Tuck:



Originally posted by clari_clyde at post

I’ve been wondering what’s up with all the DDoS attacks LJ has been receiving lately. Signal boosting [info]ingridmatthews:

Just in case anyone thinks LJ's downtime is just TPTB being incompetant, read this:

LiveJournal, Russia's blogging platform of choice, is sustaining biggest cyberattack attack in its history. Bloggers say the Kremlin wants to crack down on political discussion.

"LiveJournal, Russia’s most popular blogging platform, has been under a massive DDoS attack for the past few days. The attack has effectively wiped out Russia’s main refuge for unbridled political discussion, a hugely lively and extensive domain frequented by politicians, opposition activists and social commentators alike...

“The reason for attack is more than clear in this case — someone wants LiveJournal to disappear as a platform,” Ilya Dronov, development director at SUP, wrote in a post on his LiveJournal blog earlier this week. He said the hackers were hoping to push bloggers from LJ to social networks where “it's easier to fight individual users.”"





With all of the hoo-ha in the news recently about metal fatigue in 737s, I went searching for one of my very favorite classic movies, "No Highway In The Sky", with (of all unlikely pairings) Jimmy Stewart and Marlene Dietrich. It's the story of a brave aeronautic engineer who devises a theory that metal fatigue is about to bring down a brand new model of airline, but nobody believes him, until...

The film was released in 1951, and ironically, three years later, in 1954, the then-new De Havilland Comet jets starting dropping out of the sky due to metal fatigue.

The movies been out of print on VHS for years, and never available on DVD, at least in this country.

Amazon Instant Video will rent it for $2.99 or sell it for $5.99.

So I bought a copy.

I am pleased.

Grace Hopper & Univac

iPad 2 Update

My iPad 2 Smart Cover (Navy Blue) is in transit from Shenzhen, China. It should be here by the end of the week.

The dock for the iPad 2 ships from gawdknowswhere on April 18th, for an April 21st delivery date.

The iPad 2 itself -- WiFi only, 64GB. Black - will ship from the same place as the dock (gawdknowswhere) on April 25th, for an April 30th delivery date.


Sleeeeeeeeeeeeepy yet aggravated.

Even after a two-hour nap this morning, I'm not able to NOT be tired and sleepy. These symptoms aer leftover from my not-great-Saturday (in which I went up to Sacramento and home again on the same day in shitty driving weather). Even sleeping most of the day on Sunday hasn't allowed me to catch up.

I'm sitting in the office right now (6:15 PM or thereabouts) and trying not to fall asleep even after downing a large mocha-heavy-on-the-coffee-please around 4 PM.

Tonight, I'm meeting Randy at his tax preparer's home to get our taxes done. The Federal changes in tax filing rules this year for married/DP'd same-sex couples have driven both of us up the wall, and the only way we both believe we can survive this particular tax filing is to have the same person prepare both of our returns. (Normally, I'd use TurboTax Online, but Intuit still doesn't handle this particular situation, which I find rather aggravating.)

UPDATE: We spent 3.5 hours with Roswitha, and I found her delightful. She managed to find both of us a lovely refund in the high 4 figures. We'll take it. :) The only annoying thing is that while we e-filed our California return, we are required to mail in a physical, paper-based return to the IRS. We'll each mail our returns tomorrow. Thankfully, the USPS' automated kiosks happily accepts items for Certified Mailing, and there's a USPS with one such kiosk about 10 minutes from the house.


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