April 2010

You are currently browsing the monthly archive for April 2010.

Reepicheep’s Coracle hosts the Round Up this week.  I can finally write the name of Kelly’s blog without checking the spelling, although I still keep forgetting what it means.  Something about a mouse, I think.  Darn those literary types, anyway.

Formspring Q&A

More Q&A, brought to you by my formspring site.  I answered these a couple of weeks apart and it’s funny how my focus is slightly different so it sounds like I’m contradicting myself:  I don’t have any time to myself, or I do have enough time for myself.  I stand by both answers, though.  There was a different context to the questions and where I went with the answers.  

Remember, you can ask me anything!  I haven’t skipped any questions so far, but I still have a backlog, so if you’re still waiting for an answer, hang in there.

Are you eating paleo?

Nope. I don’t agree with the fundamental premises of paleo eating. I do like meat, though, and my personal dietary needs require me to eat a much higher proportion of protein-to-carbs than is recommended in the standard American diet. (I’m hypoglycemic.) So I end up with a very similar diet. If I’m going to look for a recipe online, I almost always search for a paleo one. I’m coming around a bit towards the idea of eating “whole foods,” but even then, I don’t think the potential value of eating this way outweighs the value of convenience food, special treats, or low-cost food. I just think there is a lot of room for “error” in what human beings eat. And I think that the range of dietary needs amongst individuals is enormous, although I’m convinced that everyone could stand to eat a lot less sugar. Massive quantities of sugar don’t seem to do anyone any good.

A bit off topic: Kelly Elmore has an excellent post about how paleo eating relates to extended breastfeeding and attachment parenting. She endorses them all while I don’t, but I appreciate the connections she makes, probably since I made the same connections myself when I decided I didn’t agree with any of them. Anyway, it’s worth reading if you are interested in paleo at all.

What is the toughest thing about being a stay-at-home mother?

That’s difficult to answer. I suppose the most challenging thing is the need to be constantly “on.” To be a good parent, you are teaching almost all of the time. You’ve got to be on the lookout for those teachable moments, and you have to control your temper, and you have to be aware of the behavior you are modeling for your child. Deciding on how to handle all kinds of different situations takes a constant effort. And the child keeps changing, so you’ve got to keep learning and growing too! It’s a relentless process.

But that is all challenging in a good way, really. The thing that is more negative to me is that my time is not my own anymore. I mean, I chose to have a child and I’d make that choice again in a heartbeat. It’s the best thing that I ever did. But still, once you’ve done it, you have a tiny human being who is dependent on you, 24/7. If I want time for anything else, I have to manufacture it. And I do manufacture it, but the effort is unending. There is never a time when I unexpectedly find myself alone, with no demands on me, without having scheduled it or arranged it in some way. Right now, I am able to write this response because it is naptime, which I’ve worked very hard to maintain, and which I had to put extra effort into today because of 2 unusual events. And there are always unusual events that make every day a challenge.

I still don’t have a reliable way to find time to shower every day, and my daughter is 3.5! I suppose that is the toughest thing, in a nutshell.

What would you be doing if you were working?

Making a whole lot more money, that’s for sure. But really, I assume you mean “working outside the home.” I must say, I’m working harder now than I ever have before in my life.

As for working outside the home, I have absolutely no idea what I would be doing. I was in the middle of a career change when I became a full time parent. I was a software developer then I went back to school and got a degree in some weird mix of engineering and business that could have led to a number of careers. 

How do you like being a stay-at-home mom?

I love/hate it. I love the mom part, and I love the “stay at home” part, but I hate the tedium. After putting in a 12 hour day of cleaning poop and doing dishes and controlling my temper and playing 150 games of hide and seek, I don’t have that sense of, “Wow, I did a great job today and I feel really proud of myself.” Maybe I should, but I don’t. I just feel tired. I have to do other things to get that feeling of productiveness and accomplishment.

However, there is nothing in the world more enjoyable than spending time with my daughter, and I feel like the luckiest person alive to get to do it as my job. I laugh and smile and get the warm fuzzies more than I ever have in my life, and the thought of working full-time is revolting. Why would I be anywhere but with her?

Now that Sam is 3, I have enough time for the kind of things that give me the sense of accomplishment that I need, so it’s pretty ideal. I think that it will be important for me to slowly transition back to those other productive endeavors as she grows older, but I don’t think I’ll have any problem with that.

What is your central purpose?

I don’t have a clearly defined central purpose. I used to feel really guilty about that. Now I don’t. I’m the kind of person who, if left to my own instincts, will not act at all until my goals are 100% defined. (Meaning, I would never do anything at all.) I only started making progress in life when I let go of that and started going wherever my interests led me.

Now that I have a better sense of who I am and what my values are, I have done some work on trying to define my central purpose, but it’s all still quite rationalistic for me.

I think some people can define their central purpose early in life (and good for them!), but the rest of us should realize that, however desirable it is to have a life-long central purpose, that it is something that we have to work towards by means of focusing on lesser goals. The Little Things are important!

Rational Jenn has a very inspiring report on an articlethat calls for parents of gifted children not to homeschool, but to keep their kids in public school for the sake of everyone but themselves.  Why is her report inspiring?  Because of the excellent responses in the comments section of the article which adamantly reject this call for sacrifice.

Thank you, Jenn, for pulling out these gems and republishing them.  I always think of parenting as one area where people are very screwed up by the idea of sacrifice and duty, so to see this kind of display of pure moral goodness from so many people made me cheer with delight!

Speaking of Rational Jenn, did you know that she and Kelly Elmore now have a parenting podcast and new blog called Cultivating the Virtues?  I’m listening to their second podcast and I’m finding it to be very enjoyable, and I expect to get a lot of great parenting advice from it.  Kelly and Jenn are just fun to listen to!  They play really well as a team and you can tell that they are enjoying the discussion.  I’m loving the “situation of the week” segment because hearing “war stories” from Objectivist parents is so incredibly valuable.  This week, Kelly explained how she handled a situation where her daughter couldn’t find a shoe she wanted to wear, but they needed to leave the house for Kelly’s own selfish reasons.  What struck me about the story was that, in deciding whether to let her daughter find the shoe or to leave, and in deciding what to do and say and ask, Kelly didn’t think in terms of permissiveness or strictness at all.  The real issue became Kelly’s effort at understanding what her daughter really needed and wanted, in a much larger sense that wanting to wear a particular shoe.  And she did it while still drawing a firm line and remaining selfish.  The podcast format seems to be really good for this kind of storytelling and I look forward to more more more!  You can listen or subscribe through their blog.

MTHFR Update

I had to go to the fertility clinic this morning for another blood test so I asked the nurse my questions mentioned in the last post.  It looks like my MTHFR issue is not likely to have caused the skeletal dysplasia in my first pregnancy, nor the trisomy 16 in the the third.  Since the problem with the fourth pregnancy was indeterminate, my mutation may or may not have been a factor.  The fact that my homocysteine levels are normal is a very good thing and I probably don’t need any further tests, although the nurse said she’d have the doctor call me on that one.

I’m starting to fall back to my earlier position that we’ve probably just had a run of bad luck with this baby-making business.

The funniest thing I found out from the nurse is that, amongst labor and delivery nurses, mutations of the MTHFR gene like mine are called, “the motherfucker gene.”  MTHFR actually stands for methylenetetrahydrofolate reductase, but I like the oh-so-appropriate nickname much better!

MTHFR

The “little thing” that turned up in my bloodwork sounds scary, but it’s really not too bad.  I’m a mutant!  I have two copies the mutation C677T on the MTHFR gene.

From what I can glean from reliable Internet sites, this is not uncommon.  5-10% of Caucasians may be homozygous for this mutant gene (have 2 copies of it).

The effect is that my body can not metabolize folate properly.  Folic acid!  Vitamin B9!  The one and only supplement that is prescribed for all pregnant women, because a lack of folic acid is one of the very few things for which they’ve found a real correlation with miscarriage, stillbirth, and birth defects.  A lack of folic acid is associated with neural tube defects, especially spina bifida.  Of all the garbage you hear about what to do to maintain a healthy pregnancy, taking folic acid is one of the few that has a basis in science, and isn’t just fear-mongering or a fad of the moment.

It is entirely possible that all of my failed pregnancies were caused by this problem, or it could have nothing to do with it.  The doctor didn’t order a test of my folic acid levels, but I see there is such a thing, so I’ll ask for it the next time I see her.  My body can metabolize some folic acid, so taking large supplements is the way to fix the problem.  (I’ve already started a supplement called NeevoDHA.)  This also means that if I’ve been getting enough of this vitamin in my diet plus the prenatal vitamins that I’ve been taking for years, I may have had plenty in my system all along.

So, as far as pregnancy goes, this is not any kind of conclusion – just one negative factor to eliminate with the easy fix of taking a different vitamin.

As for my own health, this condition means that I am at higher risk for heart attack, stroke, or anything else that involves blood clotting.  However, I am not clear (and I’m not sure doctors are either) on the causality chain here.  I think that the inability to turn folic acid into MTHFR properly causes hyperhomocysteinemia (elevated levels of homocystein in the blood), and that hyperhomocysteinemia causes the clotting problems as well as the problems in pregnancy.  My bloodwork included a homocystein test, and my levels were normal.  This may mean that I’ve been managing to get enough folate to overcome my body’s substandard production of the MTHFR enzyme, in which case, there would be no ill effects (unless I got the causality chain wrong).  But other things I’ve read indicate that it is not entirely clear whether homocystein levels are a reliable test in assessing these risks.

This web site has a brief but clear explanation of some of the issues, if you’re interested.

(I really wish I could find a link between hyperhomocysteinemia or low folate levels in the blood, and any kind of pain.  If this could explain my mystery pain, and if taking a vitamin could fix it, how happy I would be!  I did see one, less reliable web site that mentioned pain and fatigue as symptoms of hyperhomocysteinemia, but since I don’t actually have elevated homocystein levels, I think this would be grasping at straws.  Still, I’ll bring this up with my new doctor when I see him.)

Hopefully I can clarify these questions at my next appointment with the fertility doc.  In the meantime, she wants Adam and me to get genetic counseling.  We did this after our first pregnancy loss, and they didn’t find enough in our family histories to even order any tests.  Unfortunately, I can’t seem to get my hands on those medical records, and my new doctor doesn’t trust my memory.  She recommended a genetic counselor in Bethesda, which means that we’d both have to spend an entire day on that project and hire a babysitter.  Also, this geneticist does not take insurance, so we’d be paying out of pocket.  We’ve decided to put that off for the time being.

And that’s all for now, folks.

Quotes

Me:  What do you want to be when you grow up, Sammy?
Sam:  A BABY.

Sam:  MOMMY, WHY YOU GIVE THE GUM TO DADDY?
Me:  Because it’s daddy’s gum, so I gave it back to him.
Sam:  YOU CAN’T KEEP THE GUM BECAUSE IT’S DADDY’S PROPERTY.

Sam:  MOMMY, I’LL PET JINX AND YOU PET DADDY.

Up until a few days ago, Sam could not pronounce the sound “sp.”  She used a foon to eat her cereal, she liked to sing the itsy-bitsy-fider, and nothing was better than cleaning up the table with a fonge.

I don’t focus much on her pronunciation – I’ll just repeat the word back to her correctly on occasion.  I’ve been told that she speaks quite well for her age and I’ve always figured that this is something children fix on their own, so it’s not a big issue to me.  But I noticed that Sammy was starting to get frustrated more and more often when people didn’t understand her, so I figured it was time to start doing a little bit more practice.  She has other, typical preschooler speech issues like an occasional lisp and not speaking loudly enough, but the “sp” thing seemed like something very concrete that we could work on, and something that she was probably capable of correcting.  I also had a suspicion that working on making these sounds might help with her reading.

Spoon and sponge are words that she uses all the time, so I focused on those.  I started by making a big  joke about how I didn’t know what she meant when she told me that she was out of clean foons.  “What’s a foon?” I would ask in a silly way, and eventually, I’d say, “Oh, you mean a spoon!”  Luckily, this made her giggle and it got us off on the right foot.  She’d listen intently as I would separate out the sounds of “sp” and “oon.”  I showed her the motions my mouth and tongue made.  To my surprise, she could easily make the sound “sp” and she could even say, “sp” and then a moment later, “oon.”  She just couldn’t link them up because she had this bad habit with the “f” sound.  I made a lot of jokes about there being no “f” in spoon or sponge, and a lot of times, she would say foon or fonge just to make me laugh.

This went on for a few weeks.  We only worked on it when the mood struck one of us, and I was glad to see her putting an effort into it and having fun trying.  About a week ago, Adam was working on it with her and she got it!  She’s been noticing the “sp” sound in all kinds of words ever since, and she is really proud to feak, I mean speak, correctly.

And it turns out that I was right about the reading, because the very next day I caught her sounding out words in a way that I’d never heard her do it before.  I think putting that “sp” together with the “oon” finally made it click for her that all the individual letter sounds can be strung together to make words.  This is where she’s been mostly stuck for quite a long time now.  She can get some words, but much of the time, I’ll say the individual sounds for something like, “H-E-N” and I’ll say them closer and closer together until I feel like she can’t help but just hear the word, but she still won’t get it.  She does a little bit better with spelling than with reading.  But the other day I caught her sounding out “hop,” “pop,” and “mop.”  That’s progress!

Another thing I noticed about the reading is that she was doing it alone.  That figures.  Just like with the potty, she does a much better job when left alone.  If I try to help in any way, she is more interested in resisting me (or hiding her skills from me?) than in accomplishing anything.  (Did you notice that she finally got the “sp” with Adam, not with me?  This is something I’m going to have to account for when it comes time to do real homeschooling.  I’m probably going to have to bend over backwards to avoid any sense of me being the authority.)  Luckily, she can play Starfall by herself, as well as all the activities she is doing at Montessori.  Still, I wish I could find some other kind of game that she could use by herself that would focus on this particular reading skill.  I looked for one of those electronic gadgets, but I didn’t see anything that seemed right.  If you have a suggestion, please leave me a comment!

I did find one electronic reading toy that is a lot of fun – a label maker!  Since Sam is more advanced at spelling than at reading, but still can’t write letters with a pen very well, this was super-exciting for her!  And how fun is it to write words and print them on tiny little stickers!  I’m surprised that I’ve never read about this one anywhere else.  Check out the things she wrote with it, with just a tiny bit of help from me:

“MOW” is supposed to be “meow” but our cat actually does say, “mow” so I didn’t correct her.  And “DOESNG” actually stared out as “dog” but I walked away and instead of hitting the “print” button, she played around with the keyboard some more.  As it turns out, she thinks the word “doesng” is just about the most hilarious thing in the world.  I think she was quite pleased with herself for making up such a lovely little nonsense word.

Here it is, the Objectivist Round Up, hosted by Erosophia.

I made up this simple recipe for beef stew the other night when I had cubed beef that had to be used soon, but no other traditional stew ingredients - only the ingredients that I keep on hand at all times.  It was delicious!  It has either a Latin or an Italian feel to it, instead of the typical English style with potatoes, carrots and celery.  This is a dish that I think deserves to be served with mashed potatoes, but if you’re anti-potato, it certainly can stand alone.

Amy’s Beef Stew

Ingredients:
6 strips of bacon
1 yellow onion, coarsely chopped
4-5 cloves garlic, minced
1 pound stew beef
1 can Rotel diced tomatoes with green chilies
1 cup beef broth
1/4 cup red wine
Salt and pepper
6-8 oz. frozen cut green beans

In a wide, large pot, cook six strips of bacon over medium heat, turning often. When crispy, remove bacon and set aside. Keep all bacon fat in pot.

Fry onion in bacon fat over medium heat until tender, a few minutes.

Add meat and garlic. Stir occasionally and cook until meat is browned, a few minutes. 

Add tomatoes, beef broth, wine, and a bit of salt and pepper (trust me, it doesn’t need any other seasonings with the Rotel tomatoes).

Bring to a boil. Reduce heat, cover and simmer for an hour.

Crumble the bacon. Add bacon and frozen green beans. Return to a boil, cover, and simmer another 10 minutes or so.  Taste and add seasonings if necessary.  If sauce is too thin, boil uncovered for a few minutes and then let stand until sauce thickens.

Wednesday marked the one year anniversary of our decision to try to have another child.  One year, two miscarriages.

We’re now one for four.

I had my second consecutive miscarriage in March.  I didn’t write about the pregnancy this time because I knew it was all wrong from the beginning.  I won’t bore you with the details, but I was in hell for a month.  I was actually relieved when the pregnancy was over, since I was pretty sure it had to end that way anyway.  We don’t know exactly what went wrong this time because I didn’t have to go through the D&C, but after three failed pregnancies, I decided that there might be something more going on than just “advanced maternal age.”

Seeing even more doctors is just about the last thing I want to do right now, but I’ve started going to a fertility specialist.  I thought fertility doctors were for people who couldn’t get pregnant, but apparently they can help people like us, too.  They’re doing karyotypes on both me and Adam, and I’m having just about every conceivable blood test.  We’re waiting on the results of the bloodwork, and I know they’ve found something because I got a message on my voicemail the other day saying, “there were a couple of things that were just a little bit off.”  My appointment to find out what those things are is this Thursday.

The thing is, even if we find some particular problem, I’m not so sure we’d get any kind of treatment for it.  Most of the common, easy problems are not likely in our case.  There are things that can be done for certain genetic issues, but they are very expensive and have a low success rate.

We really want another child, but I don’t think we want one that badly.  I mean, it’s hard to say at this point, but we’re pretty happy with our family of three.  Neither Adam nor I have the kind of burning, relentless desire that I’ve seen other couples have when trying for subsequent children.  But who knows – maybe there is something reasonable that we would do to improve our odds.  What I really want from this is to find out if we should even bother trying any more.  I want to know that I explored all the options, and I want to know that, if we’re going to keep trying, that we have a reasonable chance at success.  And if we are going to keep trying, I want to have every bit of data available to me to try to make it happen, instead of just taking my chances.

So we’ve been banned from trying to conceive until the doctor has more information.  I haven’t had a regular cycle yet anyway, but we might have to wait an extra month or so to get started again, if we choose to do so.

So, one year and counting.  But you know what?  It took two years and one month to produce Sam, from decision to birth.  We can still beat that record!

This week’s edition of the Objectivist Round Up can be found at Sacred Ego.

You know how it is when you are house-hunting; it might be the 3rd or it might be the 53rd, but when you walk into the home you are going to buy, you know it almost immediately.

Well, apparently, it works the same way with doctors.

I found my new doctor!  He was the second doctor I interviewed and the minute I got home I cancelled my other two appointments.

This man’s philosophy of medicine could have been taken straight from Leonard Peikoff’s DIM course.  He is an integrator.  Without my prompting, he told me that everything he does is about integration:  treating the whole person instead of just a part, how bringing together all of a patient’s medical records is essential, considering ideas from alternative medicine as well as conventional medicine, and always keeping in mind that a person is physical, mental, emotional, and spiritual, and that all of these affect health.  He said that conventional Western medicine treats all human beings as essentially the same.  If you have this disease, you take this drug, period.  Disease or body parts seems to be the fundamental unit of medicine, with totally compartmentalized specialists who have no interest in anything beyond their domain.  Eastern medicine treats all humans as totally unique, is non-scientific, and relies on trial-and-error.  He believes that we all do have much in common (we are human beings, after all!) but that each person’s case is unique.  He practically, but not quite, said that the individual is the fundamental unit in the practice of medicine.   Medicine is a science that can be objectively applied to all people, but medicine is the treatment of people, not diseases.

Now, plenty of doctors will say similar things, but I’ve found that what they actually mean is that they practice alternative medicine.  This is not true of my doctor.  He claims to have been one of the founders of the term, “evidence-based medicine,” which, even though I’m suspicious of the term, is something considered in opposition to alternative medicine. 

There might be a name for the kind of medicine he practices – it might be “complementary medicine,” which seems to be some kind of fusion of conventional and alternative medicine.  But I don’t know enough about these terms or medical philosophy to know if that is correct. 

Another reason I clicked with this doctor is that he answered almost every question on my list before I asked it.  We are totally on the same page. 

Most importantly, this physician is as relentless and passionate about diagnosis as is Dr. Gregory House.  He said that everything has a cause (or causes), and we can usually find it if we look in the right place.  He was obviously excited at the prospect of having me as a patient (I have an intriguing little mystery going on), and he complimented me on the amount of research and thinking I’ve done about these issues.

I’ve signed up with MDVIP, the organization which handles the administrative, legal, and marketing work for this group of concierge physicians.  The next things I’ll do are to collect all of my medical records (a daunting task, since I’ve seen probably a dozen doctors in the past few years), and then schedule my annual physical. 

It feels so great to have taken control like this.  I’ve been in health-limbo for almost 3 years now, and it has caused me enormous stress.  I wouldn’t be surprised if that stress is one of the causes of the continuing problems.  With this new doctor, I have confidence that I will find out, once and for all.

One aspect of parenting that doesn’t seem to be a problem for me is the issue of shared or contrasting optional values.  Sammy has so many values that I don’t share, and, frankly, don’t understand (e.g., nail polish, tap dancing, Cheerios).  She hasn’t shown much interest in numbers or patterns yet, something that would make her more like me and which I could relate to better.  But I feel no resentment or disappointment about this – not even a hint of it.   Even more importantly, I don’t feel any kind of drive to push her into activities that are more in line with my values or regrets from childhood.

In contrast, her developing personality is a continual source of joyful surprise to me.  When we discovered her attraction to tap dancing, I was extra thrilled because I dislike tap.  Knowing that she came to that love on her own, with no influence from me, made it all the more enjoyable for me to witness.

I know that many of the things that look like values to Sammy now will fade away, or mature into things that I can’t anticipate.  Just because she loves piano, tap, and fancy dolls now, doesn’t mean anything specific for the future.  What I do know is that she is her own person – unique and individual.  This is one of the good things about the 3-year-old time – observing her developing individuality, will, and values.

At the same time, I know that her dad and I are influencing her choices and values heavily.  What videos I choose to show her on YouTube, what colors I point out when we take a walk, and pretty much every gesture and facial expression she observes in me, all will have an impact on her.  And those are just the Little Things.  Imagine how strongly my decision to send her to Montessori or to homeschool will affect even her optional values!

Her world revolves around her parents right now, and this will shape her future.  There is the explicit guidance that we give her to lead her towards non-optional values, virtues, preparation for life, and good habits, but I’m not talking about that.  I’m talking about the fact that we can’t help but have a huge impact on her personality and future choices about even the smallest things.  And that thought gives me enormous satisfaction, as well.  I don’t see any contradiction in enjoying both her independence, and her close connection to me.  And I don’t feel like I need to construct any unnatural dictates to myself about how much I will allow myself to influence her.  These issues will get more complicated as she grows older, but, so far, I am at peace with this aspect of our relationship.

The Book Arts Bash is a writing contest for homeschooled kids which I found out about from  Sherene Silverberg.  My family has no use for this now, with Sammy still spelling her name, T-O-O-S, but these are the kinds of things that can use all the support we can give them.  Go, homeschooled kids!

Here are the winners of this year’s contest:

Kindergarten and First Grade:

Winner:
A Big Problem by Brianna T.
Runners up:
Adventures of Big D and BMC by Emma W.
Zoo With A Strange Zookeeper by Vivian L.

Second and Third Grade:

Winner:
The Adventures of Blue Flame the Heroic Giant Squid-Fighting Hero by Sage M.
Runners Up:
Ruby, A Twisting Tale by Emilie M.
Mittens the Cat by Melea von T.

Fourth and Fifth Grade:

Winner:
1 by Nicci M.
Runners up:
One Girl Revolution by Sadie Z.
Blaze by Alexandra S.

Sixth Grade:

Winner:
The Princess by Lena G.
Runners up:
Becoming Callie by Lena G.
Trixie by Lydia A.

Seventh Grade:

Winner:
Happy Ending is a Place by Mandy H.
Runners up:
Violet Fire by Bryn B.
Kite by Hannah S.

Eighth Grade:

Winner:
Hollin by Garrett R.
Runners up:
Common Animals by Thomas B.
Little Angel by Adayla S.

Ninth Grade:

Winner:
Why I Missed the Second Set by Rose C.
Runners up:
Untitled by Larissa S.
Tales of the Humbats: The Seventh Piece by Raven M.

Tenth Grade:

Winner:
Children of the Stars by Holden M.
Runners up:
Shattering Darkness by Vienna H.
The Scouser Cap by Emily V.

Eleventh Grade:

Winner:
Cadence by Scout G.
Runners up:
Vengeance: 25 cents by Kathleen M.
Don’t Look Down by Tanya S

Twelfth Grade:

Winner:
If Pearls Could Sing by Pamela C.
Runners up:
Broken Things by Emily D.
Falling Night by Anna W.

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One of the projects that is keeping me so busy right now is my search for real medical care.  I mean, I’m looking for a doctor who will do more than listen to me for 5 minutes and indiscriminately prescribe drugs.  (Well, ok, they discriminate a little bit.  I exaggerate when I’m angry.)

My undiagnosed pain problem seems to be coming back – either that, or I’ve had a broken toe for the past 3 months which sometimes makes the rest of my foot (and sometimes my elbow) hurt, too.  I could go back for PRP therapy, but I thought I’d try again for an actual diagnosis.  That means that I’ll have to collect my medical records from about 7 places and find someone who will actually read them and use his mind to try to solve the problem.  Regular doctors have no time to use their minds.  (Hey, that’s a bit like parenting!) 

Thanks to a suggestion from Paul Hsieh on a private list, I found out about something promising:  concierge medicine.  I knew there were doctors out there who don’t take insurance, but I had assumed that they were unaffordable.  Those doctors may exist, but concierge medicine is something different.  The doctors still take your insurance, but you also pay a yearly fee for extra service.   The doctors only take a maximum of about 600 patients, instead of thousands.  The fees vary, but the ones I’m looking at charge $1,500/year.  That’s only $125/month.  I can afford that! 

There is a national group called MDVIP which has standardized the cost and service levels for the member physicians.  I’m sure there are plenty of independent operators out there, too, but what you get with MDVIP is:

  • 24X7 access to your doctor
  • a real annual physical exam which covers much more than your insurance would
  • same day or next day appointments – for anything
  • appointments that last as long as necessary
  • a CD containing your medical records
  • assistance with insurance issues
  • a doctor who might even come with you to a specialist appointment or surgery

You also get a doctor who has chosen to practice real medicine instead of herding sheep through his office.  This is the biggest selling point to me.  These doctors want to use their minds!

There is another organization called the American Academy of Private Physicians from which I’m drawing referrals as well, but I’m not sure of the annual fees yet with those.  I’m going to interview at least 3 doctors and give this a shot.  Here are the questions I’ve come up with to ask each doctor.  If anyone has any suggestions for other questions, I’d love to hear them.

  • How many doctors in your practice and do they all participate in concierge medicine?
  • How many patients in your practice?  How long are appointments?
  • Why did you decide to practice concierge medicine and how long have you been doing it?  Has it lived up to your expectations?  How could it be even better?
  • What is your philosophy of care, if any?
  • How do you decide on specialist referrals?  Will you coordinate my care?  Will you help me get appointments?
  • What are your views on nutrition and exercise?
  • I believe in informing myself about health issues and being an active part of my own care.  What if I come in with information on a study I found on the Internet or from a book and ask you if it is valid?  If you’ve never heard of the study, will you take the time to research it and help me understand if it is scientifically valid?
  • What does “evidenced-based medicine” mean and what is your view of it?
  • What tools do you use for diagnosis?  Is trial-and-error with medication part of diagnosis?

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