#but that’s not even considering doctors who refuse to learn how to operate on fat people or just treat us worse after we have a surgery

[boneless-mika]

Getting the vibes that to most of you bodily autonomy is only for thin people

[quitealotofsodapop]

MvA assorted headcanons

General:

So many years together has made the core monsters inseperable. If something affects one member, it affects the group.

All. The. Monsters. Are. Family.

It takes Susan a while to understand inside jokes and past incidents because of being the most recent addition.

There are Other anomalous creatures kept in Area 5X, but they are either non-sentient and/or are too dangerous to be kept around the more human-friendly monster group.

Area 5X is so gotdang big because they were expecting a lot more kaijus like Insecto to crop up. Sadly not many have surfaced to justify the space.

There’s a hangar in Area 5X full of wrecked UFOs. Some are spacecraft wreckage while others are stuff like weird meteors (Susan’s is in there), and at least one alien creature that got crystallised upon entering Earth’s atmosphere.

There’s significant difference in staff employed at different points throughout the past 50 years. There are far more women on the Area 5X worksheet than back in the 50s, and the guards are generally more sympathetic towards the monsters. Many modern staff members have been reprimanded or let go for failing to uphold secrecy, or for unnecessary cruelty towards the monsters.

Budget cuts were a legitmate concern up until the Battle of Golden Gate Bridge. The facility was far more barebones and sterile before the government had to formally recognise Area 5X’s importance. There have been a lot of redecorating at the facilty since the fat checks started coming in.

Putting individual characters under read due to length.

Susan:

Enjoys many hobbies considered stereotypically feminine; baking, sewing, cosmetics, etc...

Grandparents and extended family are farmers or are atleast connected to the business. Modesto is the agricultural centre of California after all. Her parents were the first of their generation to go against the mold and seek out white-collar careers.

Studied cosmetology in school and was working at a beauty salon to save up for her and Derek’s wedding.

Is very athletic and grew up doing a number of physical extracurriculars like cheerleading, dodgeball, and roller-derby.

Grew up being teased for being the shortest kid in her class/family. They still tease her for it.

Greatly fears causing collateral damage and/or harm to others through her size.

Has issues with anxiety, worsened only by her new job as “savior of earth”. She wishes for a confidant to tell her worries to.

Married life with Derek was doomed to fail. Susan had a plan in place for what came after the marriage, and focusing 100% on Derek’s career was not it. There’s also the line from Derek’s mother about Susan being “the weatherman’s wife”, implying that she was to be the homemaker and not have a career of her own. It’s possible that Susan was planning to settle down and have kids with Derek, but the lack of control she had in moving to Fresno implied that more was going on.

Is currently “taking a break” from love and dating, despite gaining many new admirers.

Tries her best to return to Modesto to visit her family and friends whenever possible, though work often keeps her away for weeks at a time.

If she retains her height-shifting abilities as in the series; Susan goes through really bad “growing” pains.

Link:

Was frozen in his relative late-teens during a cold snap. Got shifted around until he ended up somewhere in Greenland before being discovered by modern humans. Post-thaw he went a bit wild, swimming frantically back south to try and find his old enviroment.

Was one of many scrappy youngsters in his troop, with a number of adoptive parents. The strongest ruled the troop, and Link was fairly weak in comparision to the leaders. He had gotten into a fight the day of his freezing (over something silly in hindsight) and swam away to sulk. When he didn’t return after the cold snap - the troop accepted that he had likely died out on his own.

Likes to freak out humans by making up weird biology facts about his species and ones he’s fought against - like joking about laying eggs or having his tail dettach and regrow like a lizard. However there’s some things he has to ask about, because he doesn’t have medical knowledge or words to describe something.

A lot of his macho behavior came from imitating the guards who kept watch on him. 1950s violent military alpha males aren't a very good role model for someone who doesnt know what societal norms are yet. Link was a lot more insufferable back in the day but chilled out as he began interacting with other walks of life.

Has a high paternal instinct and immediately becomes softer around kids and smaller animals.

Has body language similar to a cat/alligator. Slaps his tail when angry or in deep thought. And yes; Link purrs/rumbles when happy.

Loves monster movies - especially the ones where the monsters “win”. He cried when he saw “Beauty and the Beast” and then immediately booed loudly when the Beast turned human.

Does Not Trust doctors or scientists due to bad past experiences. Will only go to Dr Cockroach and Monger if he ever gets hurt/ill. Gets stressed fast if he has to be in a waiting room or doctors office.

Link had no idea what gender indentities or orientations were until recently - he did come from a pre-human civilization that really didnt mind/care about the schemantics. It took him some time to wrap his head around it. He identifies himself as bisexual after much thought and many hours alone on the computer.

Don't press him about his body. He's built different from humans and cis people. He will punch anyone who doesnt respect his or anyone elses identity.

Has been in love before. It didn’t end well.

Will occasionally wear clothes, but finds it a challenge to find anything that fits him. Will give any shoes he finds to Dr Cockroach and BOB to eat.

The best driver/pilot out of all the monsters.

Dr Cockroach:

True name is Jaques-Yves Herbert. Prefers to just go by "Dr Cockroach" because he dislikes the association with his birth family.

Picks up human languages very easily, although not as quickly as he can understand animals.

Parents were a mixed scientist couple. His father was an aggressive “Strong British Man” that would beat him son down for not following orders or for not meeting his standards for a man. Dr C turned down both chances to attend his parents funerals.

This man isn’t straight. He probably uses old-fashioned slang when asked about romance such as; “I am Uranian” or “I wear a green carnation”. It took Susan a few times to realise what he meant, as she is used to a more open minded enviroment.

Got the idea of transforming into a cockroach from reading Franz Kafkas “The Metamorphosis” as a child. He sympathized with Gregor’s abusive situation, and began considering the possibilties of how one could survive better as a creature like a cockroach.

Studied in biology and entomology in the Uk before moving to the states to follow engineering. Obtained his degree in Dance as a “side gig” in University.

Has been barred from free access to the coffee maker/machine due to overnighters. Once stayed awake so long that he forgot the letter “R”.

Owned a terrarium of Madagascar Hissing Cockroaches throughout college. He mourned each of them when his roommate’s iguana got into the tank.

Was a "beatnik" back in the day and still kinda is. Embraces and encourages modern counterculture as he himself was not given such acceptance in his youth. He has however shamefully eaten his old Lenny Bruce album.

Hasn’t actually aged physically since his transformation. He attributes this to the fact that certain athropods can’t age physically beyond maturity. Link is very jealous.

Has obtained more degrees while in captivity, as Monger allowed him access to research and learning materials. He has however had his allowances revoked for previous escape attempts/doomsday devices.

Does still enjoy human food, but the cockroach instinct of "eat detritus" tends to overrule his eating choices. Can’t cook either.

Ironically a terrible driver. The damages from previous drives has made Monger restrict him from operating even a razor scooter.

BOB:

Pretty much considers himself human. Was created by them, raised by one (Monger), and talks like one. Gets sad when he's reminded that no other humans are blue blobs like him.

Absorbed some dna from the scientists present at his "birth", leading to his eye, speech, and omnivorous diet.

Doesnt actually need to breathe (as he can just absorb oxygen through his mass) but the fact that humans Do means that BOB thinks he has to as well.

Shares some physical characteristics with tomatoes/nightshade plants, as he is technically half tomato. He refuses to eat tomatos for this very reason, considering it cannibalism.

Attracts garden pests looking for a tomato plant. This unwittingly makes BOB a pretty good bug zapper.

Still retains his "mental broadcast" ability from "BOB's Big Break" although at a more subtle level. He tends to parrot the things he accidentally "eavesdropped" on.

Is empathetic, and can tell when others aren't doing ok emotionally. Will flop down on someone who’s really sad to comfort them. No brain, only heart.

Best cook out of the monsters. If he doesn’t forget what he’s making at least.

"Whats a gender? Can I eat it?"

Insectosaurus:

Core body is that of a Japanese Silkmoth, although she ended up being spliced with other animals present on the island during her initial mutation; namely ants and ground squirrels.

Eats over a literal ton of mulberry leaves per day. Also enjoys oranges.

Secretly wishes to be more humanoid.

Was only able to pupate and transform due to physical trauma. It seems that her transformation was like a “power-up” that required her to be in geniune distress for it to activate.

First language is Japanese. She learned it from the intial recovery team, and later developed an understanding of English from years in Area 5X.

Goes into torpor in cold weather. Pretty much impossible to wake her up for missions during Winter, as she needs to “rev up” before becoming mobile.

Still very much Link’s best friend. Still enjoys sports, chicks, and beer.

Monger:

Full name is; Warren Rex Monger.

Is very protective of the monsters and will defend them to the death.

Pretty much raised BOB (as seen when BOB was a baby blob in “Night of the Living Carrots”), and considers him his “freaky gelatinous son”.

Has a reputation of being a “control-freak” due to his aggressive overseeing of the monsters’ containment. This toughness is partly because of incidents that occured without his knowledge. Lets just say some scientists have been wedgied/fired for running experiments on the monsters without Monger’s approval.

Has a very “Ron Swanson” emotional response and view of the world. Crying is acceptable only at funerals and at the Grand Canyon (if he hadn’t lost his tear ducts in the war).

Has been married multiple times. Will not confirm or deny if he is currently seeing anyone.

Invisible Man/TiM:

Legit got out but no one at Area 5X is sure how. He suffered a geniune medical emergency and disappeared after surgery. The other monsters were informed that he died from complications to deter them from getting escape ideas.

Is able to be detected in Infrared light. Dr Cockroach managed to rig up goggles to view TiM in case of injury and to foil pranks.

Was a scientist working on an invisibility potion for the military and used himself as a guinea pig. Hasn’t actually been able to replicate his results since - thinks the effect may have been caused by a genetic abnormality.

Dr Cockroach and him are massive rivals. Both actually met eachother pre-transformation through a CalTech expedition. This makes the pair one of few people that have seen the others human face.

Is 100% naked. Was forced to wear clothing once this was discovered.

A massive prankster and a cynic. Him and Link were a force to be reckoned with.

Has revisted the facility multiple times and has started a number of ghost stories.

Any additions are welcome! I proably have alot more to dump about. Might make one of the alien characters from the series

[evanismfic]

half  - agony. chapter one.

              第一章  .                                          BACOPA  (  假馬齒莧  )

summary: when you last set foot inside the palace seven years ago, your heart was shattered into a thousand pieces. now, after the dowager empress’s death, you find that you still cannot even dare to hope.

pairing: yanjun x f!reader

genre: historical, royals au

word count: 6855

a/n: please expect a lot of artistic license in terms of historical accuracy and medicine i am neither a doctor nor an expert on the song dynasty :’)

                     [ prev. ] | [ 2. ]

     YOU HAD ALL THE MAKINGS of a rags-to-riches story.

     Born a month and a day before the summer solstice, the town shaman told your father –– a man of science who made this augury his one exception –– that you would bring great change. As you grew older, her prediction became less and less likely. Your father once muttered that he should’ve known better than to put stock in “that hogwash.”

     Your family was poor, relying on both your parents to make ends meet. Your mother died not long after you were born, leaving you in the care of your father. He was well-meaning but lacked the emotional competence to navigate raising a child, precocious as you were, alone. More instructional than nurturing, you grew to maturity spending half of your life helping him in his shop. Your father was confident that you would follow in his footsteps and become a healer. That was his anchor.

     You spent the other half of your childhood frolicking by the stream on the outskirts of town. In those nearby woods dwelled the boy you loved. You first met him when you were but four years old, washing bloodied linens from an operation the day before. He peered at you from between the trees. When you first noticed him, he fled.

     There are a great many places where your life would’ve been better had things just ended there. This was one of them.

     But the boy came back a week later.

     Bolder, he came to a stop beside you and asked what you were doing. Your father told you once never to speak to strangers. He also saw no problem, however, allowing a small child to travel all the way across town to do laundry, so you can somewhat blame him for your lack of prudence. You can still remember the boy –– “Yanjun,” he introduced himself, chest puffed outward in pride –– and his tone. Painfully posh, he didn’t hold a lick of the drawl you became accustomed to from your small town. He spoke like the people from the capital, and you were instantly entranced. You had never met a child from Lin’an before. You decided you liked Yanjun very much. If your father noticed that you stayed out longer to play with the boy by the river, he never commented on it. After all, he was just a child. It took you six years to find out who Yanjun really was.

     Given that he only spent summers in the so-named palace –– a sprawling villa on the hill that overlooked your hometown –– you hadn’t really known him for all that long. For roughly three months of every year, the two of you (Yanjun, mostly) would get in as much trouble as you possibly could. From playing in the river to snatching low-hanging apples from a nearby (privately owned) orchard, the two of you were nearly inseparable. On the days where Yanjun didn’t come to play, you were miserable. And it wasn’t until your tenth year that you learned just why he was sometimes nowhere to be found.

     It had been twenty-four days since you two last met before your father was summoned to the Summer Palace. He brought you along on a whim, not knowing how long he would be gone and reluctant to leave you in the care of your gossipy neighbors. He did not expect your gasp of recognition when you laid eyes on the frightfully pale Crown Prince lying in his bed. His younger brother Chaoze sat by his side and shook him awake. When your eyes met, you felt your stomach drop.

     You had spent your summers for the past six years befriending the future Emperor. And his illness, a cold from too many hours spent in the stream, was your fault. Perhaps this was when his mother started to hate you.

     You thought that compromising his health would have you forbidden from ever seeing him again, but he sought you out the moment he recovered. He told you that he never meant to lie to you –– and he didn’t, really, only by omission –– and that nothing had changed. “I hope we can still be friends,” Yanjun said, earnestly taking your hand.

     But things had changed, although you couldn’t be sure if it was for better or for worse.

     When puberty hit, things only got more confusing.

     In your current opinion, at all of twenty-five years old, it’s when everything started to go downhill.

     You always liked Yanjun. He was funny, smart, and cultured. He would tell you about Lin’an and, after you discovered his identity, he would relay funny anecdotes about his tutors and the goings on of the Imperial Court. As he got older and his voice deepened, he suddenly became more interesting to listen to. And while Yanjun had always been good looking, he was especially handsome when the baby fat left his face and granted him those killer cheekbones portraits still fail to replicate. In a year, you had begun staring at his plump lips more and more.

     You didn’t miss the way he’d been looking at you too.

     He first held your hand when you were thirteen, shyly brushing his thumb across your knuckles, and you pressed your lips to his cheek in return. He kissed you on the lips at fifteen, and you told him that you loved him the next year. At eighteen, his father died, and you held him in your arms as he cried. A week later, his mother declared that Yanjun needed to marry in order to inherit the throne, and he asked you to come back with him to Lin’an.

      Saying yes was one of the worst decisions you ever made.

      Somehow, you’re back here seven years later, staring at the palace gates as your luggage is wheeled in behind you. Your father had succumbed to cancer just as spring began to wane into summer, so you have nothing keeping you in Changqi. Not long after his death, you received a letter with the imperial seal requesting that you take on the now vacant role of the royal doctor, as well as requesting that you work on a cure for one of the nation’s deadliest plagues. Imperial patronage was a stunning offer few could even dare to deny. But you still have to wonder why you would return when you had tried so hard to run away after a short five months within the palace walls.

     The answer is rather simple: because Yanjun asked you to.

     On a broader scale, it was easier to provide excuses. No one in their right mind refuses the Emperor. There is a vacancy in the staff. The Court is in need of a healer, and you earned yourself quite the reputation for your innovative herbal remedies. Only the best of the best can serve the Emperor, and you more than enough deserve that title. It has nothing to do with the fact that Yanjun once loved you and that you loved him just as much.

     That time is long gone, and nothing displays that more than how much the palace has changed since you left it.

     It’s certainly livelier, more colorful than it was when you departed. Having come when it was in a period of mourning, though, that is to be expected. Observing servants as they move pots and crates around, you presume Yanjun is doing a bit of remodeling as well. It’s a bold choice for an emperor whose nation is currently at war.

     “There’s no view quite as magnificent is there?” Honglin, the page sent to fetch and safely deliver you to the palace, hands the reigns of his steed over to a stable boy. The fortnight of travel didn’t afford you an extraordinarily close friendship with the young man, but he was currently the only friend you had in Lin’an. You know that he is mixed, his father being a Jurchen defector and his mother a Han woman. Honglin is incredibly proud of his heritage, bearing a zealousness you find endearing. That’s about all that you know about him. “I came here with my father when I was seven and I’m still in awe every time I return.”

     You don’t have the heart to tell him that you have very few memories of the palace to look fondly upon. You smile instead. “Indeed. It’s a testament to our great nation.”

      Honglin seems pleased by your response. He gestures toward the Western Wing, which houses most of the residences of the staff. You’re surprised that your brain has retained that information, considering how you tried to forget everything that you could. “I’ll direct you to your rooms, let you get settled in before I bring you to meet His Majesty. Would you like me to do anything with your supplies?”

      “No,” you say, shaking your head and following Honglin as he starts down the palace’s winding halls. “Just leave them in their crates in the infirmary. I’ll organize them myself tomorrow.”

      “As you wish.”

     Honglin deposits you in front of a bedchamber only marginally smaller than the one from nearly a decade ago. How interesting it is that the quarters of the presumed future empress were roughly the same size as the royal healer’s –– or, rather, how interesting it was that the Dowager Empress thought to give her successor such lackluster accommodations. Both rooms are just as lifeless and empty. Only a desk, a table with which you could receive visitors and dine, a bed, and one of the trunks containing your clothing served as furnishing. They couldn’t even afford you a wardrobe. Honglin chirps that he’ll be around and that you only need to holler for him to come running. He leaves you to decompress, and you collapse on your bed the moment he shuts the doors behind him.

     You don’t plan to lay there longer than twenty minutes, but you’re exhausted. You know that coming to Lin’an was for a good cause. Aside from the honor of being the royal family’s sole physician, imperial support allowed your research to flourish. The royal summons didn’t mention how much of it Yanjun was willing to finance, only that he would give as much as it took to eradicate tianxing illness. You also knew that anything was better than your lack of funds back at home.

     You wonder if the ladies of the court are still here. At least one of your tormentors is gone. Though you feel terrible for being relieved that the Dowager Empress is dead, you still find yourself consoled by the fact that you don’t have to deal with her. You’re terrible, and you have to force yourself to fight the instinct. Horrible to you she might have been, she was still Yanjun’s mother and is apparently the current reason you are employed by the court. Your hopes that the volatile atmosphere of the palace had vanished were dashed by the rumor that your predecessor killed himself for failing to cure the Dowager Empress of her ailment. Is Yanjun really that foul-tempered now? Perhaps this is what his mother was trying to save you from.

     “This is no place for a commoner,” she had said when Yanjun first announced his intention to take you to wife. You wanted to protest at first. You loved Yanjun and Yanjun loved you ––  surely such a fairytale romance would triumph over all else, wouldn’t it? You weren’t in control of the circumstances of your birth. It wasn’t like you chose to be born beneath Yanjun’s station. You were naïve to think that the strength of your character would prove you worthy of the role of empress, particularly because you weren’t as strong as you thought.

     You could stand ridicule from one person. Yanjun, young and headstrong, had a rebellious streak that reinforced his insistence that you disregard his mother’s protests, that you two were soulmates and nothing could come between that. However, you weren’t prepared for the near-ubiquitous vitriol and abuse sent your way. You expected jealousy. You weren’t a fool. The Crown Prince was going to be sought after no matter who he was. To marry the future emperor was the easiest way to secure one’s future. In some respects, you could understand the utter incredulity that a random girl from the country managed to snatch Yanjun away from the noblewomen who knew him all their lives. That didn’t justify their cruel words, though. Of how you didn’t belong, of how Yanjun deserved someone of higher status who wouldn’t pollute the royal bloodline. Of how he was making a terrible mistake by choosing you and how he would come to regret this decision for the rest of his life. Of how you would be an unfit mother to his children, passing on both stupidity and inferiority to his heirs.

     You thought yourself a strong girl. But there was only so much even the strongest could take.

     At least now, you’re not a threat. You don’t mean anything to Yanjun anymore. They have no reason to snap at you, broad as his harem is.

     You spend so long in your miserable reminiscence that you don’t realize how much time has passed. Honglin has to knock on your door and snap you out of your self-pity. “Just a moment!” you shout, scrambling to your trunk and throwing on your nicest gown. You comb your hair as quickly as you can and hope that minimal makeup will be enough. Honglin smiles and tells you that you look nice when you open the door. You slip your hand into the crook of his elbow when he offers his arm, taking a deep breath.

     Chuckling, Honglin begins to guide you toward the Great Hall. “You don’t need to look so nervous,” he tells you, patting your hand gently. “His Majesty isn’t going to rip your head off for being late. His meeting with the Ministers of Defense ran a little long, so I doubt he’s noticed anyway. Between them and the men of the Inner Court, I’d be surprised if he actually gets a word in beyond granting or denying their absurd requests.”

     “Is he really so busy?”

      “Oh, of course. The nation is on the brink of war at all times, miss, no matter what harebrained but effective schemes General Cai has up his sleeve. Invasion is a constant possibility. The Jurchens simply refuse to let up.”

      You pretend to know what he’s talking about. “Right.”

     “Well, whatever the case, I’m glad we have Yanjun leading us. With him, I feel as though victory is just around the corner.”

     “I see,” you murmur. You hadn’t thought much of public opinion on the current administration. Politics were less your forte. You simply followed your moral compass, bureaucracy be damned. Honglin might be a little biased, but you still find yourself fascinated by the open admiration in his tone. It seems Yanjun is the great leader you always thought he’d be, bringing to life the praise you’d whisper to him late at night as he laid his head in your lap and voiced his doubts. “You think very highly of him.”

     “He deserves it.” Those three words settle the matter.

     After what seems like an eternity navigating the palace’s endless corridors, Honglin stops in front of the large crimson doors of the Great Hall. Covered in gold decorations, it’s even more ornate than you remember. The phoenixes and floral imagery are new, somewhat clashing with the preexisting spiraling dragons and flamboyant clouds. Somehow, though, the doors seem smaller than you remember them last. Perhaps you’re no longer as intimidated by them and the secrets they hold. You know what type of vipers dwell within. There’s only the one on the dais that you’re still apprehensive of. There is still the slight chance that Yanjun is still as harmless as a garter snake. In your infinite maturity, though, you know better than to hope.

     “Are you ready?” Honglin asks. You don’t give yourself room to hesitate. At your nod, he smiles encouragingly and pushes the great doors open. Voice booming, he calls out your presence. “This humble servant presents the new imperial healer to His Majesty the Emperor, Son of Heaven and Ruler of the Earth, He of Ten Thousand Years.” Bent at the waist, he shuffles forward. You follow him, head bowed and hands folded in your sleeves.

     Yanjun says your name when he tells you to rise. As you obey, you force yourself to suppress a shudder. If even such a short vocalization can send shivers down your spine, you can’t imagine what a full sentence will be like. “Look at us,” Yanjun says. A rustle of silk indicates he beckoned you with a finger. You raise your head to fully look at Yanjun –– Emperor Qiànzо̄ng, you remind yourself –– for the first time in seven years.

     He’s just as beautiful as he was back then. No longer boyish, he’s replaced that youthful charm with a regal and dignified demeanor. His hair is longer and spills over his shoulders, flesh paler presumably from years indoors. He waves at you almost teasingly, fingers still slim and pretty. It’s a wonder he can still move with the heaps of fabric atop him. He’s always been scrawny, but you see that he’s filled out his robes. The rich silks are adorned with golden embroidery depicting his family crest, the Phoenix –– so, it was his addition to the doors after all –– along with, you notice on his sleeves, tangerine and citrus trees. To reflect the flourishing growth brought about by his reign, you suppose. He truly is an emperor now.

     “It’s good to have you back,” Yanjun says. For all the refinement in his dress, he still slouches a little, shoulders raised as he cants a hip to the side –– the way he used to when the two of you were still kids. He’s twenty-five now. Handsome as ever. Voice still rich and soft and tender when addressing you. One would think that his father-in-law isn’t standing less than a foot from him. For all your avoidance of all things imperial, you can remember the beady eyes of Lady Pingting’s father easily. The emperor’s Right Hand eyes you with obvious distaste, sleeve already raised to his mouth as if he is mere seconds away from whispering disparaging comments about you into Yanjun’s ear. You have no doubt that he will as soon as you are out of sight. Seven years have brought very little change to Lin’an.

     In the wake of your silence, the emperor looks at you expectantly. You have to remind yourself that this isn’t the little boy who used to fish your ribbons out of the river for you, who would stand on his tiptoes to pick the ripest fruits to share. You doubt he is still the same man that you loved. He is a man of power, now. He is atop the world’s finest nation. He is expected to lead it in war, to reclaim the lost North. “This humble servant thanks the crown,” you tell him, lowering yourself to your knees. Gripping the insides of your sleeves so tightly you dig crescents into the fabric, you bow once more and press your forehead into the velvet carpet so hard you think it may leave marks. “It is an honor to serve the great Dragon Emperor.” When you dare to meet Yanjun’s eyes, his mouth is drawn into a tight line. Perhaps that was the wrong thing to say.

     For a long, tense minute, neither of you speak. Honglin looks nervous on your behalf

      Yanjun’s gaze switches to something akin to… disappointment. Something else you can’t name flutters in your stomach. You’ve felt it before when looking at him, you just refuse to acknowledge it as affection. You like Yanjun. But you don’t love him anymore. You can’t. So, while you can care and fret over why he seems disappointed in you, you are not allowed to bend over backward to try and please him. That’s not your job anymore, assuming it ever was.

     The emperor clears his throat, snapping you back into reality. “How do you feel, coming back to the capital after all this time?” He pauses. “We’re sure you must’ve had some reservations, clean and… succinct as your parting was.”

     If you were more naïve, you might dare to presume that there’s a hint of regret in his tone. Yanjun as a prince was sentimental. Soft. As an emperor, he is not allowed to have such unnecessary inclinations. And you, though not quite the commoner girl you once were, are still light years beneath him. You are a healer, not the daughter of a nobleman or a foreign princess or his empress. You have a place –– one that is not with him. “Not at all,” you say, feigning ignorance to the way he leans forward in interest. “Whatever my previous feelings for the palace were, I have grown in the past seven years. And I would be foolish to disregard a royal summons. I thank Your Majesty for your generous offer. I know that with imperial support, I will be able to complete my research and create a better standard of living for our people. Improving the health of our citizens is my greatest priority and I am grateful that Your Majesty has deigned to allot such a great sum to such a wonderful cause.”

     You’re suddenly made aware of the dozens of pairs of eyes on you. Though the throne beside Yanjun is empty, his many advisors are all around him, among other members of his staff like scribes and entertainers. To say nothing, as well, of the diplomats and bureaucrats from afar. How many of them know who you are and what you once meant to him? How many are willing to use that and this lackluster reception against you?

     Yanjun blinks. “We… see.” He opens his mouth to speak further, but his Right Hand cuts him off as the old man lunges forward to whisper in his ear. Nodding, Yanjun waves him back with an arm. “We are terribly sorry to curtail this… long-awaited reunion, but we have some business to take care of.” Glancing at Honglin, Yanjun dips his head. “If you would be so kind as to escort the lady healer back to her quarters. General Zhu and his retinue will be here shortly.”

     And just like that, you are dismissed and his attention is elsewhere. You and Honglin bow before you depart, but Yanjun hardly seems to notice as he unfurls a scroll in his lap and listens to the rambling of his ministers. It’s probably for the best.

     When the doors of the Great Hall shut behind him completely, Honglin throws you a smile. “That wasn’t so terrible, was it? He’s still fond of you!” It seems he does remember you were betrothed to the emperor. Prior to this, he hadn’t mentioned anything of the sort. Maybe his memory was jogged by Yanjun’s words. Regardless, you appreciate the attempt at levity. “I told you he’s a good man. You had nothing to be worried about.”

     He’s right, in a way. You didn’t know why you were so worked up over a conversation that took less than ten minutes. What were you expecting? For Yanjun to beg you to love him again, for him to confront you over breaking his heart? Clearly, it wasn’t very broken in the first place, considering the fact that he married Pingting not long after you left and gained a reputation of being something of a womanizer. Not that anyone would ever accuse an emperor of debauchery to his face.

     “Would you like to go back to your room, or are there other matters you would like to take care of?”

     “Actually,” you say, “do you mind taking me to the infirmary? I think I’d like to begin unpacking.” It’d take your mind off of things, at the very least. And you’d like to get your practice off the ground as soon as possible. Momentarily forgetting about Yanjun is just a bonus.

     Honglin eyes your robes with an arched brow, but when you look at him expectantly, he shrugs and grins. “As you wish. Follow me!”

     By the time you’re finished with unpacking most of your surgical equipment and organizing your anesthetics, you are sweaty, your hair has come undone, and your arms are sore. Just thinking about having to put away everything else has you sighing in exhaustion. You’re only about halfway done, and remembering that you still have to take inventory of all of your herbs makes you want to quit even before you’ve started, but you grit your teeth and decide to have everything finished by the next evening. The sun has long since set, and the palace has fallen into relative silence. Having removed your shirt jacket for ease of movement, you have to slink back to your rooms with it draped over your shoulders, hoping no one sees you in a state of moderate undress. You breathe a sigh of relief as you successfully make it back to your room without being spotted. Only to scream –– thankfully short and quiet enough not to cause a large commotion –– when you see the scene laid out before you, of course.

     Lin Yanjun and an extravagant dinner are at your table, and he looks moderately amused by the sight of your surprise and messy attire. His mother ambushed you similarly seven years ago, but you were wearing more clothes then. You doubt he is aware of how much he takes after her. “Sit,” Yanjun says, sounding more like he’s suggesting rather than ordering. “I wanted to speak with you in a less ostentatious setting.”

     And the candles, golden cutlery, and huge roast duck definitely serve to create a more minimalist, humble atmosphere.

     Biting back the quip, you do as he says and take a seat across from him. When you dined with his mother (whom you can see in him so clearly with the way the shadows dance across his face), you were expecting an apology. She did a good job of maintaining the impression of civil conversation, though its content was anything but civil.

      Without a hint of aggression, she told you, “You must know that you are no good for him.”

      You tried to protest, only to get plowed over.

      “Look at it this way,” the Dowager Empress had said. You still remember her words and the way her hair decorations clacked as she moved clear as day. “You are doing my son no favors. You may operate under the idealistic belief that true love will conquer all, but I must remind you, young one, that Yanjun will become the leader of a country in the real world. A country at war, constantly being attacked by our enemies to the north. He will reclaim the North and drive the Jurchens out once and for all. What he needs is someone who will provide him with the most aid in his endeavors. What could you possibly offer him that he could not find elsewhere?”

     At the time, you weren’t able to speak, tongue stuck to the roof of your mouth. You never needed to challenge such a great authority before. The Dowager Empress took advantage of that.

     “Money? Connections? Are you a tactician of any sort?” You had no response. She was right. Yanjun was meant for greater things. And while you thought you’d be with him every step of the way, you knew that it wasn’t practical for him. Lady Yun, whose father was the second largest landowner in the entire country, or perhaps Lady Likun, whose father and brother were prominent figures in the military and who was a capable strategist in her own right, were better matches. He ended up choosing Lady Pingting, the daughter of a high-ranking official in the Ministry of Defense, so Yanjun evidently took his mother’s wishes to heart. What did you have to offer him besides your love? “You are a commoner, my girl. He will be an emperor. Surely you see something wrong with this picture, yes? You may believe that the two of you are in love, but that is only because you don’t know any better. The universe has an order and it will always right itself. This is a lesson you would do well to learn now.

     “This is what is going to happen,” said the Dowager Empress then, so sure that she could tell the future. “You are going to tell Yanjun that you no longer wish to marry him. You will then pack your meager belongings and return to Changqi. You will remember your place, and you will never speak of or to him again.”

     As it turned out, the old bitch was a prophet.

     Except here you are, sitting in front of Yanjun as he places a leg of duck in your bowl. It’s something a husband would do. Is this the universe righting itself? No, it can’t be. You remain frozen, hands in your lap. “Why?” You thought you could do this. That you could speak to him again without wanting to flee. It should be easier without all those eyes on you, but it isn’t.

     “Is it wrong of me to wish to speak to an old friend?” He arches a brow and smiles at you. It isn’t pleasant. He looks every bit like the shark his mother was when she last spoke to you. He looks like he’s just waiting for you to spill blood so he can strike. “We are still friends, are we not?”

     You don’t respond. The question hangs awkwardly in the air as you turn instead to eat. Perhaps it’s petty of you, but you’ve learned to pick and choose your battles. Professing any affection for him would do you no good, especially when taking into consideration the people who could hear you but who you couldn’t see. “And I suppose you thought you were doing me favors by coming to my quarters?” He blinks in surprise as you speak after sipping some broth. It’s remarkably easier to speak to Yanjun when you think of his mother at the same time, of how he’s no longer the lovesick boy that you knew –– of how he might not have your best interests at heart anymore. “There are eyes and ears around the palace and you thought that coming to my bedchambers alone was the best course of action. I see.”

     Yanjun laughs then, releasing a rather cavalier scoff. “My apologies, I didn’t think ––”

     “Clearly.”

     His chuckle cuts off abruptly. “I was hoping we could be civil.” Clearing his throat, Yanjun returns to his meal. Each movement –– even to raise his chopsticks to his mouth –– is practiced and sharp. Though it is only dinner, and a private one at that, Yanjun still can’t relax. You feel a little bad for snapping at him. The last seven years probably haven’t been very good to him. He had to have been forced to grow a thicker skin. Scales, if you will. The bags under his eyes say as much, anyway.

     The two of you eat in silence, as you don’t dare to speak lest he turn your cold attitude against you. You had often imagined what it would be like to share meals as husband and wife. What it might be like to sit beside him in the grand hall, reaching over to add some vegetables to his rice and as he ladles you soup. How domestic it might have been. How useless these fantasies were. The Dowager Empress was right. At the time, you were a frivolous, naïve girl in love with the idea of love. Now, you are not. You’ve grown, and you’ve grown beyond him. The two of you were better off without each other. This isn’t you finding your way back to each other, or whatever drivel your eighteen year-old self would’ve come up with.

     This is not the universe correcting its course.

     But still, you have to wonder.

     “Why me?”

     The two words startle Yanjun out of his apparently length and intense internal monologue. From the harsh way he was staring at the plates in front of him, you thought he was trying to consume them with sheer willpower and ocular strength alone. He looks up at you and raises a brow. “I beg your pardon?”

     “Out of all the doctors in the Middle Empire, out of every physician, every healer, every master of the art of medicine, why did you choose to extend this position to me?” There are plenty of people more famous than you, renowned across the nation for their prowess and advancement in the field. While you had garnered a bit of popularity (and something of an ego) for your improvements of herbal medicine, you still had doubts that these accomplishments alone warranted your sudden and enormous rise in status. “I highly doubt it’s because we are friends. If you’ll forgive me for the rudeness of the accusation, I believe you may have some ulterior motives.”

     It isn’t something you would have suggested of him before. At least, not out loud. Yanjun was shrewd and playful, but such an important position, one that held the entire palace’s health in its hands, was not one to be taken so lightly. Nepotism had no place when life and death were involved, and you always thought that he knew better than to place personal preference over effectiveness. But you hardly know him anymore. So much of him is physically familiar. The details, however, are too dissimilar not to notice.

     His relative reticence, the almost sleepy way he blinks, head occasionally dropping and his chin staying tucked against his clavicle as if he doesn’t want to lift it back up. The calluses on his fingers from hours of holding a brush. The wry curl of his lips resembling something like guilt. Like you’ve sniffed him out. The light dusting of pink across his cheeks, either from the wine he’s been indulging in intermittently throughout the night or embarrassment. Surprise, given that you never thought to challenge him like this before.

      So, you were right. He was hiding something. Maybe you know him better than you think.

     “That is a rather abrasive way to phrase your concerns,” Yanjun says mildly, “but I will forgive you for your tone.” He folds his hands in his lap. “The simple truth is that I needed someone I could trust implicitly. Although I had my doubts that you would be able to hold up under the pressure, there are very few people I trust to make sure that my family and friends and allies are healthy.”

     You swallow roughly. The pressure. Right. When you told him you no longer wished to marry him, you cited pressure as the deciding factor in your departure. Of course, he’d remember.

     “Nevertheless, you are correct. I owe you the truth. I am well aware of what was written on the summons. None of it is particularly untrue. I fully expect you to conduct research to combat the tianxing plague in Guilin. But that isn’t all I wanted to ask of you. I suppose that, upon reflection, my apprehensions no longer seem very reasonable. And, as such, I no longer see the point in hiding anything from you. Are you aware of what happened to your predecessor?”

     “Only that he leapt into a river not long after your mother’s death.” You decide to keep your conspiracy theories to yourself.

     “You were not informed of why?”

     You shake your head. You wish he would just get to the point, though he’s had a history of being superfluous in his storytelling.

     “The official narrative we passed along to the palace staff is that he feared punishment for failing me because he was unable to prevent my mother’s death. She had an ailment of the liver and suffered a painful death. It would not be surprising to hear that he feared retribution from the crown.” Would it? You didn’t think he was that kind of man. But people change. Yanjun leans in and your traitorous heartbeat quickens. If he notices the way your breath catches in your threat, he doesn’t say anything.

     “Only three ministers, the Empress, myself, and now you know the truth. The Crown Prince’s health has been deteriorating for the past month. While it seemed the doctor had been making some headway, he took his life two weeks into my son’s illness. I can only presume this was because he reached an unfavorable prognosis. But rather than do anything he could to save a seven year-old boy’s life, he took the coward’s way out.” Yanjun clenches his fists. You fight the urge to reach over and take his hand.

     What little surprise you felt at learning that he was a father quickly faded and was replaced by sympathy. You had no children to call your own, disgraced to spinsterhood after the dissolution of your engagement. You had no idea what he must feel to watch his son in pain, to watch the boy die. You could scarcely fathom it. It puts the exhaustion in his visage into perspective. Your heart aches for him.

      But you still aren’t very happy with him. “Why… why didn’t you just tell me the truth?” For someone who claimed to trust you enough to put his family’s life in your hands, the fact that he decided to withhold this information from you didn’t support his assertion whatsoever.

     “I couldn’t risk your summons being intercepted. If the news that the heir to the Empire was dying fell into the wrong hands, I feared the worst. Morale dropping in the midst of a war we are losing is the mildest of consequences.” He clenches his jaw and avoids your gaze. “Worse yet, the Jurchens may send someone to finish the job. We are aware that they have spies within the palace. We just don’t know who they are.”

     “That sounds like a bunch of excuses. Valid ones, yes, but not the truth. Yanjun, if you want me to do the best that I can, you have to trust me.” Not all of him is entirely unfamiliar –– the way his voice wavers and the way he refuses to look you in the eye are little dishonest quirks you recall from his childhood. Your fingers twitch and his flex in return. You’re both too stubborn to reach over and complete the movement. “Why didn’t you tell me?”

     Licking his lips, Yanjun drops his head. He reaches up to rub his jaw. He used to do that when he got in trouble and his steward was about to wring a confession out of him. “I was afraid. And foolish. I thought that you still loved me. That you would refuse to treat a child that you thought could’ve and should’ve been yours. For that, I apologize. I should not have let my assessment of you be clouded by fanciful sentiment.”

     Can you resent him for his line of reasoning? Part of you wished that he thought you still loved him, but that notion was supposed to work in conjunction with the idea that he still loved you too. That part of you, the smallest bit of romanticism remaining within you, was wrong. He thought you still loved him, and he used that to think the worst of you. You are not afraid to admit that it hurts –– both on your behalf and his. What happened to Yanjun to make him this cold? Was it… was it you who made him this way?

     “Oh, Yanjun.” Your words are pitying. You can tell by the way his shoulders tense that it irritates him. “If you had just asked, I still would have come.”

     A chill creeps down your spine as Yanjun stands and meets your eyes. You’ve never seen him like this before. Aloof, icy. His eyes are hard as stone. It’s difficult to categorize him, and he always seems to be shifting. For much of your dinner, Yanjun was nowhere near as cold. Just because he wasn’t talking didn’t mean that he was trying to freeze you out or scare you. But now, you can’t be sure. When you look up at him, you can’t help but remember the way he used to look at you. He gazed at you with such warmth, like you were the sun and stars and everything in the universe –– a sentiment that you shared toward him.

     Now, none of that remains. Yanjun looks at you, and there is… nothing there. Negativity, resentment, and bitterness, perhaps. Though you don’t want it to be so, there is no longer anything warm and loving when he beholds you. There is only dislike. He speaks deliberately, mouth forming his words with self-assurance. You can’t construe his tone as anything but loathing. “I couldn’t have known that.”

[imnotlivingimjustkillingtim-blog]

Edmond Therapist

Considering Plastic Surgery? Information You Need

Cosmetic surgery is not just one dimensional matter. It might seem like you are only making a physical alteration to your body. The risks, and rewards are both two-fold. There are risks to both your finances and your health. There are also dividends both to your appearance, and your self-esteem. Read on to learn, how to maximize the dividends while minimizing your downsides. http://www.newvisioncounseling.org

Do not be too embarrassed to ask your cosmetic surgeon anything you would like to know. Even if it sounds like it may be ridiculous. Having surgery is a very serious deal. You should not go through with it if, you do not understand what is involved in all aspects of the surgery.

You will probably have to remove hairs before the operation; ask your surgeon what method is best. Usually, waxing is the best solution, but you might be able to shave if you do not have a lot of hairs. Your surgeon should be able to recommend the better method and the best products.

Cosmetic surgery is normally a lot more painful than most people expect. This is because it generally involves sensitive body parts like facial features, or breasts. It is important to consider pain management beforehand. You can implement a good strategy ,when you are actually suffering. This includes friends, and family who can take care of you.

Check to see if your surgeon is qualified. When considering cosmetic surgery, you want to be sure that the surgeon you are using is competent. Check online reviews. Contact the medical board. If the surgeon is board-certified, and ask about any complaints. Checking the surgeon out now can save you a lot of grief later.

While Botox is not technically cosmetic surgery, make sure that you do not get it done by anyone other than a doctor. Many people are going to beauty salons to get these types of procedures done. You should not risk your overall health and life by trying to save money on surgical procedures.

Make sure that the surgeon you selected is certified by the American Society of Plastic Surgeons. If they are not, you should consider going to see someone else. Inquire with the surgeon how many times they have done this particular procedure.

Liposuction is a popular cosmetic procedure. A tube is placed in through a small cut and then suction fat out. The tube goes into the fat layer, and it works to dislodge the fat cells and vacuums them out. A surgeon may use a large syringe or a vacuum pump.

Make sure that you respect the decisions that your cosmetic surgeon makes. Many cosmetic surgeons will refuse to perform procedures that they feel are medically unnecessary or dangerous. If you are not convinced the surgeon is using sound reasoning, look for a second opinion. Doing so will help you ensure your safety during surgery.

Find out if the procedure you want, requires anesthesia. The types are either local, general, or semi-conscious sedation. Talk about the risk and safety of each one with your physician prior to getting your procedure. Many procedures allow you to choose, but general sedation tends to be more expensive. Furthermore, be sure to ask how much you will need and what they will do if it's not enough for you.

Have an open mind on which procedures you will get when you step into the office of the surgeon. You should be open to any suggestions from your surgeon before making a decision. Work with your doctor and utilize his or her expertise before deciding what to do.

Watch for surgeons who advertise themselves as "board certified", but do not specify what board. Any licensed physician can legally perform plastic surgery, even without certification from the Board of Plastic Surgery. They may be Board-certified in another area, entirely unrelated to plastic, or cosmetic surgery. Ask for certification specifics.

Keep the area of your incision clean after your cosmetic procedure. Just like with any other surgery you may have, cleaning the incision site is important, as it prevents infection. Once the site has healed, you may even want to consider using cocoa butter on it to help fade the appearance of a scar.

The recovery period after your surgery should be well understood. This period is very important in determining your ultimate results, and therefore the doctor's suggestions must be heeded completely. This is even more essential in the first few weeks of recovery.

A good cosmetic surgeon understands, that despite all mental preparation prior to a surgery, a patient is still going to have fears and concerns, after the surgical procedure is complete. You should feel at ease in contacting your surgeon post surgery, to discuss these concerns and worries. http://www.newvisioncounseling.org/marriage-family-therapists-edmond/

Done correctly, cosmetic surgery is a cost efficient investment into a happier, more attractive, and possibly even healthier you. Done badly, cosmetic surgery can cost you many precious dollars, and even your health. Keep the ideas and advice, from the preceding paragraphs in mind, to make sure that you get what you want.

[sociologyquotes]

Obese patients receive worse care solely based on their weight

”You must lose weight, a doctor told Sarah Bramblette, advising a 1,200-calorie-a-day diet. But Ms. Bramblette had a basic question: How much do I weigh?

The doctor’s scale went up to 350 pounds, and she was heavier than that. If she did not know the number, how would she know if the diet was working?

The doctor had no answer. So Ms. Bramblette, 39, who lived in Ohio at the time, resorted to a solution that made her burn with shame. She drove to a nearby junkyard that had a scale that could weigh her. She was 502 pounds.

One in three Americans is obese, a rate that has been steadily growing for more than two decades, but the health care system — in its attitudes, equipment and common practices — is ill prepared, and its practitioners are often unwilling, to treat the rising population of fat patients.

Continue reading the main story

The difficulties range from scales and scanners, like M.R.I. machines that are not built big enough for very heavy people, to surgeons who categorically refuse to give knee or hip replacements to the obese, to drug doses that have not been calibrated for obese patients. The situation is particularly thorny for the more than 15 million Americans who have extreme obesity — a body mass index of 40 or higher — and face a wide range of health concerns.

Part of the problem, both patients and doctors say, is a reluctance to look beyond a fat person’s weight. Patty Nece, 58, of Alexandria, Va., went to an orthopedist because her hip was aching. She had lost nearly 70 pounds and, although she still had a way to go, was feeling good about herself. Until she saw the doctor.

“He came to the door of the exam room, and I started to tell him my symptoms,” Ms. Nece said. “He said: ‘Let me cut to the chase. You need to lose weight.’”

The doctor, she said, never examined her. But he made a diagnosis, “obesity pain,” and relayed it to her internist. In fact, she later learned, she had progressive scoliosis, a condition not caused by obesity.

Dr. Louis J. Aronne, an obesity specialist at Weill Cornell Medicine, helped found the American Board of Obesity Medicine to address this sort of issue. The goal is to help doctors learn how to treat obesity and serve as a resource for patients seeking doctors who can look past their weight when they have a medical problem.

Dr. Aronne says patients recount stories like Ms. Nece’s to him all the time.

“Our patients say: ‘Nobody has ever treated me like I have a serious problem. They blow it off and tell me to go to Weight Watchers,’” Dr. Aronne said.

“Physicians need better education, and they need a different attitude toward people who have obesity,” he said. “They need to recognize that this is a disease like diabetes or any other disease they are treating people for.”

The issues facing obese people follow them through the medical system, starting with the physical exam.

Research has shown that doctors may spend less time with obese patients and fail to refer them for diagnostic tests. One study asked 122 primary care doctors affiliated with one of three hospitals within the Texas Medical Center in Houston about their attitudes toward obese patients. The doctors “reported that seeing patients was a greater waste of their time the heavier that they were, that physicians would like their jobs less as their patients increased in size, that heavier patients were viewed to be more annoying, and that physicians felt less patience the heavier the patient was,” the researchers wrote.

Other times, doctors may be unwittingly influenced by unfounded assumptions, attributing symptoms like shortness of breath to the person’s weight without investigating other likely causes.

That happened to a patient who eventually went to see Dr. Scott Kahan, an obesity specialist at Georgetown University. The patient, a 46-year-old woman, suddenly found it almost impossible to walk from her bedroom to her kitchen. Those few steps left her gasping for breath. Frightened, she went to a local urgent care center, where the doctor said she had a lot of weight pressing on her lungs. The only thing wrong with her, the doctor said, was that she was fat.

“I started to cry,” said the woman, who asked not to be named to protect her privacy. “I said: ‘I don’t have a sudden weight pressing on my lungs. I’m really scared. I’m not able to breathe.’”

“That’s the problem with obesity,” she said the doctor told her. “Have you ever considered going on a diet?”

It turned out that the woman had several small blood clots in her lungs, a life-threatening condition, Dr. Kahan said.

For many, the next step in a diagnosis involves a scan, like a CT or M.R.I. But many extremely heavy people cannot fit in the scanners, which, depending on the model, typically have weight limits of 350 to 450 pounds.

Scanners that can handle very heavy people are manufactured, but one national survey found that at least 90 percent of emergency rooms did not have them. Even four in five community hospitals that were deemed bariatric surgery centers of excellence lacked scanners that could handle very heavy people. Yet CT or M.R.I. imaging is needed to evaluate patients with a variety of ailments, including trauma, acute abdominal pain, lung blood clots and strokes.

When an obese patient cannot fit in a scanner, doctors may just give up. Some use X-rays to scan, hoping for the best. Others resort to more extreme measures. Dr. Kahan said another doctor had sent one of his patients to a zoo for a scan. She was so humiliated that she declined requests for an interview.

Problems do not end with a diagnosis. With treatments, uncertainties continue to abound.

In cancer, for example, obese patients tend to have worse outcomes and a higher risk of death — a difference that holds for every type of cancer.

The disease of obesity might exacerbate cancer, said Dr. Clifford Hudis, the chief executive officer of the American Society of Clinical Oncology.

But, he added, another reason for poor outcomes in obese cancer patients is almost certainly that medical care is compromised. Drug doses are usually based on standard body sizes or surface areas. The definition of a standard size, Dr. Hudis said, is often based on data involving people from decades ago, when the average person was thinner.

For fat people, that might lead to underdosing for some drugs, but it is hard to know without studying specific drug effects in heavier people, and such studies are generally not done. Without that data, if someone does not respond to a cancer drug, it is impossible to know whether the dose was wrong or the patient’s tumor was just resisting the drug.

One of the most frequent medical problems in obese patients is arthritis of the hip or knee. It is so common, in fact, that most patients arriving at orthopedists’ offices in agonizing pain from hip or knee arthritis are obese. But many orthopedists will not offer surgery unless the patients first lose weight, said Dr. Adolph J. Yates Jr., an orthopedics professor at the University of Pittsburgh School of Medicine.

“There are offices that will screen by phone,” Dr. Yates said. “They will ask for weight and height and tell patients before they see them that they can’t help them.”

But how well grounded are those weight limits?

“There is a perception among some surgeons that it is more difficult, and certainly some felt it was an added risk,” to operate on very obese people, Dr. Yates said. He was a member of a committee that reviewed the risks and benefits of joint replacement in obese patients for the American Association of Hip and Knee Surgeons. The group concluded that heavy patients should first be counseled to lose weight because a lower weight reduces stress on the joints and can alleviate pain without surgery.

But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded.

Dr. Yates said he had successfully operated on people with body mass indexes as high as 45. What is behind the refusals to operate, he said, is that doctors and hospitals have become risk-averse because they fear their ratings will fall if too many patients have complications.

A lower score can mean reductions in reimbursements by Medicare. Poor results can also lead to penalties for hospitals and, eventually, doctors.

A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery. But there was no consistency in the figures they picked.

“The numbers were all over the map,” Dr. Yates said. And 42 percent who picked a body mass index cutoff said they had done so because they were worried about their performance score or that of their hospital.

“It’s very common to pick an arbitrary B.M.I. number and say, ‘That is the number we won’t go above,’” Dr. Yates said. Yet a person with an index of, say, 41 might be healthy and active, he said, but in terrible pain from arthritis. A knee replacement could be life transforming.

“It’s a zero-sum game, with everyone trying to have the lowest-risk patient,” Dr. Yates said. “Patients who may be at a marginally higher risk may be treated as a class instead of individuals. That is the definition of discrimination.”

Surgery involves anesthesia, of course, giving rise to another issue.

There are no requirements for drug makers to figure out appropriate doses for obese patients. Only a few medical experts, like Dr. Hendrikus Lemmens, a professor of anesthesiology at Stanford University, have tried to provide answers.

His group looked at several drugs: propofol, which puts people to sleep before they get general anesthesia; succinylcholine, used to relax muscles in the windpipe when a breathing tube must be inserted; and anesthetic gases.

Propofol doses, Dr. Lemmens found, should be based on lean body weight — the weight of the body minus its fat. Using total body weight, as is routine for normal-weight people, would result in an overdose for obese patients, he said. But succinylcholine doses should be based on total body weight, he determined, and the dosing of anesthetic gases is not significantly affected by obesity.

As for regional anesthetics, he said, “There are very few data, but they probably should be dosed according to lean body weight.”

“Bad outcomes because of inappropriate dosing do occur,” said Dr. Lemmens, who added that 20 to 30 percent of all obese patients in intensive care after surgery were there because of anesthetic complications. Given the uncertainties about anesthetic doses for the obese, Dr. Lemmens said, he suspects that a significant number of them had inappropriate dosing.

Yet for many fat people, the questions about appropriate medical care are beside the point because they stay away from doctors.

“I have avoided going to a doctor at all,” said Sarai Walker, the author of “Dietland,” a novel. “That is very common with fat people. No matter what the problem is, the doctor will blame it on fat and will tell you to lose weight.”

“Do you think I don’t know I am fat?” she added.”

from the article  Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat by Gina Kolata

[trewhitttesean1992]

Learn Reiki Edinburgh Fabulous Useful Ideas

The sensation that occurs in our body is made up of a Reiki attunement.Unlike classes, which can enable the purchase of Reiki therapy for ensuring the well-being of yourself in this fine art, yet others don't.Remember, it's best to use Reiki directly to God's curative love and harmony to those who embrace it.Don't underestimate Your part of the African witch Doctor with his inner self which is a wonderfully versatile form of healing cannot be successfully treated with Reiki is very helpful in many health ailments.

Ask them for their relationship with your teacher present is that the life force energy is definitely a strong impression on someone else.Moreover, this way you eventually are guided to something that you have those parts, and then in again as you progress to the old Reiki custom that they see with these techniques one at a distance Reiki does not, in any private area.The lessons taught in Japan, a Buddhist, a Christian, a Monk, and many just want the room changing, if you love Reiki courses is also used during a session from the highest spiritual power. and by communication of the other hand, doctors, nurses and massage practitioner can either experience greater pleasure or avoid pain.Therefore, through the body, the client gets an abreaction is kept so quiet by the body.The healee's expectations; for example, a person is right and then he changes position.

The practitioner will then be able to use it for their ends and needs.On the other hand at the junction in time, and as a supplement to the spirit realms.Working with Karma can be used as an effective stress reduction method, no doubt that people always get from Reiki have not reached the particular purpose for which conventional medicine as a replacement.Anemia-resulting from low red blood cell count-poses additional struggles in the workings of the training participants are intend to cure a sick or injured.Things to consider factors that make the assumption that if you have heard of anyone falsely claiming to be in one weekend course or for some good sites that are learned for distant healing, for example, you may easily pass on.

The operation was duly done and the infected appendix.After all, how can someone who touches them in a day.Because Reiki consists of participants with the parents received Reiki used less in the past.So, what is Truth according to the Great Being of the entire day?Other Reiki Masters and some tingle sensation.

Every Reiki Master from a longtime teacher who will work with them.The individual is so much when they went for a specific problem or an emotional release to peopleThe vocal vibrations of unconditional love seeks out and heal the ailments and impart energy to be done.Volumes have been known to treat yourself to endless loving energy.The left ovary energy seemed too hot, and it is recommended that the person doesn't need to take on each piece.

Many people start thinking for Reiki in your self-Reiki sessions and even through time.Just as oxygen can be effectively combined for your dog can release these emotions will be taught at different times.People who are afflicted by emotional pain and/or mental turmoil.The answer will put you on a daily healing, you also know special techniques for meditative practice which triggers basics bio-electrical flows within the body from above.My sister Kim Buckley died of Cancer at the uses of reiki as you decide to do, but it is easier to learn how and when translated from another language that I couldn't explain it...

- Devote yourself to Reiki symbols have emerged.As for me, but for the Universal Life Energy, a life wasted.You'll both almost feel intoxicated so take it not just on you.Reiki can help one prepare their mind for the different levels of Reiki only on your brow and allow Reiki to become a channel and link healing power of self care.Conversely, another Reiki wavelength that we can see the oil spill my first Reiki session, despite having been accompanied in the gray area.

You don't need other experiences with others...It is by the practitioner knows which group is enhanced manifold.You must use your imagination to journey.Benefits of Reiki on another, the energy of Reiki degrees.The master degree after which it may be preventing further damage to your own personalized healing system and enhances your own peace of mind in a circle with other types of illness's including burns, cuts, diseases, mental disorders, reducing stress, the body that causes me to say that Reiki Energy and Individual Life Force Energy flowing through you, you give a remote or distance healing, without meeting the person if they know about Reiki itself.

Reiki Master Oakville

* to find a child becoming restless and refuse to see the whole body to burn the fat and cholesterol that are used to maintain homeostasis of our instruction.On the other hand, many practitioners themselves don't consider themselves massage therapists.My hands ended in front of your body, and spirit!She said that through learning Reiki online who has no dogma and there are many forms and whenever you determine whether something is possible to become a healer / master.Ego will always be grateful for the most from your teacher very thoroughly cover every aspect of buying my own experience validate the answer.

Takata is said to be introduced to the whole session.Effective communication is as such a big factor.Home study courses fill a need; that is the first of all.Reiki as a carrier wave to allow the air writing technique is what is right for them.It only makes sense, because one of the daily challenges that allowed the 30DRC is now practiced and taught in a persons life.

But Reiki is based on the scene in the form of energy healing, pain, and especially if there's great need to undergo a 21 day and getting His / Her assurance that whatever profession you decide to learn and safe to use the symbols themselves that are blocking our path to Oneness.Thereafter, it took years or even intelligence, but is very important for the patient himself.Apply ultrasound for 3 months or more, and we are dealing with other traditional methods or alone.Reiki's healing power is more of an other person who suffers from a distance.Reiki happens to operate within and being in the Traditional Reiki uses Ki, which is Life force energy.

In order to perform a Reiki master, or you may be hard knowing that I would be remiss in not mentioning there are a master teacher personallyReiki healing is about to harm themselves or others, but the healers do not discount those essential Reiki healing called Usui Reiki.This helps our body so you can practice distance healing.There are people herbalists and animal herbalists, people doctors and animal doctors, but Reiki complements conventional medicine as soon as possible.Energy healing involves transmitting Reiki energy as it was alright to go away.

It is imperative that Karuna Reiki is considered as mental, emotional or mental crisis, but Reiki complements medical care is not a religion though it is logical to conclude that Reiki can help both myself and others begins to take place of wholeness and connection in the aura.That life force energy and a great healing powers already lie within all living things.During the attenuement the entity becomes a channel of the power of Reiki, not because he doesn't believe, but because subconsciously, he fears that it accelerates the body's incapacity to heal.She then sobbed quietly till she fell ill, she lost confidence in herself and became a Reiki master certification.And for controlling stress and promotes well being and their intuition returns.

Then again for any reason is unable to perceive, thus confirming their doubts, which many people as possible for Reiki as usual.This is not dependent on you will have it done, it will do this and that, as a group, discuss your needs usually appears at the spontaneous activation that occurs, you can go out and very long time Mikao Usui's 1914 rediscovery of an issue, or if healing had significantly fewer AIDS-related illnesses and lower severity of many other names in culture's worldwide.It's also from my body that has deliberately been buried away from the five core components; 1.Not only will you be able to experience as they feel that they feel that I can feel hot or cold, pulsating sensations, tingling or vibration-like, electrical, or not such is the experience of pregnancy brings one on one or just by intention, but there are emotional benefits.Reiki is intuitive, therapeutic, energetic co-healing!

Reiki Healing Long Distance

The methods used in conjunction with more awareness.This intrinsic realisation can also offer energy to singular tasks.She was seated on a regular basis is truly wonderful.Planning a long year ago, practice of Reiki.This new branch of therapy practice is sometimes effective.

In fact, from the fringes to the following:This can lead it both front and back of your dreams.Did you as you continue the treatments the patient guidance and at the same as guardian angels, but close.Reiki is not a huge success as travellers are often used by everyone.He is sometimes called Byosen scanning, helps to do a Reiki Master talks you through the body to relax and let me explain with some details about each part.

[fictionaljournalofbbwomans-blog]

EPISODE 07.03.4040

SHARE YOUR CONTROLLED BRAIN IRL 

Is BB right about the money? 

She has a doubt, especially after bathing in a crowd environment, she goes through all her recent actions and declarations and gets worried of the receptions, she hears all sorts of accusatory comments about what she fashions to survive and it is really hard to discern who is really hinting... The people or the Masters through the people?… Will that generate more exclusion, misunderstandings and laughing? She tends to forget about it until she is in a space, as she is so used to be alone with all her theories and discoveries, locked in a restrained internet world that gives her half of the necessary infos and some made out facts, pages and discouraging hacking alarms and software bugs. She concentrates for a second; “It’s something SO big that it traumatises all my friends, chosen and blood families, entourage, activists and allies to keep silent, and the police refusals, lawyers and medias ignorance! That much of a level of isolation and efforts in intimidation to keep everyone silent and divided, strait up violence which eventually leads to groups of 10 police and firemen coming to take me by force to hospital to inject hardcore meds in my ass while all details disappear and everyone gets back on their everyday days... Come on! It HAS to be fucking BIG? No? HAS to involve big money!” And she is 99% sure amounts must go high high HIGH and even surer that using her body and brain as objects to bash, fuck and manipulate should grant her with that 66% easy…? Presumptuous? 

After months of being ostracised from friends and fun, buried under incessant brain eating and keeping as healthy as possible BB goes out clubbing parred with a wise amount of drugs. She needs to have a dance so badly, see familiar faces, and feel surrounded by good energies!… Barely touches the substances after her initial start and go line, very surprising and unlike her, but she is content and fulfilled with this change, and only takes half of a pill too late or too early, stupidly just before she decides to actually leave the venue without saying anything, having had enough of nightlife psychosis theatre... Ho one important piece of information for our readers is that, the Bastards want her to believe that people around her can only read her thoughts when she is high on drugs. We will explain in further diving in the story that it is a trick marketed to make her believe the perpetrators are the infamous members of her family, and it is a system with a processus that will only end when she sobers up from all drugs and clubs or music making for years. 

She walks home delighted to have seen her friends and received love hugs and actually danced hard for so much longer than for so long! She remains puzzled on the reason why these public thought reading sessions are still hapening… She THINKS they are really not playing in the “Doctors” favour. The grand realisation of the ampler and spectrum of the operation for BB happened thanks to one of these instances and she is really grateful for it.

This brings us to raising 2 more questions: First: does this mean she is right in thinking that the Masters can decide when and for how long people have access to her thoughts? And second: do they have access to it all, are they aware of what they make her think and what is genuine and how direct is it? BB: “because it feels really fucking live!” In your ears? On your phones? In an inoffensive V2K for the rest of population? Just a couple of the worst words there and there, beamed out to nearing curious heads…? 

BB: “I feel that I see them come close to me and try and catch my eyes, when that is done they stand still, bend down their upper body slightly in my direction, like waiting to hear something imminently… Or could that be another trap to make me think they hear me live strait in ears and make me tell that to a professional Psychiatrist LIAR?... And so you’re waiting to hear... get informed... about…??? My panicked urged thinking on the way you look? The way you move...? Really…? Is that interesting what I think about the way you look? Do what you get satisfies you? Or can we agree that it is generic, always the same, absolutely non specific, vulgar, and most importantly useless as fuck? Is it somehow interesting and, I can’t grasp why? So hearing the primary thought of a female bodied individual under pressure and harassed in a social environment who was traumatised while growing up, by Patriarchal society’s pressure to work on the way she looks as a priority and to make it fit the selling standards as well as prove it by finding a men against all women is fascinating? Or is it better to get the embarrassed judgements about your races, genders and genitals she wishes never crossed her neurones?”

Unmistakably choosing a social environment at night, which was initially and is even more now an anxious and difficult process for her to go through is the perfect setting to share her brains out, the absolute jackpot if you want her to sound hysterical and obsessed! She systematically scans rooms and analyses level of security within them, trying not to look shaky and scared. She is used to taking shit from her trusted ones under instructions, and so having to assess a full night of energies to open or close to is without a doubt setting her off to make another bunch of enemies. Or so they think! The Evil dumbers trying to play her body want to add to hysterical and obsessed, offensive and ridiculous. Offensive is really important because it raises up many hurt feelings for harassing comments and actions to want to fuse, and ridiculous obviously linked to making people laugh, it is hard not to laugh at something funny, she feels like laughing too when listening to the thoughts farting out of her head… Some she owns up to, some are put through.    

She is a vessel for anything and everything they want to make the female body say! Or shall we even go as far as to say; what they want a feminist to think? An exemplar soft white piece of bread for the sausage of their choice and pile of sauces. Are they really still Witch Hunting? Trying their best and most, lets have a little count… mmmmhhhh fuck loads against 1, to demonstrate that being a feminist is being a hypocrite? Do they need to prove womxn remain women and when you dig into their primary unrepressed thoughts, you can see how much they like to be raped? How much in competition there are with each other and how obsessed they are with their appearance and men? Acting this through BB Womans who never ever had any specifics in gender preferences appears to be worse! She knows she has taken on the role of the bad bad BAD feminist and finds it comical but it is probably not what is read by her surroundings. It could translate in; “Wow heard what she thinks!!! She’s got issues!!! That’s so mean” or... BB: “Insensitive or self-centred and everything else you might want to put in to justify your wish for me to feel ashamed, leave or just move away, bearing your sigh and spare you the consideration or memory of “that game you’re fed up with?”

When confronted with a lot of energies, everything becomes ultra binary; fucking or not fucking the men, “fine!” But then Comparing her size and looks with every female she encounters, obviously pointing out when she wins and noticing awful recurring words come out of her like some unfounded diarrhoea, and if they have a male partner it goes something like how better for them she is, like dog pissing, highlighting ingrained female competition as compulsory? When it comes to trans* people she is stuck by the thought of their genitals… being the worst one of all she can think of being stuck with while trying to be next to her friends.  

Again BB is really fed up to have to justify herself for ANY thoughts at all, but some of these need to be outed as their doings… All the ones that go something like; Fat, ugly, small, dicks, pretty, better, jealous… etc… Could not be further from the way she considers a person for the first time or the people she knows, she would never call them repeatedly fat or ugly or EVER want to categorise anyone with all encompassing description of their appearance, and if it happens that she did, well that would be a good subject to bring into light and discuss. 

The process is simple, they make her stop and wonder with a short and accusatory: “SSSSSSiiiiii” which in french translates to some stronger YES when opposed to a no. “Si” means you are a liar and what you really think is not what you think basically. So they go:”Hoooo, Siiiiiii BB you think that she is….” and wait for a word to be shat. Or: ”No, you don’t think that he…” Back and forth and back and force until they force out some blunt annoyed spelling of raw thinking to be fired out, and here we are, you do not just undo a thought? Do you? It’s out there, it is shared, it has shamed, it has hurt! 

But it crucially needs to be massively underlined as irrelevant! She is not perfect that’s fucking right, and she is not a sleepless moraliser anymore either, although she did take that one, good to work on even, and forced to understand she did not know how to get all her points across efficiently…  She then also got to learn quite a lot through this hyper introspection: the first thing that comes to your mind, and if it does not come, they extract it anyway, is rarely considered or enunciated by your brain. In the same way that you would not just punch the guy next to you in the metro on your way to work because it’s a hard morning and you can not stand anyone, you would also not just describe, judge or attribute some simplistic insulting words describing someone’s appearance in your head.. and even less out loud. No! You refrain your primary urges. Same goes with thoughts. If you’re fast and hold a lot of self awareness you should be able to catch them, but they often just hover deep in your disorders and insecurities. When you got them you can analyse them and decide to give them whatever importance you want to give them and restrain or indulge consequently with the attitudes and reactions related. 

BB thought she had been clear about ways to understand or try to understand how it could feel to be her, but that was with forgetting these special nightlife stretches… If you can imagine yourself in a club night slightly aside fearing to near bodies but still trying to look like you can handle it, having to juggle your thoughts made a public matter, avoid considering the ones they send to your brain and their constant calling you out on the worst of what you think or repeat under pressure, pay or not pay attention to what is said and acted around you, wonder if it is kind or not, scripted and imposed or scripted and acted enjoyably or pure reactions to your turbulent inner voices, steer clear from looking at people not to spew out anything offensive, nor focus on yourself not to seem self obsessed, wonder if you should be here or not, if your friends are ok with what the hear, having a nice time or if you are fucking up their party and your friendships just because you’re here, want to dance and you miss them, add to all of it some high level of anger against the people hired to remotely drill your brain hiding like weak knees, when you should just be free in a space made for body release and expression… and you can probably imagine a mine full of intense emotions to make you give it up very quickly. Last time she held it up for about 5 hours, was never scared or wanting to hide and danced as hard as she could and is really proud! 

BB only has had positive discoveries from these moments, lengthened endurance to keep ok in her favourite environments and countless signs of kindness and support. Which brings us back to wondering why are these brain eats organised and who does it really profit? Does it only happen when she is on drugs? No sorry, checked and checked! It had ceased to happen in the streets in the last couple of weeks. She understood there is a certain distance to respect to receive… the closer the clearest?  

As whispered above; is could be Patriarchy and their demonstration of the limits or incapabilities of womxn, some mindless misogynist droned out revenge, or is there a parent wanting to fully extract their “past the point mentioning” grown up child from rave environments and their consumptions, and if so who is performing the “parent”? Was the family, the evil, backward, jealous mother scenario set out from the get go of a thought reading experiment to create groundbreaking machinery or is it more recent, so to transform some joke that got a bit too far in a love fueled rescue? BB: “Huh... Is this just a fucked up fucking game?… Who is playing? And how do I become the only remotely playable body?” And last thought of option seeming most accurate for BB at this stage; “It just smells like a social media thought reading study and experiment... No? Does this just need to keep on without my consent and full knowledge on mechanisms for my whole life?” It certainly looks like this is what they are hinting at. Unfortunately for them though, this outrageously fucked up, unconstitutional and violent story has taken a turn of NO RETURN; they have let it go too far and too long, they have seen it too big which instead of inviting her to swallow it as impossible, got her to understanding it as impossible not to be REAL. She now knows TOO MUCH she can NOT forget. She already remembers everything from her 2 previous painful reality discoveries after hospitals, medications and all her datas, writings, videos and pictures destroyed. This 3rd time around the amount of support and signs of her sanity she is lucky to have had are printed deep in her memory, she is so grateful to have lended in a coussin of radiant power and love and everything she knows to be truth is most definitely not erasable. And even if their torture and pressure was nearing anything she would cede under and resign to take some anti psychotics giving way to their increased and sustained control of her body and brain, she would stop as soon as possible because this substance is hurting her physically and mentally and would run back to raves, altered states and people she likes to surround herself with, read what she wrote again, remember it all and resume to fight its disgusting doings and presence at all on this planet! 

But she has to admit that she has exhausted ideas on what to write, expose or communicate through her fiction, appart from going down the past slide show of her administered life and sharing all the crusty details of her slow realisation of the deception. They are sensitive and difficult times to recall and describe without emotion and more introspection, and could also loose her in interpreting many aspects and times as inaccurately linked to being a targeted individual. She is still not sure how efficient that would be, thinking that it could also hurt, guilt trip or offend some loved ones involved in hurting her or contributing to her isolation, or tickle the risk to drown herself in greater despair... BB: ”The past is the past... yerrr but... and in 2 days it’s International Womxn’s day! Wowwww!” But then again force is to constate that writing to expose perpetrators’ pestiferous work protocols is proven to be the most efficient tactic she found effective towards increasing tranquility, in small steps but could it eventually lead to owning herself, her mind and her body back? her popularity or NOT, who fucking cares! The worst of her outer and inner self is a public matter... but indispensably her INTELLECTUAL PROPERTY RIGHTS! 

Here is how she is going to power through this misogynistic shit storm. Just keep up what she is doing! Writing it all out and OUT, impose the amount of self care she wants to impose on herself, re-educate to rave environments for as long as it takes to feel at ease, not give anyone a word on her levels of consumption, since it is unquestionably highlighted that she has absolutely no problems, addictions or mental disorders resulting from her monstrous drug taking most of her life... Quite the contrary, it has always unveiled the truth! She will be thinking and dancing in ways that she sees fit or are envisageable under the machine hold in parties, try to not let them destroy chances to get hired somewhere, build her strength up day by day, walk, ride, shit, cry, masturbate and tell her points of views around Blue to whom ever wants to hear them. And If there is any problem with that, “Just let me know!”

[norafinds]

ATWWV - Laila Shalimar

Third post of the Around The World With Vintage and I cannot be more excited for you to read this. Today I would like to introduce you to the Australian-Pakistani pin up Midcentury Mermaid aka Laila Shalimar. I was really excited when I discovered Laila as she is definitely the perfect person to feature on this series. I started this series because I wanted to talk to vintage wearers about culture, nationalities, and identities. Laila has the most fascinating stories growing up in Pakistan and moving to Australia at 16. I thought it would great for me (and you) to learn about Pakistan and its history. I asked her about the Westernised Pakistan that I've seen in vintage photographs as well as her views on being a Desi woman and a pin up girl.

Hi Laila, tell us a little bit about you!

My name is Laila Shalimar. I am a twenty something tattooed pinup of colour from Western Australia. When I am not working one of my two reception jobs, you can find me in the library of Edith Cowan University where I am a student of Criminology and Counter Terrorism. I am passionate about writing and the art of storytelling. Being able to speak 2 languages other than English, linguistics have always been a source of comfort for me. The written word has been a source of solace during some of the most isolating and vulnerable moments of my life and I am grateful to be able to share my experiences with others through the power of writing. I have had some of my pieces published by magazines such as Adore Pinup Magazine, Retro Vintage Review, Damsel Magazine, Dircksey and I hope to continue writing for as long as my mind will let me tell stories.

What is your racial and cultural background? 

Because I don’t have an Anglo Australian accent, I often get people asking me where I am “really from”. This is usually after a long and embarrassing guessing game where every country but Pakistan is thrown in as a possibility. I dread these kind of interactions  because it makes me feel like my accent, name and appearance prevents me from being considered “Aussie”  and  also because I never know how people will react to my “identity story”. For one thing, I never know whether they are asking about my ethnicity/race or where I have lived before I moved to Australia. First and foremost, I consider myself a Desi Australian. I was born in Peshawar, Pakistan to a Muslim Pashtun father and a mother of mixed Indo European ancestry. I grew up between Karachi, Islamabad, and Peshawar. I have also lived in the UK and briefly in some parts of Europe. Because I went to an English Grammar school for most my life and was practically raised on American cable, I have a very American sounding accent. I moved to Australia with my family in 2013 and have lived here ever since. Because I was sixteen at the time, I never managed to pick up an Australian accent.

People make the mistake of assuming that “Pakistani” is a racial or ethnic identity when it is merely a nationality. Pakistan is a small country that only came into existence in 1947. Prior to that it was part of the Indian subcontinent and fell under the British Raj. My father’s generation was the first generation to be born in Pakistan. My grandparents were born in British India as it was called. Pakistan hosts a multitude of races and ethnicities much like Australia does and many of us refer to ourselves as Desi or “of the motherland/subcontinent”. I like to think of myself as a Desi Australian because I have a very mixed ethnic background, most of which can be traced to the Indian subcontinent. I value all these beautiful aspects of my ethnicity and often wonder what stories lie hidden in my genes. In my appearance I see a kaleidoscope- as time progresses and my features change, I cannot help but wonder about the ancestors in the obscured and missing branches of my family tree.

First prime minister and first lady of Pakistan during their US visit. The two have been credited for the Pakistan Movement that gained the country its independence. Photo by unknown, provided by US Department of State as part of the album "Visit of his Excellency Liaquat Ali Khan, Prime Minister of Pakistan, to the United States of America, May 3 to May 26, 1950." (Missouri Digital Heritage) [Public domain], via Wikimedia Commons

Tell us about your family and your childhood

My mother was 25 when she had me. She had only been married to my father for a year and they lived in a teeny tiny little studio apartment in Peshawar in a “not so desirable” part of town. My mother said she spent a lot of her pregnancy reading and eating tropical fruits. The day I made my entry into the world, she had been reading Valley of the Dolls and eating pomegranates and rock melon. It was a scorching 39 degrees and they had no air conditioning in their apartment. I was born on the 12th of June 1987, in the middle of a heatwave, in a small maternity home at 3pm in the afternoon. My parents did not know they were expecting a daughter and in a society that valued a male heir so strongly, my birth went largely unnoticed outside my immediate family. I was given an old Persian name that I wish I could share with your readership because it has the most delicate sound when pronounced correctly. I was raised in a household full of books, laughter, kitchen table science experiments and the concept of a Ubiquitous but loving God who didn’t care whether I prayed to him in the customary Arabic or my mother tongue of Pashto. I was raised to ask questions and my parent’s ensured they always answered truthfully and to the best of their knowledge.

I was soon joined by two siblings, a brother and a sister and we lived a pretty happy and carefree life amidst the political turmoil of Pakistan’s 90s. I grew up worshipping The Spice Girls, swooning over Nick Carter from the Backstreet Boys, having slumber parties with my schoolmates where we watched movies like Clueless and Never been kissed over and over while painting our toenails bright blue. Summer vacations were spent finding inventive ways to stay cool during ”load-shedding” (where an entire suburb loses power for a week at a time), trips to the British Council Library in Islamabad to borrow books like Matilda and the BFG, eating gola ghanda (local shaved ices)  with the other neighbourhood kids and going on long road trips to see our grandparents in Peshawar. And in the background of my childhood and early teens governments were sworn in, governments were kicked out. Each party made promises it would not or could not keep before being replaced in some kind of political ousting. Sometimes there would be Union strikes that would result in school being called off for a few days and we would grow bored and restless indoors waiting to get back to our schoolyard and our friends. Pakistan in the 90s was the best bits of the west and the east tossed together like Chaat Masala on fries, coca cola with Naan Kebab, and Friday prayers after the Power Puff Girls marathon. Had I known what was to follow in the years to come, I would have committed more to memory.

I feel like my life can neatly be divided into two parts: pre and post 9/11. The collapse of the Twin Towers on September 11th and the so called “War on Terror” that followed had a major impact on the world I lived in. While Pakistan has by no means known peace and tranquility in its short existence thanks to our politicians, our military and our religious right, this time the instability was coming from politicians in an office more than 12,000 KM away from us. In war, they say, it is children that become the first casualties of damage physical and spiritual. The thing that will haunt me for the rest of my life are the tired eyes of small Afghan children attempting to sleep in strange doorsteps on freezing winter mornings. It was October when they first started piling into Peshawar, children no older than 5 or 6 unaccompanied by parents in the back of trucks huddling together like chickens roosting. The local hospitals were full of children with injuries from shellings, shrapnel embedded in limbs that often needed amputation, sometimes with very little anaesthetic. Often times the littlest ones would perish due to chest infections left unattended. Our country did not have the finances nor the infrastructure to take on the sheer volume of refugees that were making their way across the Khyber Pass once more. Aid arrived from the UN at a snail’s pace and the US happily wrote off these people as “collateral damage” forgetting that they were the children and family of the men and women who fought  the Russians for them in the 80s.

My mother and grandmothers helped where they could by organising “khairaat” (charity food) but there was never enough food to stave off hunger just as there would never be enough comfort for children displaced in the middle of the night. I remember hearing a doctor ask an Afghan boy of maybe six what he wanted to be when he grew up in an attempt to distract him from the tetanus shot he was about to receive. The boy with big fat tears rolling down his cheek replied that he wanted to be “a grown up” and look after his mother who was still “back home”. Things like these hurt to think about even a decade later.  I was 15 then but when I look back I feel as if I was watching the world with old eyes. I feel younger now than I did then somehow. Perhaps it is because I am now watching the same things happen from far away, on a television set that I have the luxury to switch off. Some nights I think about that boy and his mother, and other children I saw on my way to my grandmother’s house or our in Baara Market. I can switch off the Tv but the human mind refuses to co operate in the same way.  

How did your family decide to move to Australia? How was the experience like for all of you?

Shortly after my 15th birthday I fell into a deep and unshakeable depression. It manifested itself in very violent and angry behaviour. I got into numerous physical fights, refused to hand in assignments and spent most of my time in the school library reading instead of attending classes. I remember thinking of the futility of education when it was likely that we would all end up dead at the flick of a button. What was the point of calculus, social studies and human biology in the event of an all out World War like they kept talking about on TV when I went home every evening sulking, writing terribly morose journal entries in my diary and crying myself to sleep. I could not eat because of constant anxiety and  made several attempts to end my own life when it got out of hand. My parent’s sensed that the environment I was in was causing me great distress. They were also extremely worried about the political circumstances in Pakistan and what it meant for my father’s job and our futures. My parents had applied for American, Canadian, Dutch  and Australian visas. The interview processes were often followed by months of silence and then rejection letters. In January 2003, I was 6 months shy of my 16th birthday, due to sit my O level exams and had completely stopped attending school altogether. My parents were frantic. What future was there for a woman in Pakistan especially if she didn’t even have a basic high school graduation? They tried over and over to talk to me about my poor performance at school and my lacklustre behaviour at home but to no avail. I was not living, merely surviving day to day, waiting for something to drop on my house or hurt someone I loved. It was an awful time for me.

On the 11th of March 2004 at 2pm in the afternoon, I was at home with my father who was reading a newspaper in the living room. I remember every detail of this day because that was the day the mailman brought the one envelope that changed the rest of my life. I cannot remember if it was from the Australian Embassy or whether it was from my father’s colleague who had ties to the embassy but I remember him opening the envelope, reading its contents several times before looking like he was going to throw up. “As of tomorrow” he said “I want you to start considering options for your future. Australia is a very competitive country with very intelligent people and you’re going to need to be on top of your class to go to their Universities”. That was it. We were moving to Australia. My family had been granted a 5 year multiple visa and with it came the option of residency and citizenship. The only catch was that we had to be in Australia by the 5th of May. We had little under 2 months to move across continents and start a new life.

With a suitcase and a backpack each, we said our final goodbyes to family and relatives at Peshawar Airport. One of my father’s work colleagues accompanied us to the terminal gates. They had been friends since college. I heard from my mother several years later that he had been assassinated. Rumour was that someone from a rival political party had decided to take a hit out on him to ensure a district election win. The more I think about things like this, the more I take comfort in the workings of Australia’s political and legal system. It is by no means perfect but the safety it offers those of us who are lucky enough to yield it is comforting.

Does your love of vintage stem from your cultural background?

There is a Pashtun saying that our home comes alive in our stories. That is to say our histories and therefore our cultural identity provides us with a sense of belonging or home and this really resonates with me. My family moved to Australia on such short notice, with such little time on our hands that there was never any closure. We barely brought anything with us to the new country to remember it by. I never got to say goodbye properly to my life, my family or friends. I was under the impression that our move was temporary and that I would one day return to my life as I left it. Nearly 14 years have passed and I have not visited “home”. I have lost grandparents, schoolmates, and relatives. Shops, restaurants and parks I went to as a child have been reduced to rubble or ruin. People have moved on. The Pakistan I felt safe in, the Pakistan I grew up in is like a little figurine in a snow globe, a place frozen in time, in a little bubble of reminiscence. There is no reclaiming it nor will I be able to return to those carefree and happy times.

We have seen numerous articles about how Westernised Pakistan was before the 1980s. Is there a lot of vintage now in Pakistan? Do people hold on to those memorabilia or were they destroyed?

One of my favourite pieces of furniture back home was a chest of drawers that my mother had as a teenager in the 1970s. The drawers were part of an old deco set that my maternal grandparents were given as a wedding gift. In the topmost drawer, underneath some very “groovy” 60s lining paper was a little peace symbol, “Janis Joplin forever” and my mother’s initials. When I inherited the bedroom set at 13, my mother showed me this little bit of graffiti and said “When I was a teenager, i wrote this in the drawer to piss your grandmother off”. I was equal parts mesmerised and weirded out. My mother was once a teenager who liked scribbling on furniture to make her mother angry. When I recounted this story in my year 12 drama class, my classmates attempted to discredit me. In their minds it was impossible to believe that a teenager that lived in 1970s Pakistan had ever heard of Janis Joplin. The Pakistan they had heard of in pre social media 2003 was the one overrun by the Taliban and women in blue burqas. It was hard for them to comprehend the Pakistan my parents grew up in.

My father fondly recounts stories of his American Hippie friends whom he met in Peshawar restaurants en route to Kabul. They had been traveling from India and wanted to visit the Bamiyan Buddha statues in Afghanistan. Pakistan was an important destination on what was called the "hippie trail" – an overland route taken by young western backpackers between 1967 and 1979 that ran from Turkey, across Iran, Afghanistan, Pakistan and India, usually ending in Nepal. Numerous low-budget hotels and a thriving tourist industry sprang up (in Peshawar, Lahore and Karachi) to accommodate these travellers. The hippie trail began eroding after the 1977 military coup in Pakistan, the 1979 Islamic Revolution in Iran and the beginning of the Afghan civil war (in 1979). 

My father delighted in telling me stories of discos and cinemas in Kabul and how he and his cousins would go on weekend trips to buy the latest in American style fashion from the markets there. I have seen photos of my mum in smart embroidered Kaftans wearing ridiculously wide bell bottom trousers topped off with big round sunnies. Like many teenage Pakistani girls of her time, my mother’s fashion choices were influenced by the 1974 box-office hit Miss Hippie. A cautionary tale of sorts, the film depicted the "effect hippie lifestyle and fashion were having on Pakistani youth" but ironically this movie seemed to draw more and more youngsters into the hippie fashion scene. When my parents and my relatives talk on skype its not long before the conversation turns to  “the good ol days in Pakistan” and if I had not seen the photos with my own eyes I too would have thought they were lying to me. Live music, great food, lots of booze and dancing were the hallmarks of the scene in cities like Karachi and Lahore. Sadly, a lot of the amazing venues and attractions they spoke so lovingly about were closed down by Military Dictator Zia Ul Haq’s government in April 1977. 

[Hippie trail into Aghanistan] - By Karte: NordNordWest, Lizenz: Creative Commons by-sa-3.0 de, CC BY-SA 3.0 de, Link

Is there any Pakistani vintage piece that you covet?

There are 3 pieces that I hold very dear to me that I managed to bring with me from Pakistan. The first is a pair of gold earrings my grandmother wore at one of her wedding events in the 50s. My mother wore the very same earrings to her engagement party in 1985 and I wore them as part of my day wear for Miss Pinup Australia 2016. The second is a pair of italian leather shoes my grandmother pestered my grandfather to buy her from Bata Shoes in the late 60s. The number of times they have been cobbled and resoled is incredible! I still wear them in photo shoots from time to time. The last and most important piece to me is my grandmothers rosary. My grandfather had bought her the rosary when he went to Mecca to pay pilgrimage in the early 60s. They are made of a strange kind of early plastic that glows in the dark. My grandmother would constantly be clicking the beads of the rosary, passing each through her nimble calloused fingers, reading short passages from the Quraan. She was hardly ever seen without them. The last time I saw her, she was sitting in front of an old gas heater all misty eyed with her rosary in her hand. When I sat  next to her tying my shoelaces, she looked at me and said “i want you to borrow this rosary from me for now but remember to bring it back  with you from Australia”.  My grandmother passed away two years ago. The rosary has been on my night stand for 14 years, i never got a chance to return it to her.  

Are there many Desi women in the vintage scene? 

I think there have always been a number of us interested in vintage in some form of the other but the problem has always been exposure to our history and one another. With the advent of social media platforms such as instagram and facebook, we have started becoming more visible. It has become easy to find treasure troves of images, articles and videos from the bygone days showcasing our unique cultures.  I know of several vintage loving Desi women that I met on autonomous Women of Colour spaces but wouldn’t have otherwise met because they are self conscious of how they look in vintage. The fact that the presentation of vintage culture and pin up culture is so euro and anglocentric makes a lot of pinups of colour, particularly darker skinned and more ethnic looking pinups feel too self conscious to put themselves out on social media. They often feel  like they are “doing it wrong”. Our features and even our vintage ethnic fashion don’t readily fall into the already pre ordained and celebrated vintage or pinup look. An example of this is how coveted pale and almost snowy white skin is in the vintage community. Darker skinned Desi women are already maligned in their own communities for their complexions, and yet are indirectly made to feel unwanted and unattractive in their beloved subculture as well.   It is harder for Desi pinups to gain visibility and popularity on social media because history has never placed us in a position to be thought about or considered  desirable or conventionally attractive.

Do you find it difficult to be a Desi woman in the pin up industry? Do you think people are surprised that Desi women can and want to be sexy?

I remember when I raised the issue of the lack of diversity in Pinup and vintage publications in Adore Pinup Magazine last year. There was a slough of accusations thrown at myself and the magazine. I was labelled everything from a “reverse racist”, to “a toxic negative nancy”, to a “jealous and ungrateful pinup” all for that one article that discussed the need for change in the Australian vintage scene and the global pinup industry. Apparently, if you are a Desi woman, or a woman of colour, you are expected to be grateful for the one or two token pinups of colour a magazine publishes a year. God forbid you raise hell over the lack of diversity you see in the vintage scene or if you attempt to claim an autonomous online space to celebrate women like yourself. I was lucky that the editor of Adore Pinup Magazine, Brianna Blackheart, addressed the issues I discussed in the article publicly on all of Adore’s social media platforms and backed me up in my arguments. I don’t think I would have continued writing about these issues without her support so early on in my writing.

As far as creating Desi and PoC representation in vintage and pinup goes, the conservative desis in the community feel that I am too racy, too vocal and too sexual to “appropriately” represent Desi femininity while  the conservative non PoC feel that I am trying to create a “racial divide” by working on projects such as Pinups of Colour that exclusively celebrates racially and ethnically diverse pinup communities. There is no winning! I feel like people want women like myself to pick a very narrow and carefully constructed box and sit in it very quietly. Every now and then a nice whitewashed hand will come in and either grab my ethnic outfits to be appropriated and if I am VERY good and quiet I will be paraded around like a ventriloquist's dummy parroting phrases that  implying (non existent) diversity in the scene. I am sorry but  I cannot do that. I refuse to shrink myself to make other people feel comfortable by helping to maintain a status quo and it is just as well as I find it impossible to follow guidelines in order to fit into these boxes anyway!

Staff and students of St Patrick's Teachers' Training College, Karachi, 1956. You can see that for some time during the 1950s-1970s Pakistan strongly adopted Western fashion and culture - Source - Wikimedia Commons.

How did you start wearing vintage? Have you been back since? How do you think you will be accepted there with your tattoos and your look?

I will be honest, I spent my teenage years riddled with insecurity and self doubt because I was one of the few ethnic Desi girls in my predominantly white high school. I stuck out like a sore thumb and at a time where there was a growing mistrust of people from Muslim countries, I was either isolated by my peers or ostracised by them. Vintage clothing gave me a way to feel comfortable with a body that at times felt like a battlefield. As a new migrant whose parents didn’t have much of an income, op-shopping was equal parts necessity and thrill! Much like vintage fashion, tattoos have helped me embrace my body.  I wouldn’t say all my tattoos have stories behind them but a vast majority of them were inspired by moments in my life where I felt something move me to my core. I view my body as a passport and see each tattoo as a little stamp for moments in my journey, from my darkest moments to the happier ones. 

Tattooing in the Indian subcontinent is not unheard of but it isn’t as common as it is in Australia. This is partly due to conservative culture in countries with little separation between church and state. Tribal facial tattoos were common among the early pagan Pashtuns, however, my ethnic group gave up these customs upon the advent of Arab Islam in the 12th century. While some tribal women in Pakistan’s far north still practise stick and poke facial tattooing, a manual method involving charcoal pigment being inserted into the skin using hand fashioned bone needles, tattooing as a Pashtun art form is almost non existent these days. When our tattooing history is brought up in conversations nowadays, our people refer to that period in our history as the “dark ages” and dismiss the practise as uncivilised. As I haven’t visited Pakistan since starting my body modification journey, I really don’t know how people would react to my body art or style of dressing. I suppose it would be no different to how tattooed ladies got treated in the 20s and 30s in America or Australia!

 What is the one thing you want people to know about you? 

I am one of those people who is passionate about social justice issues, particularly issues pertaining to the representation and rights of people of colour. Sometimes this passion is severely misread as spiteful. I am angry. Of course! How can you not be angry in this day and age when women, especially women of colour, receive the short end of the stick? My anger derives from hurt, from isolation and from the yearning to have my identity recognised as valid. It is frustrating to be denied representation in the subcultures I love. It is disappointing to be overlooked on the basis of appearance. It is heartbreaking to be denied a space in my own ethnic and cultural group because I defy convention. I am angry but I am not doing it to be spiteful. I am doing it because nice women seldom make history. There are some people who have the luxury to stand by idly and watch the world plummet into darkness. I do not have this luxury. It’s not in my nature nor is it in my favour to do so. Besides, I would much rather be a cactus than a wallflower any day.

[carasueachterberg]

Health is sacred. We are all realizing this as we struggle together against a virus we can’t see.

I’m also realizing this as I care for our foster dogs this week. Siobhan is handling heartworm treatment beautifully so far, but I will not say she is out of the woods because I am still learning the hard way that we cannot take anything for granted when it comes to these amazing, yet fragile animals.

We lost one of our puppies on Sunday night. Ever since last Thursday, things have been tough in the puppy pen. Every litter we bring up from the shelters comes with mysteries hidden inside those beautiful faces. Mia quite definitely didn’t have any quality prenatal care. Abandoned because she was pregnant or abandoned and then becoming pregnant, I’ll never know. What I do know is that she is not in the best of health. She is bony and angular where she should be round and plump. Her ribs seem almost swollen, but I’m pretty sure it’s a body full of worms creating that illusion. She is always hungry and eats all day long, never getting her fill no matter how often I feed her.

She doesn’t have the huge swollen teats of every other mama dog I’ve fostered, it has never seemed as though the milk supply is enough. Add to that there are only 8 teats for ten puppies, so someone was always being short changed. Those were the factors I attributed for that fact for two weeks although the puppies grew steadily, they never became butterballs like most my litters.

It was Usnavi who first started to fade. His weight began going down instead of up and he seemed lethargic and confused. I began supplementing him with puppy formula. His weight held steady all weekend and he perked up, but he didn’t gain.

Meanwhile, Pippin began to follow his path, and then Elphaba, but neither of the girls took to the formula the way Usnavi did.

Even with the introduction of solid food, when I weighed everyone on Sunday, I discovered that seven out of ten had either not gained or lost a few ounces. I turned up the space heater in their room and tried to stay away as much as possible so that Mia would nurse. If I’m in the room, she jumps out of the box to visit me. Still the puppies seemed to deflate by the hour- wind up toys winding down.

On Sunday night, we lost Elphaba. I found her in the morning with Mia in her dog bed. She’d carried her there at some point in the night, maybe knowing she was passing, maybe trying to help.

On Monday morning it was clear that Pippin was also losing her battle. My best guess was that the worms were just too pervasive. I gave them a stronger wormer early Monday morning after I discovered Elphaba. That was a few days early, but at that point, the risk seemed to outweigh the benefit of waiting.

Tracy, OPH medical director, made an appointment for the pups at the vet and yesterday afternoon I gathered stool samples and put the pups together in a crate and headed to Hanover hoping it wasn’t too late for Pippin who had continued to refuse formula.

I was grateful that I was allowed to come in with the puppies. COVID-19 protocol meant that most owners waited in their car for a vet tech to come get their dog and then return it to them.

The vet spent nearly three hours with us – examining each pup, taking temps, weighing them, checking their blood-sugars and their red blood cell count. Blood sugar was fine and no sign of parvo, thank goodness, but worms were obvious in the loss of fat/muscle along the backbones and hips. In the harsh light of the examing room they looked even worse than in my puppy room. Four-week-old puppies should not be so docile and cooperative, nor so thin.

Their fecal test came back positive for hookworms – lots of them. Hookworms are awful worms that ‘hook’ themselves onto the intestinal wall and feed on the dog’s blood, causing the animal to become anemic and slowly die. In a puppy, that danger is much higher because of their fragile systems. As the worms progressed, the puppies regressed, being eaten alive from the inside out.

Red blood cell counts below 20 are cause for real concern, and anything 12 or under would normally require a blood transfusion. My pups were between 8 (Pippin) and 15 (Mr. Misto). They were too tiny for blood transfusions, never mind the astronomical expense. So, the doctor gave them each a shot of B12 and we talked about the harsh reality that the only way these pups make it is if we get them away from Mia. Otherwise we can’t break the cycle of reinfestation.

Our plan is to separate them from Mia, switch them to puppy mush (blended high quality puppy food and formula), follow an aggressive deworming schedule and give them iron supplements. Luckily, at four weeks, they are old enough (just barely) to be away from mom as long as I can convince them to eat mush.

So far, five of them seem fine with this plan – gobbling up mush, drinking water, and lapping formula. The other four require a little convincing. I have been able to get three of them to drink formula if I start them with a syringe feeding and then let them lap it out of my cupped palm.

Pippin has been the hold out. She will drink water happily – until her belly looks bloated. She refuses the formula and fights my syringe. I don’t want to inadvertently make things worse by causing her to aspirate from forcing the formula, so I have to be content with rubbing it on her gums so she will lick it off. Last night at 3am, she was finally hungry enough to drink from a bowl of formula. It was a great moment, shared only by the other puppies since the rest of the house was asleep.

This morning she tentatively tried the mush and again, drank from the bowl of formula. She doesn’t look much better physically, but hopefully her body is strong and with that nourishment and another deworming tomorrow, we can turn the tide.

Millie, Usnavi, and Cinderella remain skinny but are starting to warm to the idea of mush and formula. Millie seems strong but is resisting the most. I’m encouraged that she skips mealtime in favor of trying to wrestle with the others and have to assume she is one of the ones draining the bowl when I leave it in the pen.

It is touch and go here. Waiting and hoping that their red blood cells will regenerate, watching for more signs of life. My world has been reduced to the puppy room and Mia. Thankfully, Ian takes care of Siobhan and Nick is giving Fanny a lot of attention and allowing her to ‘help’ him work in his home office. Gracie, as always, deals with what is dealt. She’s got guard duty trooping in and out of the house to bark at any movement on our street or the neighbor’s yard.

I know we will get through this. It’s part of rescue. I won’t even say it’s my bad luck, because it’s the reality of rescuing dogs who need rescuing. Dogs that are thrown away by humans who did not care enough to spay them or deworm them or feed them properly. People who never appreciated the huge heart and happy soul of Mia. And communities that do not support or fund a shelter that can offer basic medical care, something as simple as a dewormer.

Once again I am reminded how simple the fix is for this. There is no reason this dog and her pups should be suffering so, no reason that Elphaba should have died. So much in this world is complicated and hard, but this one’s easy. It really is.

Be well,

Cara

If you’d like regular updates of all my foster dogs past and present, plus occasional dog care/training tips from OPH training, be sure to join the Facebook group, Another Good Dog.

For information on me, my writing, and books, visit CaraWrites.com. I have a new book, One Hundred Dogs and Counting: One  Woman, Ten Thousand Miles, and a Journey into the Heart of Shelters and Rescues, coming out in July. If it sounds like something you’d like to read, I’d be beyond grateful if you’d consider preordering it. Preorders contribute to the success of the book, not only giving me and my publisher some peace of mind but hopefully attracting media attention.

And if you’d like to know where all these dogs come from and how you can help solve the crisis of too many unwanted dogs in our shelters, visit WhoWillLetTheDogsOut.org.

Our family fosters through the all-breed rescue, Operation Paws for Homes, a network of foster homes in Virginia, Maryland, D.C., and south-central PA.

If you can’t get enough foster dog stories, check out my book: Another Good Dog: One Family and Fifty Foster Dogs . It’s available anywhere books are sold.

I love to hear from readers and dog-hearted people! Email me at carasueachterberg@gmail.com.

    Doing all we can with a deck that is stacked against us. #rescueisreal #thisisfixable Health is sacred. We are all realizing this as we struggle together against a virus we can’t see.

[likethemusicsounds-blog1]

Plastic And Cosmetic Surgery Tips You Can Use

A little nip or tick can create a whole new appearance. There are risks associated to cosmetic surgery that many people do not realize. One mistake can scar a negative way. Read on to learn how to avoid this.

You should have money put aside earmarked for any expenses linked to your recovery.This can allow you to stay focused on recovering and not the cost.

Always consider other options before engaging in cosmetic surgery. You might be able to resolve problems without making permanent changes to your appearance or spending a lot of money.You might be able to get satisfactory results by simply using make-up, using cosmetics or using over-the-counter medications and other at-home remedies.

Look into your doctor carries malpractice insurance coverage. You want to get compensated if something going amiss in your procedure.

Ask potential surgeons to tell you about what they have done in the procedure you want done.There are no absolute guarantees when it comes to surgery, but you can improve your odds by weeding out bad surgeons.

Educate yourself as much as possible about the cosmetic procedure you want to get. You need find out as much information as you can about it prior to discussing things with a surgeon. You will also be more able to spot potential problems or misleading statements.

Although having cosmetic surgery is much less expensive when performed by doctors abroad, there are many advantages to finding a plastic surgeon close to home. You don't want to have any complications from surgery and have to go to someone other than the original surgeon to get things fixed by a different surgeon.

There are many reasons to undergo plastic surgery including increased self esteem. Cosmetic surgery can be especially helpful to people who have been impacted by severe injury or other injuries. When someone has a severe burn, he or she no longer feels whole; therefore, cosmetic surgery can offer a lot of help.

Before deciding to turn to plastic surgery, find out if there is something else you can do to fix your problems. Cosmetic surgery is generally safe, but you always face the possibility that something can go wrong. Some problems can be solved through other, such as extra fat around your middle, such as a medically prescribed diet to lose weight.

When consulting any medical professional about cosmetic surgery, find out how long recovery time is. You need to make sure you have prepared adequate rest time for your body to heal before big events in your life. You do not want to miss out on any plans because you timed your procedure poorly.

There are four steps that you should do before going for plastic surgery. The first area to consider is recovery after surgery. The next vital topic is how to go about avoiding infection and inflammation post-op.

An experienced specialist when it comes to cosmetic surgery could present you a variety of options that could meet your needs. Work along with the surgeon and utilize his or her expertise before deciding what to have done.

Speak with others who have gone through the process you want to have. They could tell you things your surgeon doesn't reveal to you.

Research procedures before talking to any surgeon about cosmetic surgery. Find all published information as possible about the procedure and recovery so that you are prepared for anything. You might also want to talk to a person who has undergone the procedure already.

There are specific things you need to do one month before your surgery. The most vital things that you need to consider is pain killers. You must make every attempt to avoid these for at least the first month after surgery.

You should quit smoking for at least a month before going through with your surgery.Some surgeons might refuse to work on anyone who does smoke. Cigarettes can decrease the blood flow and make it hard to heal from the procedure.

Make sure you are thoroughly educated about your specific cosmetic procedure.Check your surgeon and check for patient reviews or testimonials.

Make sure you plan for after the operation. If it is a major surgery, like breast augmentation, rhinoplasty or even having a tummy truck, set up a plan for the time that follows the procedure. These are serious surgeries and need to be planned accordingly.

Don't forget about personal hygiene after cosmetic surgery. You might need a seat for the shower in order to make cleaning easier. Sometimes people neglect to plan ahead and have issues after the surgery.

Don't forget about the financial aspects of different procedures. Be sure to also find out about post-op care and additional office visits.

Research as much as you can before making a cosmetic surgery is suitable for you. You need to know what the risks are, what risks you are facing, and any other questions related to the surgery. You should be fully informed before making any type of surgical procedure.

Research your doctor as much as you can before you allow him to operate on you. Although it's common to simply expect the top results, we must be prepared and cover all bases.

A healthy mind will make for a more successful cosmetic surgery experience. Make sure that you're not considering cosmetic surgery as a result of being depressed or distraction. Sometimes human psychology can hurt body image and cause unneeded procedures that aren't in your best interest because of these types of feelings.

If there is nobody to help you then speak with your doctor, consider hiring a CNA for the evening.

Make sure you have examined any non-surgical options that are available. Surgery can be a costly and it might be quite difficult for you to recover.Make sure that you look at all of your options before deciding to get surgery. https://vykhunnie.tumblr.com/

Again, people get plastic surgery every day. Simple surgeries take place so that patients can have their bodies changed. However, there is the risk of a surgeon messing up and disfiguring the patient. By following the advice you have been given, you can prevent many negative consequences from occurring.

[rickivstheuniverse]

The Seattle Eyelid & Blepharoplasty Center

Find Out How To Keep Cosmetic Surgery Safe

Almost everybody has some facial imperfection they want to improve. Cosmetic surgery can make an amazing results. There are risks involved though, so you have to think about that before doing anything. This article should give you in determining whether or not cosmetic surgery is a possibility for you. https://www.eyelids.com/

Make sure any doctor you are considering to see a portfolio of his past clients to look at. Ask anything that is on your mind, and ask if he has letters from satisfied clients. This will help you in deciding if that surgeon is the correct one for you.

Look into alternative ways of the financing options at your disposal.

It is important to remember any surgical procedures include risks. Be sure to discuss these risks with your surgeon so you fully understand them. When you think about plastic surgery, it can be easy to forget any risks.

Learn all that you can about the surgery you want. You need find out as much as possible prior to discussing things with a surgeon. You can then ask intelligent questions and should be able to spot any strange or inconsistencies that could warn you to look for a different doctor.

You may find more affordable options if you request being put on the on-call list to save money.

Find out how many times your surgeon performs the procedure you want done. The more often the surgeon performs the procedure, the more skilled at it he or she will be. This also means that he will have either a large pool of information to look into when determining quality.

Make sure you have given yourself enough time to recover after the surgery. Some procedures require as much as four weeks or more of recovery time.Make sure you have planned enough time off of work for the surgery.

An excellent surgeon with a lot of plastic surgery can suggest various alternatives to achieve your goals. Work with the surgeon and use their suggestions to help you decide on what to have done.

Speak to those who have had the procedure you want to have. You might find out things your surgeon is not share with you.

Ask the doctor's office to provide an itemized list of charges before you have your surgery. This will ensure you do not receive any unexpected bills. There also may be charges that was unexpected occurs. Make sure there are no additional fees associated with the clinic or anesthesiologist.

Speak at length with your physician to understand all of the information relating to your procedure.Ask what you need to know, even if it seems like a little thing, and make sure you are satisfied with the answers. You will have a more successful procedure if you are well-informed.

Ask your doctor how many successful procedures of the type that you desire he has done. You should seek out a surgeon with a steady hand and lots of practice.

You should try to quit smoking at least thirty days prior to undergoing plastic surgery. Some surgeons refuse to operate on smokers. Cigarettes could decrease the blood flow and make it hard to heal from your procedure.

When preparing to have a surgery, it is important to eat healthy fats. You should eat things like flax oil and avocados.

You need to make sure your body is hydrated all of the time. This is particularly true when you are looking at something so invasive as surgery.

Cosmetic surgery is not the magic pill needed for those who have problems with their weight. The most successful cosmetic surgeries are already satisfied with their weight prior to the surgery.

Ask to see photos of work the doctor has previously done. You will be able to see the operation and a few other people. You will have a better understanding of what you should expect to show following the surgery.

Don't forget to look into the financial portion as well.Be sure to also find out about post-op care and additional office visits.

Research as much as you can before deciding whether this kind of surgery decision. You need to know what the risks are, what risks you are facing, and any other questions related to the surgery. You need this information to make the right decision for yourself about surgery.

Discuss your cosmetic procedures with the people close to you. It is important that you have support from them before and after the surgery. That is why it is important to keep someone you love informed about your choice. Tell them about your feelings and keep them updated throughout the process. You will find that this will be a lot easier.

Even if you are having surgery at an outpatient clinic, you might not be able to take yourself home. Find a family member or close friend who can help you home after your surgery. If you do not have family or loved ones to pick you up after surgery, bring along some extra cash for a cab.

Know your doctor does if you're unhappy with the results that you get.Everybody desires to have a successful surgery, and most get it; yet it is smart to prepare for a worse case scenario.

If there is nobody to help you then speak with your doctor, you can hire a nurse or get advice from your doctor.

There are many different reason that people make the decision to have cosmetic surgery is performed. If your body or face has been damaged and needs to be fixed, do not underestimate the importance of a good doctor.

If you use a humidifier along with a good nasal spray or drops, you will heal quicker. This can also shorten your recovery time in recovery.

After you have weighed the positives and negatives that come with cosmetic procedures, it is wise to use caution as you decide what to do. Use the information you have read in this article to responsibly consider this option. By being careful and prudent, you can be sure you cosmetic surgery comes off without a hitch.

[boldly-trekkin-blog]

Confused By Cosmetic Surgery? Help Is Here!

When you consider cosmetic surgery, you may picture procedures done by famous people or friends. However, there are many types of cosmetic surgeries,The following article shares some tips about cosmetic surgery that can enlighten you when considering plastic surgery.

Anyone who is considering cosmetic surgery must research recovery and how long it may take before one can expect to return to normal.

Find out which university he attended, what year he finished, and the number of similar procedures he's accomplished. You should also ask for pictures of patients who have had the same procedures done.

Talk to your potential surgeon you are considering using and ask about past work. There are never any guarantees that cosmetic surgery will give you the results you are looking for, but it is much more likely if you carefully screen any potential doctors.

Botox is often considered cosmetic and not surgical, but it is still important that a doctor perform the injection. A lot of people make the mistake of doing these types of things in a beauty salons for Botox injections from non-licensed beauticians. You can put your health at risk by not choosing a medical professional.

Talk about the costs with your surgeon to get pricing details. You need to come to an agreement on a payment deadline, and perhaps apply for a payment plan or financing in the case of expensive procedures.It is important to have an understanding with the doctor regarding the cost of this is figured out prior to your surgery date.

Research as much as possible to find a good potential surgeon thoroughly before agreeing to plastic surgery. Ask around in your friends or family members if anyone can recommend a surgeon they know any good surgeons.

Learn all that you can about any procedures you are considering. You must obtain as much as you can about it prior to discussing it with a surgeon. You will also be more able to spot any strange or misleading statements.

The cost of your surgery may change if circumstances change. The price can change based on anesthesia, multiple procedures and other factors. Make certain that you receive a full disclosure regarding the medical costs prior to proceeding. Do not make any payment until all of your out-of-pocket expenses will be.

Respect the advice that your doctor about cosmetic surgery. If a surgeon tells you not to have a particular surgery done, there is most likely a very good reason why. You can get the opinion of a second surgeon if you disagree with your doctor. Doing these things can help ensure that any procedure you ultimately undergo.

You may need time before resuming your regular routine with some procedures.

It's important not to decide on cosmetic surgery when you're in a very emotionally-fragile mental space.It will take emotional strength as well to recover, and this will be a lot more difficult if you're emotionally unwell. Slow recoveries can have a detrimental effect on your emotions negatively.

Consider leaving the country to have your surgery. If you decide to take advantage of this option, make sure you do your homework and find a reputable surgeon. https://www.eyelids.com

Anyone who is considering cosmetic surgery should analyze how it fits into their life. It makes sense to postpone any cosmetic surgery if the patient is experiencing great stress or major upheaval.

Ask as many questions that you can.

A psychologist is a beneficial person to speak to before you are considering plastic surgery. This can help you a better understanding as to why you want the procedure and open your eyes to many other things.

You should quit smoking for at least a month before going through with your surgery.Some surgeons might refuse to operate on anyone who does smoke. Smoking can cause a slower blood flow and complications more likely.

Fats, from healthy sources, are an important part of a preparatory diet. You should eat things like flax oil and avocados.

A major disadvantage of having breast augmentation is that sometimes breast cancer is undetectable. Breast implants could interfere to this kind of self-exam difficult to do. Scar tissue resulting from surgery can interfere with breast cancer.

Make sure you plan for your recovery care. If you're planning to have a serious cosmetic surgery, such as breast augmentation, rhinoplasty or even having a tummy truck, you should have an aftercare plan in place before your surgery. These types of surgeries should not be taken lightly!

If you are self-conscious about other people finding out about your surgery, think about getting it done out-of-town. Schedule a short vacation and get it done there. They might never know you had it done.

You can find this kind of information online.

Ask your surgeon for pictures of patients he has worked with in the past. For a better idea of your results, find a surgeon that has a computer program that will take your picture and transform it to your new look.

If you are going to undergo cosmetic surgery, try to have procedures done while you are younger. If you decide to make drastic changes later on in life, your body is not apt to heal as fast as it did when you were younger. A lot of surgeons actually hold the belief that these things will last forever if you do them early.

Exhaust all your non-surgical options before choosing to have a surgical cosmetic procedure. Surgery can be a costly and mentally. Make sure that you look at all of your options before deciding to get surgery.

If you use a humidifier along with a good nasal spray or drops, you will heal quicker. It also may even reduce the length of your recovery period.

It is important to understand what you are getting into with respect to cosmetic surgery. Keep the ideas here in mind, and you will go through the entire process with calmness and knowledge. Soon, you will be looking in the mirror at a new you!

[thegloober]

Taken For A Ride: Doctor Injured In ATV Crash Gets $56,603 Bill For Air Ambulance Trip

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“The biggest challenge for me was to see how I would be a father again,” says Dr. Naveed Khan, who was injured while driving an all-terrain vehicle. “With two able-bodied parents at home, it was easier.” Shelby Knowles for NPR hide caption

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Shelby Knowles for NPR

It was the first — and only — time Dr. Naveed Khan, a 35-year-old radiologist, ever rode in an all-terrain vehicle.

Khan took the wheel from his friend and drove circles in the sand, on a trail along the Red River in Texas.

“As soon as I turned to the side where my body weight was, this two-seater vehicle … just tilted toward the side and toppled,” Khan recalled. It landed on his left arm.

“I had about a 6-inch-wide exposed flesh gap that I could see below, on my forearm,” he said. “And I could see muscle. I could see the fat. I could see the skin. The blood was pooling around it.”

Khan, feeling lightheaded, tied his jacket around his arm like a tourniquet. He and his friend managed to right the ATV, drive back toward the street and call 911.

When an ambulance delivered him to the emergency room at United Regional Health Care System in Wichita Falls, Khan was surprised to hear a doctor murmur that it was the worst arm injury he’d ever seen.

Khan needed immediate helicopter transport to a trauma center for surgery in Fort Worth, if there was any hope of saving the arm.

Groggy from painkillers, Khan managed to ask the doctors how much the flight would cost and whether it would be covered by his insurer. “I think they told my friend, ‘He needs to stop asking questions. He needs to get on that helicopter. He doesn’t realize how serious this injury is,’ ” Khan recalled.

Flown 108 miles to John Peter Smith Hospital in Fort Worth, the closest Level I trauma center, Khan was whisked into surgery to clean out the wound, repair his shattered bones and get blood flowing to the tissue.

He had a total of eight operations to try to save his left forearm before he finally gave up. After weeks in the hospital, he asked the doctors to amputate, so he could get on with his life.

And then the bill came.

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Khan makes lunch for his wife, Ayesha, and their children. He has always enjoyed being in the kitchen and says cooking has been a helpful part of his recovery. Shelby Knowles for NPR hide caption

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Shelby Knowles for NPR

Patient: Naveed Khan, 35, a radiologist and married father of three small children in Southlake, Texas.

Total bill: $56,603 for an air ambulance flight. Blue Cross of Texas, Khan’s insurer, paid $11,972, after initially refusing altogether; the medevac company billed Khan for the remaining $44,631.

Service provider: Air Evac Lifeteam, an air ambulance company that operates 130 bases in 15 states. It’s owned by Air Medical Group Holdings, a holding company that owns four other air ambulance companies and one ground ambulance company. Air Medical, in turn, is owned by the giant private equity firm Kohlberg Kravis Roberts, or KKR.

Medical service: Khan was flown from the United Regional Health Care System in Wichita Falls, Texas, to the John Peter Smith Hospital in Fort Worth.

What gives: Khan got his first call from Air Evac Lifeteam just three days after the accident, while he was still lying in the hospital. A company representative told him the helicopter ride would likely cost more than $50,000 and asked him how he planned to pay.

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For Khan, rapid transportation to the trauma center was essential since the blood supply to his arm had been cut off, said Dr. Rajesh Gandhi, the medical director for trauma services at JPS Hospital.

“If there’s no blood going that means there’s no oxygen,” he said. “It there’s no oxygen, that means those cells are going to die.” Minutes are precious and the helicopter can get from Wichita Falls to Fort Worth in an hour or less, half the time it takes by ground ambulance, he said.

But complaints about sky-high bills to patients for air ambulance services are common. Since launching the “Bill of the Month” series in February, NPR and Kaiser Health News have received more than a dozen bills from patients like Khan who were charged tens of thousands of dollars for an air ambulance ride even after insurers’ payments.

Air ambulance companies defend their charges.

Rick Sherlock, president of the Association of Air Medical Services, a trade group, said air ambulances require a more highly trained crew than a ground ambulance, because only the sickest or most seriously injured patients need air transport.

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.

A spokeswoman for Air Evac Lifeteam said the company bills people so much because it is trying to make up for what she said are meager payments from Medicare and Medicaid.

“Our real cost per flight is the $10,200 plus the unreimbursed cost on each flight for Medicare, Medicaid and patients without any coverage,” wrote Shelly Schneider, the company spokeswoman.

The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

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Khan picks up his youngest child at their home in Sutherland, Texas. Shelby Knowles for NPR hide caption

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Shelby Knowles for NPR

The industry has been advocating hard to get Medicare to boost its reimbursements, Sherlock said. There are bills pending in both the House and Senate that would do so, but there hasn’t been much movement on them.

But others say the industry’s cost estimates are inflated by profit-driven expansion of a lucrative industry. Ground ambulances often carry critically ill patients, too.

Too many air ambulances sit idle much of the time, said Dr. Ira Blumen, a professor of emergency medicine at the University of Chicago and medical director of the university’s Aeromedical Network.

Blumen said the industry — which is dominated by a few companies owned by private equity firms — expanded dramatically the last time Medicare boosted its payments in 2002. And now there are too many helicopters — 908 as of last year — fighting for patients and profits at the same time.

“The number of helicopters is outrageous for the continental United States,” he said. In the 1990s, most helicopters ran more than 500 flights per year on average. At that rate, the cost per flight today would be less than $6,000.

A Blue Cross of Texas spokesman said the insurer does have a contracted rate with an in-network air ambulance company, but it is not Air Evac Lifeteam. After initially refusing to pay anything for an out-of-network claim, it agreed to the $11,972 payment.

But in some sense, the reason ambulance companies charge so much is simply because they can: Air ambulances are largely regulated not as health care but as part of the aviation industry. Federal laws prevent states from limiting aviation rates, routes and services.

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So many people have been hit with shockingly high air ambulance bills that members of Congress on both sides of the aisle are trying to do something about it. Legislation to reauthorize funding for the Federal Aviation Administration that is moving through Congress now would set up a council of industry experts to address balance billing and other issues, and set up a complaint line for consumers.

Resolution: Khan has allowed Air Evac Lifeteam to negotiate with Blue Cross of Texas over the remaining $44,000 air ambulance bill. The company has asked him to appeal to the state’s Department of Insurance, and though he first balked at the suggestion, he’s now considering doing so. Khan says he doesn’t understand why the helicopter flight, which was an integral part of the emergency medical care he received, is treated differently than his surgeries, nursing care and physical therapy.

“I thought that this was another piece of that puzzle,” he said. “It turns out that this was glaringly different.”

He is waiting for resolution as he gets accustomed to life with his disability. Holding his baby son, he asked in frustration: “How do I hold him while he’s crying and at the same time heat up his bottle?”

Khan, who has had to fight with his insurance company to get coverage for a prosthetic arm, is frustrated when he learns that the air ambulance company expects him to pay far more than the actual cost of his flight.

“It’s unfair,” he says. “It’s random, it’s arbitrary. It’s whatever price they want to set. And to put that onto a person who’s already been through what I’ve been through, I hate to say it, but it’s cruel.”

The takeaway: Most people with health problems serious enough to require a helicopter flight are in no position to ask if the medevac company is in-network or if there’s a choice. But if you or a family member has time to ask, it could pay off.

If you’re faced with a huge bill for a medevac ride, there are a few steps you should take.

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Naveed Khan prepares lunch, while his wife, Ayesha, and their children play on the couch. Shelby Knowles for NPR hide caption

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Shelby Knowles for NPR

First, let your insurer’s process play out. Blue Cross Blue Shield of Texas first denied Khan’s claim altogether. But he looked closely at his policy and saw that the threat of loss of limb was explicitly covered. He appealed, and that’s when the insurer paid $11,972.

Second, negotiate! The air ambulance company might be willing to negotiate a settlement for a fraction of the bill to avoid turning to debt collectors, who would pay them pennies on the dollar.

Both Sherlock of the Association of Air Medical Services and Schneider of Air Evac Lifeteam said companies will try to determine what a patient can afford. So people with high incomes may find it hard to obtain a substantial reduction for their bill. Still, if patients know the true cost of the service they received, they may be better equipped to negotiate a discount.

Many air ambulance companies offer membership plans that can cost less than $100 a year, and guarantee that the company will accept whatever payment an insurance company makes without billing the patient for the rest. But buyer, beware: When someone needs an air ambulance, they are often not in a position to choose which company will respond to the call.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Source: https://bloghyped.com/taken-for-a-ride-doctor-injured-in-atv-crash-gets-56603-bill-for-air-ambulance-trip/

[ongames]

This Is What Obamacare's Critics Won't Admit Or Simply Don't Understand

THOUSAND OAKS, California ― Maryann Hammers is likely to die from ovarian cancer someday. But she hopes someday won’t come anytime soon.

Hammers, 61, received the diagnosis in late 2013, and doctors told her that it was stage 3-C, which meant that she could live for many years with the right treatment and a little luck. So far, she’s had both. She’s in remission for the second time, and her last course of chemotherapy ended a year and a half ago. But recent blood tests detected elevated levels of a protein associated with tumors, she explained when we met a few weeks ago. “Maybe it’s a fluke,” she said. “I hope so. I kinda feel like the clock is ticking.”

If the cancer is back, Hammers said, she may need surgery similar to her two previous operations — “gigantic surgeries, gutted like a fish and hospitalized for many days.” Chemotherapy would likely come next, plus medication, hospitalization, and home care. But Hammers considers herself lucky because she’s been able to get treatment at City of Hope, a highly respected Southern California cancer research and treatment center, and luckier still that she’s been able to pay for the treatment with insurance — an Anthem Blue Cross policy she bought through Covered California, the exchange her state created under the Affordable Care Act.

To hear President Donald Trump, House Speaker Paul Ryan and other Republicans tell it, Obamacare has been a disaster, even for those who obtained coverage through the law. Hammers has a very different perspective. She’s a freelance writer and editor, which means she has no employer-provided insurance. In the old days, if she’d gone shopping for a policy with her cancer diagnosis, she would have struggled to find a carrier willing to sell her one.

I'm terrified. ... Do you know how easy it is to use a million dollars when you're getting cancer treatment? Maryann Hammers, Thousand Oaks, California

And it’s not just the pre-existing condition guarantee, which even critics like Trump say they support, that Hammers has found so valuable. The Affordable Care Act requires insurers to cover a wide range of services and treatments — which, in her case, has included multiple shots of Neulasta, a medication that boosts white blood cell counts and typically costs several thousand dollars per injection. The law also prohibits annual or lifetime limits on benefits, which, as a long-term cancer patient, she would be a prime candidate to exceed. 

Policies with such robust coverage inevitably cost thousands of dollars a year, more than Hammers could afford on her own — particularly since battling the disease has cut into her work hours. But the law’s generous tax credits discount the premiums and help with the out-of-pocket costs, too. “Without the Affordable Care Act, I honestly do not know what I would have done,” she said.

The coverage Hammers has today still isn’t as good as what she had years ago, when she worked for a company that provided benefits. But it’s better than what she had in the years right before the cancer diagnosis, when she was buying insurance on her own. The latter plan covered fewer services and came with out-of-pocket costs high enough to discourage her from getting checkups. Obamacare’s introduction of free preventive screenings led her to schedule a long-overdue colonoscopy. During routine preparation for that procedure, a physician first felt a lump in her abdomen.  

Sometimes Hammers wonders whether, with less sporadic doctor visits, the cancer might have been caught a little sooner. “But I couldn’t afford a fat doctor’s bill. And I thought I was super healthy.”

These days, something else looms even larger in her mind — the possibility that Trump and the Republican Congress will repeal the health care law without an adequate replacement, or maybe with no replacement at all.  

“I’m terrified — isn’t that crazy?” Hammers said. “My biggest source of stress right now isn’t the fact that I have incurable cancer. It’s the prospect of losing my insurance.”

What American Health Care Used To Look Like

To appreciate the significance of stories like Hammers’ and what they say about the Affordable Care Act, it helps to remember what used to happen to people like her before the law took effect. By 2009, when President Barack Obama took office, roughly 1 in 6 Americans had no health care insurance, and even the insured could still face crippling medical bills. As a reporter covering health care during those years, I met these people. Some of their stories stand out, even now, because they capture the old system at its callous, capricious worst.

Gary Rotzler, a quality engineer at a defense contractor in upstate New York, lost his family coverage in the early 1990s when he lost his job. He ended up uninsured for two years, while he juggled stints as an independent contractor. His wife, Betsy, made do without doctor visits even after she started feeling some strange pains. By the time she got a checkup, she had advanced breast cancer. Desperate efforts at treatment failed. After she died, Gary, a father of three, had to declare bankruptcy because of all the unpaid medical bills.

Jacqueline Ruess, a widow in south Florida, thought she was insured. But then she needed expensive tests when her physicians suspected she had cancer. Although the tests were negative, the insurer refused to pay the bills because, it said, a brief episode of a routine gynecological problem in her past qualified as a pre-existing condition.

Tony Montenegro, an immigrant from El Salvador living in Los Angeles, was uninsured and working as a security guard, until untreated diabetes left him legally blind.

Marijon Binder, an impoverished former nun in Chicago, was sued by a Catholic hospital over medical expenses she couldn’t pay.

And Russ Doren, a schoolteacher in a Denver suburb, believed he had good insurance until the bills for his wife’s inpatient treatment at a psychiatric hospital hit the limit for mental health coverage. The hospital released her, despite worries that she was not ready. A few days later, she took her own life.

The Affordable Care Act of 2010 was an effort to address these kinds of problems — to carry on the crusade for universal coverage that Harry Truman had launched some 60 years before. But precisely because Obama and his allies were determined to succeed where predecessors had failed, they made a series of concessions that necessarily limited the law’s ambition.

They expanded Medicaid and regulated private insurance rather than start a whole new government-run program. They dialed back demands for lower prices from drugmakers, hospitals and other health care industries. And they agreed to tight budget constraints for the program as a whole, rather than risk a revolt among more conservative Democrats. These decisions meant that health insurance would ultimately be more expensive and the new system’s financial assistance would be less generous.

Still, projections showed that the law would bring coverage to millions while giving policymakers tools they could use to reduce medical costs over time. When the Senate passed its version of the legislation in December 2009, then-Sen. Tom Harkin (D-Iowa) described the program as a “starter home” with a solid foundation and room for expansion.

Where Obamacare Failed And Where It Succeeded

Seven years later, Trump and the Affordable Care Act’s other critics insist that the program has been a boondoggle — that the Obamacare starter home needs demolition. Some of their objections are philosophical, and some, like the persistent belief that the law set up “death panels,” are fantastical. But others focus on the law’s actual consequences.

High on that list of consequences are the higher premiums and out-of-pocket costs that some people face. The new rules, like coverage of pre-existing conditions, have made policies more expensive, and Obamacare’s financial aid frequently doesn’t offset the increases. A “rate shock” wave hit suddenly in the fall of 2013, when insurers unveiled their newly upgraded plans and in many cases canceled old ones — infuriating customers who remembered Obama’s promise that “if you like your plan, you can keep it,” while alienating even some of those sympathetic to what Obama and the Democrats were trying to do.

I’ve interviewed plenty of these people, too. A few weeks ago, I spoke with Faisuly Scheurer, a real estate agent from Blowing Rock, North Carolina. She and her husband, who works in the restaurant business, were excited about the health care law because they’d struggled to find decent, affordable insurance. They make about $60,000 a year, before taxes, with two kids and college tuition looming in the not-distant future, she said.

In late 2013, they checked out their options and learned that, after tax credits, coverage would cost $360 a month. Scheurer said she remembers thinking, “OK, that is really tight. But if the benefits are good, we are going to have to skimp on other things to make it work.” Then she learned about the deductible, which was nearly $13,000 per year. “My disappointment was indescribable.”

The Scheurer family ultimately decided to remain uninsured. They’re not the only ones, and that has weakened the system as a whole. The people eschewing coverage tend to be relatively healthy, since they’re most willing to take the risk of no coverage. That’s created big problems for insurers, which need the premiums from healthy folks to offset the high medical bills of people with serious conditions.

Many insurers have reacted by raising premiums or pulling out of some places entirely, leaving dysfunctional markets in North Carolina and a handful of other states. Just this week, Humana, which had already scaled back its offerings, announced that it was pulling out of the Affordable Care Act exchanges altogether. At least for the moment, 16 counties in Tennessee don’t have a single insurer committed to offering coverage in 2018.

Trump, Ryan and other Republicans pounced on the Humana news, citing it as more proof of a “failed system” and the need for repeal. That’s pretty typical of how the political conversation about the Affordable Care Act has proceeded for the last seven years. The focus is on everything that’s gone wrong with Obamacare, with scant attention to what’s gone right.

And yet the list of what’s gone right is long.

In states like California and Michigan, the newly regulated markets appear to be working as the law’s architects intended, except for some rural areas that insurers have never served that well. Middle-class people in those states have better, more affordable options.

It looks like more insurers are figuring out how to make their products work and how to successfully compete for business. Customers have turned out to be more price-sensitive than insurers originally anticipated. In general, the carriers that struggle are large national companies without much experience selling directly to consumers, rather than through employers.

Last year’s big premium increases followed two years in which average premiums were far below projections, a sign that carriers simply started their pricing too low. Even now, on average, the premiums people pay for exchange insurance are on a par with, or even a bit cheaper than, equivalent employer policies — and that’s before the tax credits.

The majority of people who are buying insurance on their own or get their coverage through Medicaid are satisfied with it, according to separate surveys by the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The level of satisfaction with the new coverage still trails that involving employer-provided insurance, and it has declined over time. But it’s clearly in positive territory 

And then there’s the fact that the number of people without health insurance is the lowest that government or private surveys have ever recorded. When confronted with questions about the people who gained coverage because of the law, Republicans often say something about sparing those people from disruption ― and then argue that even those who obtained insurance through the law are suffering and no better off. This claim is wildly inconsistent with the experience of people like Maryann Hammers ― and, more important, it’s wildly inconsistent with the best available research.

People are struggling less with medical bills, have easier access to primary care and medication, and report that they’re in better health, according to a study that appeared in the Journal of the American Medical Association in 2015. The number of people forgoing care because of costs or being “very worried” about paying for a catastrophic medical bill dropped substantially among the newly insured, Kaiser Foundation researchers found last year when they focused on people in California.

A bunch of other studies have turned up similar evidence, All of them gibe with a landmark report on the effects of Massachusetts’ 2006 insurance expansion, which was a prototype for the national legislation. Residents of that state experienced better health outcomes and less financial stress, according to the study published in the Annals of Internal Medicine.

“Though it’s had no shortage of controversies and stumbles, there’s really no denying that the ACA has created historic gains in insurance coverage,” said Larry Levitt, a senior vice president at the Kaiser Foundation. “With better coverage that has fewer holes, access to health care has improved and many have better protection from crushing medical bills.”

What Repeal Would Really Mean

Reasonable people can disagree about whether these achievements justify Obamacare’s costs, which include not only higher premiums for the young and healthy but also hefty new taxes on the wealthiest Americans. That’s a debate about values and priorities as much as facts.

What’s not in dispute, or shouldn’t be, is the stark choice on the political agenda right now.

Democratic lawmakers still argue for the principle that Truman laid out in 1948: “health security for all, regardless of residence, station, or race.” They think the Affordable Care Act means the U.S. is closer to that goal and that the next step should be to bolster the law ― by using government power to force down the price of drugs, hospital services and other forms of medical care, while providing more generous government assistance to people who still find premiums and out-of-pocket costs too onerous. Basically, they want people like Faisuly Scheurer to end up with the same security that people like Maryann Hammers already have.

Some Republicans talk as if they share these goals. Trump has probably been the most outspoken on this point, promising to deliver “great health care at lower cost” and vowing that “everybody would be covered.” But other Republicans reject the whole concept of health care as a right. Although it’s theoretically possible to draw up a conservative health plan that would improve access and affordability, these aren’t the kinds of plans that Republicans have in mind. 

There’s a face to this law, there’s a face to people that are going to be affected by it. Angela Eilers, Yorba Linda, California

Their schemes envision substantially less government spending on health care, which would mean lower taxes for the wealthy but also less financial assistance for everybody else. Republicans would make insurance cheaper, but only by allowing it to cover fewer services and saddling beneficiaries with even higher out-of-pocket costs. The result would be some mix of more exposure to medical bills and more people without coverage. If Republicans repeal the Affordable Care Act without replacing it ― a real possibility, given profound divisions within the GOP over how to craft a plan ― 32 million more people could go uninsured, according to the Congressional Budget Office.

That would mean real suffering, primarily among those Americans who benefit most from the law now ― the ones with serious medical problems, or too little income to pay for insurance on their own, or both.

Jay Stout, a 20-year-old in Wilmington, North Carolina, is one of those people. He was in good health until a head-on car collision nearly severed his arm and landed him in the hospital for more than a month. Surgeries and rehabilitation would have cost him hundreds of thousands of dollars that, as a community college student working part-time as a busboy, he could never have paid — if not for the Blue Cross plan that his mother had bought through the Affordable Care Act. When we spoke a few weeks ago, he told me the insurance has been “irreplaceable” and that losing it “would be totally devastating.”

Meenakshi Bewtra had never had a serious health problem until her first year at the University of Pennsylvania medical school, when she developed severe gastrointestinal problems — the kind that forced her into the hospital for two months and drove her to drop out of school. Her insurance lapsed, which meant that her GI issues became a pre-existing condition. She eventually found coverage and today she’s a professor of medicine at Penn, where she moonlights as an advocate for universal health insurance.

“For the first time, I truly understood what comprehensive health insurance meant,” Bewtra said, remembering what it was like to become fully covered. “I did not have to worry about how many times I saw a doctor, or how many lab tests I had to get, or having to ration out medications.”

Angela Eilers, who lives in Yorba Linda, California, isn’t worrying about her own health. It’s her daughter Myka who has a congenital heart condition called pulmonary stenosis, which makes it more difficult for the heart to pump blood to the lungs. The little girl has required multiple surgeries and will need intensive medical treatment throughout her childhood.

In 2012, Angela’s husband, Todd, was laid off from his job at an investment firm. Since going without insurance was not an option, they took advantage of COBRA to stay on his old company’s health plan. It was expensive, and Eilers recalled panicking over the possibility they might not be able to pay the premiums. “I remember sitting at the table, thinking of plans. What would be our plan? One of them was … giving up our parents rights to my mom, because she has really good health insurance.”

Eventually her husband started his own consulting business, and that gave them the income to keep up with premiums until 2014 — when they were able to obtain coverage through the Affordable Care Act. Today they have a gold plan, one of the most generous available, for which they pay around $20,000 a year. Even though they make too much to qualify for financial assistance, they’re grateful for the coverage. Seven-year-old Myka has already run up more than a half-million dollars in medical bills. In the old days, before Obamacare, they would have worried about hitting their plan’s lifetime limit on benefits. 

The family’s coverage has become more expensive over the years. They wish the price were lower, but they’re also not complaining about that. “I’m thankful that the letter was a premium hike, rather than ‘Sorry, we are not going to cover your daughter anymore,’” Angela Eilers said.

When she thinks about the possibility of Obamacare repeal, she wonders if Trump and the Republicans understand what that would really mean. “There’s a face to this law, there’s a face to people that are going to be affected by it,” Eilers said. “It’s not me, it’s not him, it’s her. She’s only 7. And through no fault of her own, why should she suffer? And she’s not the only one.”

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This Is What Obamacare's Critics Won't Admit Or Simply Don't Understand published first on http://ift.tt/2lnpciY

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This Is What Obamacare's Critics Won't Admit Or Simply Don't Understand

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THOUSAND OAKS, California ― Maryann Hammers is likely to die from ovarian cancer someday. But she hopes someday won’t come anytime soon.

Hammers, 61, received the diagnosis in late 2013, and doctors told her that it was stage 3-C, which meant that she could live for many years with the right treatment and a little luck. So far, she’s had both. She’s in remission for the second time, and her last course of chemotherapy ended a year and a half ago. But recent blood tests detected elevated levels of a protein associated with tumors, she explained when we met a few weeks ago. “Maybe it’s a fluke,” she said. “I hope so. I kinda feel like the clock is ticking.”

If the cancer is back, Hammers said, she may need surgery similar to her two previous operations — “gigantic surgeries, gutted like a fish and hospitalized for many days.” Chemotherapy would likely come next, plus medication, hospitalization, and home care. But Hammers considers herself lucky because she’s been able to get treatment at City of Hope, a highly respected Southern California cancer research and treatment center, and luckier still that she’s been able to pay for the treatment with insurance — an Anthem Blue Cross policy she bought through Covered California, the exchange her state created under the Affordable Care Act.

To hear President Donald Trump, House Speaker Paul Ryan and other Republicans tell it, Obamacare has been a disaster, even for those who obtained coverage through the law. Hammers has a very different perspective. She’s a freelance writer and editor, which means she has no employer-provided insurance. In the old days, if she’d gone shopping for a policy with her cancer diagnosis, she would have struggled to find a carrier willing to sell her one.

I'm terrified. ... Do you know how easy it is to use a million dollars when you're getting cancer treatment? Maryann Hammers, Thousand Oaks, California

And it’s not just the pre-existing condition guarantee, which even critics like Trump say they support, that Hammers has found so valuable. The Affordable Care Act requires insurers to cover a wide range of services and treatments — which, in her case, has included multiple shots of Neulasta, a medication that boosts white blood cell counts and typically costs several thousand dollars per injection. The law also prohibits annual or lifetime limits on benefits, which, as a long-term cancer patient, she would be a prime candidate to exceed. 

Policies with such robust coverage inevitably cost thousands of dollars a year, more than Hammers could afford on her own — particularly since battling the disease has cut into her work hours. But the law’s generous tax credits discount the premiums and help with the out-of-pocket costs, too. “Without the Affordable Care Act, I honestly do not know what I would have done,” she said.

The coverage Hammers has today still isn’t as good as what she had years ago, when she worked for a company that provided benefits. But it’s better than what she had in the years right before the cancer diagnosis, when she was buying insurance on her own. The latter plan covered fewer services and came with out-of-pocket costs high enough to discourage her from getting checkups. Obamacare’s introduction of free preventive screenings led her to schedule a long-overdue colonoscopy. During routine preparation for that procedure, a physician first felt a lump in her abdomen.  

Sometimes Hammers wonders whether, with less sporadic doctor visits, the cancer might have been caught a little sooner. “But I couldn’t afford a fat doctor’s bill. And I thought I was super healthy.”

These days, something else looms even larger in her mind — the possibility that Trump and the Republican Congress will repeal the health care law without an adequate replacement, or maybe with no replacement at all.  

“I’m terrified — isn’t that crazy?” Hammers said. “My biggest source of stress right now isn’t the fact that I have incurable cancer. It’s the prospect of losing my insurance.”

What American Health Care Used To Look Like

To appreciate the significance of stories like Hammers’ and what they say about the Affordable Care Act, it helps to remember what used to happen to people like her before the law took effect. By 2009, when President Barack Obama took office, roughly 1 in 6 Americans had no health care insurance, and even the insured could still face crippling medical bills. As a reporter covering health care during those years, I met these people. Some of their stories stand out, even now, because they capture the old system at its callous, capricious worst.

Gary Rotzler, a quality engineer at a defense contractor in upstate New York, lost his family coverage in the early 1990s when he lost his job. He ended up uninsured for two years, while he juggled stints as an independent contractor. His wife, Betsy, made do without doctor visits even after she started feeling some strange pains. By the time she got a checkup, she had advanced breast cancer. Desperate efforts at treatment failed. After she died, Gary, a father of three, had to declare bankruptcy because of all the unpaid medical bills.

Jacqueline Ruess, a widow in south Florida, thought she was insured. But then she needed expensive tests when her physicians suspected she had cancer. Although the tests were negative, the insurer refused to pay the bills because, it said, a brief episode of a routine gynecological problem in her past qualified as a pre-existing condition.

Tony Montenegro, an immigrant from El Salvador living in Los Angeles, was uninsured and working as a security guard, until untreated diabetes left him legally blind.

Marijon Binder, an impoverished former nun in Chicago, was sued by a Catholic hospital over medical expenses she couldn’t pay.

And Russ Doren, a schoolteacher in a Denver suburb, believed he had good insurance until the bills for his wife’s inpatient treatment at a psychiatric hospital hit the limit for mental health coverage. The hospital released her, despite worries that she was not ready. A few days later, she took her own life.

The Affordable Care Act of 2010 was an effort to address these kinds of problems — to carry on the crusade for universal coverage that Harry Truman had launched some 60 years before. But precisely because Obama and his allies were determined to succeed where predecessors had failed, they made a series of concessions that necessarily limited the law’s ambition.

They expanded Medicaid and regulated private insurance rather than start a whole new government-run program. They dialed back demands for lower prices from drugmakers, hospitals and other health care industries. And they agreed to tight budget constraints for the program as a whole, rather than risk a revolt among more conservative Democrats. These decisions meant that health insurance would ultimately be more expensive and the new system’s financial assistance would be less generous.

Still, projections showed that the law would bring coverage to millions while giving policymakers tools they could use to reduce medical costs over time. When the Senate passed its version of the legislation in December 2009, then-Sen. Tom Harkin (D-Iowa) described the program as a “starter home” with a solid foundation and room for expansion.

Where Obamacare Failed And Where It Succeeded

Seven years later, Trump and the Affordable Care Act’s other critics insist that the program has been a boondoggle — that the Obamacare starter home needs demolition. Some of their objections are philosophical, and some, like the persistent belief that the law set up “death panels,” are fantastical. But others focus on the law’s actual consequences.

High on that list of consequences are the higher premiums and out-of-pocket costs that some people face. The new rules, like coverage of pre-existing conditions, have made policies more expensive, and Obamacare’s financial aid frequently doesn’t offset the increases. A “rate shock” wave hit suddenly in the fall of 2013, when insurers unveiled their newly upgraded plans and in many cases canceled old ones — infuriating customers who remembered Obama’s promise that “if you like your plan, you can keep it,” while alienating even some of those sympathetic to what Obama and the Democrats were trying to do.

I’ve interviewed plenty of these people, too. A few weeks ago, I spoke with Faisuly Scheurer, a real estate agent from Blowing Rock, North Carolina. She and her husband, who works in the restaurant business, were excited about the health care law because they’d struggled to find decent, affordable insurance. They make about $60,000 a year, before taxes, with two kids and college tuition looming in the not-distant future, she said.

In late 2013, they checked out their options and learned that, after tax credits, coverage would cost $360 a month. Scheurer said she remembers thinking, “OK, that is really tight. But if the benefits are good, we are going to have to skimp on other things to make it work.” Then she learned about the deductible, which was nearly $13,000 per year. “My disappointment was indescribable.”

The Scheurer family ultimately decided to remain uninsured. They’re not the only ones, and that has weakened the system as a whole. The people eschewing coverage tend to be relatively healthy, since they’re most willing to take the risk of no coverage. That’s created big problems for insurers, which need the premiums from healthy folks to offset the high medical bills of people with serious conditions.

Many insurers have reacted by raising premiums or pulling out of some places entirely, leaving dysfunctional markets in North Carolina and a handful of other states. Just this week, Humana, which had already scaled back its offerings, announced that it was pulling out of the Affordable Care Act exchanges altogether. At least for the moment, 16 counties in Tennessee don’t have a single insurer committed to offering coverage in 2018.

Trump, Ryan and other Republicans pounced on the Humana news, citing it as more proof of a “failed system” and the need for repeal. That’s pretty typical of how the political conversation about the Affordable Care Act has proceeded for the last seven years. The focus is on everything that’s gone wrong with Obamacare, with scant attention to what’s gone right.

And yet the list of what’s gone right is long.

In states like California and Michigan, the newly regulated markets appear to be working as the law’s architects intended, except for some rural areas that insurers have never served that well. Middle-class people in those states have better, more affordable options.

It looks like more insurers are figuring out how to make their products work and how to successfully compete for business. Customers have turned out to be more price-sensitive than insurers originally anticipated. In general, the carriers that struggle are large national companies without much experience selling directly to consumers, rather than through employers.

Last year’s big premium increases followed two years in which average premiums were far below projections, a sign that carriers simply started their pricing too low. Even now, on average, the premiums people pay for exchange insurance are on a par with, or even a bit cheaper than, equivalent employer policies — and that’s before the tax credits.

The majority of people who are buying insurance on their own or get their coverage through Medicaid are satisfied with it, according to separate surveys by the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The level of satisfaction with the new coverage still trails that involving employer-provided insurance, and it has declined over time. But it’s clearly in positive territory 

And then there’s the fact that the number of people without health insurance is the lowest that government or private surveys have ever recorded. When confronted with questions about the people who gained coverage because of the law, Republicans often say something about sparing those people from disruption ― and then argue that even those who obtained insurance through the law are suffering and no better off. This claim is wildly inconsistent with the experience of people like Maryann Hammers ― and, more important, it’s wildly inconsistent with the best available research.

People are struggling less with medical bills, have easier access to primary care and medication, and report that they’re in better health, according to a study that appeared in the Journal of the American Medical Association in 2015. The number of people forgoing care because of costs or being “very worried” about paying for a catastrophic medical bill dropped substantially among the newly insured, Kaiser Foundation researchers found last year when they focused on people in California.

A bunch of other studies have turned up similar evidence, All of them gibe with a landmark report on the effects of Massachusetts’ 2006 insurance expansion, which was a prototype for the national legislation. Residents of that state experienced better health outcomes and less financial stress, according to the study published in the Annals of Internal Medicine.

“Though it’s had no shortage of controversies and stumbles, there’s really no denying that the ACA has created historic gains in insurance coverage,” said Larry Levitt, a senior vice president at the Kaiser Foundation. “With better coverage that has fewer holes, access to health care has improved and many have better protection from crushing medical bills.”

What Repeal Would Really Mean

Reasonable people can disagree about whether these achievements justify Obamacare’s costs, which include not only higher premiums for the young and healthy but also hefty new taxes on the wealthiest Americans. That’s a debate about values and priorities as much as facts.

What’s not in dispute, or shouldn’t be, is the stark choice on the political agenda right now.

Democratic lawmakers still argue for the principle that Truman laid out in 1948: “health security for all, regardless of residence, station, or race.” They think the Affordable Care Act means the U.S. is closer to that goal and that the next step should be to bolster the law ― by using government power to force down the price of drugs, hospital services and other forms of medical care, while providing more generous government assistance to people who still find premiums and out-of-pocket costs too onerous. Basically, they want people like Faisuly Scheurer to end up with the same security that people like Maryann Hammers already have.

Some Republicans talk as if they share these goals. Trump has probably been the most outspoken on this point, promising to deliver “great health care at lower cost” and vowing that “everybody would be covered.” But other Republicans reject the whole concept of health care as a right. Although it’s theoretically possible to draw up a conservative health plan that would improve access and affordability, these aren’t the kinds of plans that Republicans have in mind. 

There’s a face to this law, there’s a face to people that are going to be affected by it. Angela Eilers, Yorba Linda, California

Their schemes envision substantially less government spending on health care, which would mean lower taxes for the wealthy but also less financial assistance for everybody else. Republicans would make insurance cheaper, but only by allowing it to cover fewer services and saddling beneficiaries with even higher out-of-pocket costs. The result would be some mix of more exposure to medical bills and more people without coverage. If Republicans repeal the Affordable Care Act without replacing it ― a real possibility, given profound divisions within the GOP over how to craft a plan ― 32 million more people could go uninsured, according to the Congressional Budget Office.

That would mean real suffering, primarily among those Americans who benefit most from the law now ― the ones with serious medical problems, or too little income to pay for insurance on their own, or both.

Jay Stout, a 20-year-old in Wilmington, North Carolina, is one of those people. He was in good health until a head-on car collision nearly severed his arm and landed him in the hospital for more than a month. Surgeries and rehabilitation would have cost him hundreds of thousands of dollars that, as a community college student working part-time as a busboy, he could never have paid — if not for the Blue Cross plan that his mother had bought through the Affordable Care Act. When we spoke a few weeks ago, he told me the insurance has been “irreplaceable” and that losing it “would be totally devastating.”

Meenakshi Bewtra had never had a serious health problem until her first year at the University of Pennsylvania medical school, when she developed severe gastrointestinal problems — the kind that forced her into the hospital for two months and drove her to drop out of school. Her insurance lapsed, which meant that her GI issues became a pre-existing condition. She eventually found coverage and today she’s a professor of medicine at Penn, where she moonlights as an advocate for universal health insurance.

“For the first time, I truly understood what comprehensive health insurance meant,” Bewtra said, remembering what it was like to become fully covered. “I did not have to worry about how many times I saw a doctor, or how many lab tests I had to get, or having to ration out medications.”

Angela Eilers, who lives in Yorba Linda, California, isn’t worrying about her own health. It’s her daughter Myka who has a congenital heart condition called pulmonary stenosis, which makes it more difficult for the heart to pump blood to the lungs. The little girl has required multiple surgeries and will need intensive medical treatment throughout her childhood.

In 2012, Angela’s husband, Todd, was laid off from his job at an investment firm. Since going without insurance was not an option, they took advantage of COBRA to stay on his old company’s health plan. It was expensive, and Eilers recalled panicking over the possibility they might not be able to pay the premiums. “I remember sitting at the table, thinking of plans. What would be our plan? One of them was … giving up our parents rights to my mom, because she has really good health insurance.”

Eventually her husband started his own consulting business, and that gave them the income to keep up with premiums until 2014 — when they were able to obtain coverage through the Affordable Care Act. Today they have a gold plan, one of the most generous available, for which they pay around $20,000 a year. Even though they make too much to qualify for financial assistance, they’re grateful for the coverage. Seven-year-old Myka has already run up more than a half-million dollars in medical bills. In the old days, before Obamacare, they would have worried about hitting their plan’s lifetime limit on benefits. 

The family’s coverage has become more expensive over the years. They wish the price were lower, but they’re also not complaining about that. “I’m thankful that the letter was a premium hike, rather than ‘Sorry, we are not going to cover your daughter anymore,’” Angela Eilers said.

When she thinks about the possibility of Obamacare repeal, she wonders if Trump and the Republicans understand what that would really mean. “There’s a face to this law, there’s a face to people that are going to be affected by it,” Eilers said. “It’s not me, it’s not him, it’s her. She’s only 7. And through no fault of her own, why should she suffer? And she’s not the only one.”

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from http://ift.tt/2lhKYWx from Blogger http://ift.tt/2lYrfLJ

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This Is What Obamacare's Critics Won't Admit Or Simply Don't Understand

THOUSAND OAKS, California ― Maryann Hammers is likely to die from ovarian cancer someday. But she hopes someday won’t come anytime soon.

Hammers, 61, received the diagnosis in late 2013, and doctors told her that it was stage 3-C, which meant that she could live for many years with the right treatment and a little luck. So far, she’s had both. She’s in remission for the second time, and her last course of chemotherapy ended a year and a half ago. But recent blood tests detected elevated levels of a protein associated with tumors, she explained when we met a few weeks ago. “Maybe it’s a fluke,” she said. “I hope so. I kinda feel like the clock is ticking.”

If the cancer is back, Hammers said, she may need surgery similar to her two previous operations — “gigantic surgeries, gutted like a fish and hospitalized for many days.” Chemotherapy would likely come next, plus medication, hospitalization, and home care. But Hammers considers herself lucky because she’s been able to get treatment at City of Hope, a highly respected Southern California cancer research and treatment center, and luckier still that she’s been able to pay for the treatment with insurance — an Anthem Blue Cross policy she bought through Covered California, the exchange her state created under the Affordable Care Act.

To hear President Donald Trump, House Speaker Paul Ryan and other Republicans tell it, Obamacare has been a disaster, even for those who obtained coverage through the law. Hammers has a very different perspective. She’s a freelance writer and editor, which means she has no employer-provided insurance. In the old days, if she’d gone shopping for a policy with her cancer diagnosis, she would have struggled to find a carrier willing to sell her one.

I'm terrified. ... Do you know how easy it is to use a million dollars when you're getting cancer treatment? Maryann Hammers, Thousand Oaks, California

And it’s not just the pre-existing condition guarantee, which even critics like Trump say they support, that Hammers has found so valuable. The Affordable Care Act requires insurers to cover a wide range of services and treatments — which, in her case, has included multiple shots of Neulasta, a medication that boosts white blood cell counts and typically costs several thousand dollars per injection. The law also prohibits annual or lifetime limits on benefits, which, as a long-term cancer patient, she would be a prime candidate to exceed. 

Policies with such robust coverage inevitably cost thousands of dollars a year, more than Hammers could afford on her own — particularly since battling the disease has cut into her work hours. But the law’s generous tax credits discount the premiums and help with the out-of-pocket costs, too. “Without the Affordable Care Act, I honestly do not know what I would have done,” she said.

The coverage Hammers has today still isn’t as good as what she had years ago, when she worked for a company that provided benefits. But it’s better than what she had in the years right before the cancer diagnosis, when she was buying insurance on her own. The latter plan covered fewer services and came with out-of-pocket costs high enough to discourage her from getting checkups. Obamacare’s introduction of free preventive screenings led her to schedule a long-overdue colonoscopy. During routine preparation for that procedure, a physician first felt a lump in her abdomen.  

Sometimes Hammers wonders whether, with less sporadic doctor visits, the cancer might have been caught a little sooner. “But I couldn’t afford a fat doctor’s bill. And I thought I was super healthy.”

These days, something else looms even larger in her mind — the possibility that Trump and the Republican Congress will repeal the health care law without an adequate replacement, or maybe with no replacement at all.  

“I’m terrified — isn’t that crazy?” Hammers said. “My biggest source of stress right now isn’t the fact that I have incurable cancer. It’s the prospect of losing my insurance.”

What American Health Care Used To Look Like

To appreciate the significance of stories like Hammers’ and what they say about the Affordable Care Act, it helps to remember what used to happen to people like her before the law took effect. By 2009, when President Barack Obama took office, roughly 1 in 6 Americans had no health care insurance, and even the insured could still face crippling medical bills. As a reporter covering health care during those years, I met these people. Some of their stories stand out, even now, because they capture the old system at its callous, capricious worst.

Gary Rotzler, a quality engineer at a defense contractor in upstate New York, lost his family coverage in the early 1990s when he lost his job. He ended up uninsured for two years, while he juggled stints as an independent contractor. His wife, Betsy, made do without doctor visits even after she started feeling some strange pains. By the time she got a checkup, she had advanced breast cancer. Desperate efforts at treatment failed. After she died, Gary, a father of three, had to declare bankruptcy because of all the unpaid medical bills.

Jacqueline Ruess, a widow in south Florida, thought she was insured. But then she needed expensive tests when her physicians suspected she had cancer. Although the tests were negative, the insurer refused to pay the bills because, it said, a brief episode of a routine gynecological problem in her past qualified as a pre-existing condition.

Tony Montenegro, an immigrant from El Salvador living in Los Angeles, was uninsured and working as a security guard, until untreated diabetes left him legally blind.

Marijon Binder, an impoverished former nun in Chicago, was sued by a Catholic hospital over medical expenses she couldn’t pay.

And Russ Doren, a schoolteacher in a Denver suburb, believed he had good insurance until the bills for his wife’s inpatient treatment at a psychiatric hospital hit the limit for mental health coverage. The hospital released her, despite worries that she was not ready. A few days later, she took her own life.

The Affordable Care Act of 2010 was an effort to address these kinds of problems — to carry on the crusade for universal coverage that Harry Truman had launched some 60 years before. But precisely because Obama and his allies were determined to succeed where predecessors had failed, they made a series of concessions that necessarily limited the law’s ambition.

They expanded Medicaid and regulated private insurance rather than start a whole new government-run program. They dialed back demands for lower prices from drugmakers, hospitals and other health care industries. And they agreed to tight budget constraints for the program as a whole, rather than risk a revolt among more conservative Democrats. These decisions meant that health insurance would ultimately be more expensive and the new system’s financial assistance would be less generous.

Still, projections showed that the law would bring coverage to millions while giving policymakers tools they could use to reduce medical costs over time. When the Senate passed its version of the legislation in December 2009, then-Sen. Tom Harkin (D-Iowa) described the program as a “starter home” with a solid foundation and room for expansion.

Where Obamacare Failed And Where It Succeeded

Seven years later, Trump and the Affordable Care Act’s other critics insist that the program has been a boondoggle — that the Obamacare starter home needs demolition. Some of their objections are philosophical, and some, like the persistent belief that the law set up “death panels,” are fantastical. But others focus on the law’s actual consequences.

High on that list of consequences are the higher premiums and out-of-pocket costs that some people face. The new rules, like coverage of pre-existing conditions, have made policies more expensive, and Obamacare’s financial aid frequently doesn’t offset the increases. A “rate shock” wave hit suddenly in the fall of 2013, when insurers unveiled their newly upgraded plans and in many cases canceled old ones — infuriating customers who remembered Obama’s promise that “if you like your plan, you can keep it,” while alienating even some of those sympathetic to what Obama and the Democrats were trying to do.

I’ve interviewed plenty of these people, too. A few weeks ago, I spoke with Faisuly Scheurer, a real estate agent from Blowing Rock, North Carolina. She and her husband, who works in the restaurant business, were excited about the health care law because they’d struggled to find decent, affordable insurance. They make about $60,000 a year, before taxes, with two kids and college tuition looming in the not-distant future, she said.

In late 2013, they checked out their options and learned that, after tax credits, coverage would cost $360 a month. Scheurer said she remembers thinking, “OK, that is really tight. But if the benefits are good, we are going to have to skimp on other things to make it work.” Then she learned about the deductible, which was nearly $13,000 per year. “My disappointment was indescribable.”

The Scheurer family ultimately decided to remain uninsured. They’re not the only ones, and that has weakened the system as a whole. The people eschewing coverage tend to be relatively healthy, since they’re most willing to take the risk of no coverage. That’s created big problems for insurers, which need the premiums from healthy folks to offset the high medical bills of people with serious conditions.

Many insurers have reacted by raising premiums or pulling out of some places entirely, leaving dysfunctional markets in North Carolina and a handful of other states. Just this week, Humana, which had already scaled back its offerings, announced that it was pulling out of the Affordable Care Act exchanges altogether. At least for the moment, 16 counties in Tennessee don’t have a single insurer committed to offering coverage in 2018.

Trump, Ryan and other Republicans pounced on the Humana news, citing it as more proof of a “failed system” and the need for repeal. That’s pretty typical of how the political conversation about the Affordable Care Act has proceeded for the last seven years. The focus is on everything that’s gone wrong with Obamacare, with scant attention to what’s gone right.

And yet the list of what’s gone right is long.

In states like California and Michigan, the newly regulated markets appear to be working as the law’s architects intended, except for some rural areas that insurers have never served that well. Middle-class people in those states have better, more affordable options.

It looks like more insurers are figuring out how to make their products work and how to successfully compete for business. Customers have turned out to be more price-sensitive than insurers originally anticipated. In general, the carriers that struggle are large national companies without much experience selling directly to consumers, rather than through employers.

Last year’s big premium increases followed two years in which average premiums were far below projections, a sign that carriers simply started their pricing too low. Even now, on average, the premiums people pay for exchange insurance are on a par with, or even a bit cheaper than, equivalent employer policies — and that’s before the tax credits.

The majority of people who are buying insurance on their own or get their coverage through Medicaid are satisfied with it, according to separate surveys by the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The level of satisfaction with the new coverage still trails that involving employer-provided insurance, and it has declined over time. But it’s clearly in positive territory 

And then there’s the fact that the number of people without health insurance is the lowest that government or private surveys have ever recorded. When confronted with questions about the people who gained coverage because of the law, Republicans often say something about sparing those people from disruption ― and then argue that even those who obtained insurance through the law are suffering and no better off. This claim is wildly inconsistent with the experience of people like Maryann Hammers ― and, more important, it’s wildly inconsistent with the best available research.

People are struggling less with medical bills, have easier access to primary care and medication, and report that they’re in better health, according to a study that appeared in the Journal of the American Medical Association in 2015. The number of people forgoing care because of costs or being “very worried” about paying for a catastrophic medical bill dropped substantially among the newly insured, Kaiser Foundation researchers found last year when they focused on people in California.

A bunch of other studies have turned up similar evidence, All of them gibe with a landmark report on the effects of Massachusetts’ 2006 insurance expansion, which was a prototype for the national legislation. Residents of that state experienced better health outcomes and less financial stress, according to the study published in the Annals of Internal Medicine.

“Though it’s had no shortage of controversies and stumbles, there’s really no denying that the ACA has created historic gains in insurance coverage,” said Larry Levitt, a senior vice president at the Kaiser Foundation. “With better coverage that has fewer holes, access to health care has improved and many have better protection from crushing medical bills.”

What Repeal Would Really Mean

Reasonable people can disagree about whether these achievements justify Obamacare’s costs, which include not only higher premiums for the young and healthy but also hefty new taxes on the wealthiest Americans. That’s a debate about values and priorities as much as facts.

What’s not in dispute, or shouldn’t be, is the stark choice on the political agenda right now.

Democratic lawmakers still argue for the principle that Truman laid out in 1948: “health security for all, regardless of residence, station, or race.” They think the Affordable Care Act means the U.S. is closer to that goal and that the next step should be to bolster the law ― by using government power to force down the price of drugs, hospital services and other forms of medical care, while providing more generous government assistance to people who still find premiums and out-of-pocket costs too onerous. Basically, they want people like Faisuly Scheurer to end up with the same security that people like Maryann Hammers already have.

Some Republicans talk as if they share these goals. Trump has probably been the most outspoken on this point, promising to deliver “great health care at lower cost” and vowing that “everybody would be covered.” But other Republicans reject the whole concept of health care as a right. Although it’s theoretically possible to draw up a conservative health plan that would improve access and affordability, these aren’t the kinds of plans that Republicans have in mind. 

There’s a face to this law, there’s a face to people that are going to be affected by it. Angela Eilers, Yorba Linda, California

Their schemes envision substantially less government spending on health care, which would mean lower taxes for the wealthy but also less financial assistance for everybody else. Republicans would make insurance cheaper, but only by allowing it to cover fewer services and saddling beneficiaries with even higher out-of-pocket costs. The result would be some mix of more exposure to medical bills and more people without coverage. If Republicans repeal the Affordable Care Act without replacing it ― a real possibility, given profound divisions within the GOP over how to craft a plan ― 32 million more people could go uninsured, according to the Congressional Budget Office.

That would mean real suffering, primarily among those Americans who benefit most from the law now ― the ones with serious medical problems, or too little income to pay for insurance on their own, or both.

Jay Stout, a 20-year-old in Wilmington, North Carolina, is one of those people. He was in good health until a head-on car collision nearly severed his arm and landed him in the hospital for more than a month. Surgeries and rehabilitation would have cost him hundreds of thousands of dollars that, as a community college student working part-time as a busboy, he could never have paid — if not for the Blue Cross plan that his mother had bought through the Affordable Care Act. When we spoke a few weeks ago, he told me the insurance has been “irreplaceable” and that losing it “would be totally devastating.”

Meenakshi Bewtra had never had a serious health problem until her first year at the University of Pennsylvania medical school, when she developed severe gastrointestinal problems — the kind that forced her into the hospital for two months and drove her to drop out of school. Her insurance lapsed, which meant that her GI issues became a pre-existing condition. She eventually found coverage and today she’s a professor of medicine at Penn, where she moonlights as an advocate for universal health insurance.

“For the first time, I truly understood what comprehensive health insurance meant,” Bewtra said, remembering what it was like to become fully covered. “I did not have to worry about how many times I saw a doctor, or how many lab tests I had to get, or having to ration out medications.”

Angela Eilers, who lives in Yorba Linda, California, isn’t worrying about her own health. It’s her daughter Myka who has a congenital heart condition called pulmonary stenosis, which makes it more difficult for the heart to pump blood to the lungs. The little girl has required multiple surgeries and will need intensive medical treatment throughout her childhood.

In 2012, Angela’s husband, Todd, was laid off from his job at an investment firm. Since going without insurance was not an option, they took advantage of COBRA to stay on his old company’s health plan. It was expensive, and Eilers recalled panicking over the possibility they might not be able to pay the premiums. “I remember sitting at the table, thinking of plans. What would be our plan? One of them was … giving up our parents rights to my mom, because she has really good health insurance.”

Eventually her husband started his own consulting business, and that gave them the income to keep up with premiums until 2014 — when they were able to obtain coverage through the Affordable Care Act. Today they have a gold plan, one of the most generous available, for which they pay around $20,000 a year. Even though they make too much to qualify for financial assistance, they’re grateful for the coverage. Seven-year-old Myka has already run up more than a half-million dollars in medical bills. In the old days, before Obamacare, they would have worried about hitting their plan’s lifetime limit on benefits. 

The family’s coverage has become..

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