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The Value of Life ??

Started by Magicman, September 03, 2015, 09:24:11 PM

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Magicman

Since this situation could apply to different illnesses or ailments, I pulled it from the Colonoscopy thread.

Today I had a colonoscopy and the results were fantastic.  No polyps.  Good news.

The Doctor's reaction from these results was a bit discerning.  Yes, he was pleased but.  Two years ago and every couple of years for the past ~12 years I have had polyps removed.  None this time, which is excellent news.  Thus, I was expecting to be rescheduled in ~5 years.  When I asked, the surgeon said that there would be no reschedule.  ??

My thoughts are that in 5 years I will be 77 years old and by then I will be deemed to be dispensable.  I will either have no problem, or I will be at an age where I am no longer worth treating. ??  I suppose that my life then will have value only to myself and my family.
Knothole Sawmill, LLC     '98 Wood-Mizer LT40SuperHydraulic   WM Million BF Club Member   WM Pro Sawyer Network

It's Weird being the Same Age as Old People

Never allow your "need" to make money to exceed your "desire" to provide quality service.....The Magicman

Dan_Shade

Woodmizer LT40HDG25 / Stihl 066 alaskan
lots of dull bands and chains

There's a fine line between turning firewood into beautiful things and beautiful things into firewood.

WmFritz

Lynn, I know ultimately your life is most valuble to you and the folks that love you, but don't forget that your valuable to your FF family too.

~Bill

2012 Homebuilt Bandmill
1959 Detroit built Ferguson TO35

Magicman

Thanks Fritz.  Dan, as goofy as I was about then, I did not even think about it until just a while ago.   smiley_dizzy
Knothole Sawmill, LLC     '98 Wood-Mizer LT40SuperHydraulic   WM Million BF Club Member   WM Pro Sawyer Network

It's Weird being the Same Age as Old People

Never allow your "need" to make money to exceed your "desire" to provide quality service.....The Magicman

Ianab

One thing they have to consider with older patients is the increased risk from even "routine" procedures. Even going under anaesthetic becomes risky as you get older. If you knock out a hundred 80 year old patients, chances are one wont wake up.

Then it becomes a matter of weighing up the risk vs the benefits. Risk killing you now to check for something that might kill you in 20 years time? Or just leave it alone and maybe you die of a stoke @ 90, with some random polyps. So you risk the procedure, but don't actually gain any real benefit. It's like backing a race horse that only pays 90 cents to win.

When you are younger there is less risk to treat, and more to be gained. So when you are 50, and they treat some polyps that might have killed you by now, it was a good bet. Low risk, high return.

You don't want the good news, bad news thing.
Good news - no polyps.
Bad news - MM didn't wake up....
Weekend warrior, Peterson JP test pilot, Dolmar 7900 and Stihl MS310 saws and  the usual collection of power tools :)

Magicman

Ian, your response was exactly what Pat drilled into me last night.  I guess that I do not mind getting older, just have not realized/accepted the baggage and possible limitations that go along with it.  The "obits" are filled with folks much younger than I am.
Knothole Sawmill, LLC     '98 Wood-Mizer LT40SuperHydraulic   WM Million BF Club Member   WM Pro Sawyer Network

It's Weird being the Same Age as Old People

Never allow your "need" to make money to exceed your "desire" to provide quality service.....The Magicman

Jeff

This is a chunk of Forestry Forum gold here if you ask me. Lynn, when you posed the question, my blood pressure rose thinking, "what the heck?  You can't devalue a life like that!"  and then when Ian posted, my blood pressure went down and I returned to a oh yea, that makes perfect sense.



Just call me the midget doctor.
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Ljohnsaw

My neighbors are in their mid 80s and he could really use a hip replacement, though he is still active with the pain.  But the doctors won't do it now - too much risk.  He put it off about 6 or 8 years ago and is sorry he did now. :(

John Sawicky

Just North-East of Sacramento...

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Raider Bill

The First 70 years of childhood is always the hardest.

Ron Scott

Yes, my doctor has told me the same thing as what Ianab stated as I approach "80".
~Ron

WV Sawmiller

Ian,

    I understand your response but am concerned we are letting statistics govern what has to be the most sensitive area we deal with - our life and health. From what I have concluded Lynn is not the typical 72 y/o so why should he be treated the same as a couch potato.

   I have a 14 month younger brother who weighs 500 lbs and everything he does is a struggle. I would certainly expect my doctor to treat me, who am half his size, different that him. I'm not in the shape I was as a 25 y/o Marine but I can still get out a walk around these hills and hollers and do the things I enjoy.

   I would expect the doctor to treat each of us patients different according to our on physical factors and family history. I am concerned the insurance and admin folks are driving the health train instead of the trained medical community.
Howard Green
WM LT35HDG25(2015) , 2011 4WD F150 Ford Lariat PU, Kawasaki 650 ATV, Stihl 440 Chainsaw, homemade logging arch (w/custom built rear log dolly), JD 750 w/4' wide Bushhog brand FEL

Dad always said "You can shear a sheep a bunch of times but you can only skin him once

redprospector

Sounds to me like as we get older we will have to really start trusting God to do for us what He said, and believe totally in what Jesus did for us.
I wonder if that was their intention when all the "health care" rules got changed? I kinda doubt it.  ;)
1996 Timber King B-20 with 14' extension, Morgan Mini Scragg Mill, Fastline Band Scragg Mill (project), 1973 JD 440-b skidder, 2008 Bobcat T-320 with buckets, grapple, auger, Tushogg mulching head, etc., 2006 Fecon FTX-90L with Bull Hog 74SS head, 1994 Vermeer 1250 BC Chipper. A bunch of chainsaws.

beenthere

WV
QuoteI am concerned the insurance and admin folks are driving the health train instead of the trained medical community.

That is becoming very evident with Dr's (sorry, not my Doctor anymore but he is now my "provider" ) and their selection of referrals to specialists. It was subtle, but not so much any more.
south central Wisconsin
It may be that my sole purpose in life is simply to serve as a warning to others

Dan_Shade

the problem is everyone is scared and/or concerned about potential litigation.
Woodmizer LT40HDG25 / Stihl 066 alaskan
lots of dull bands and chains

There's a fine line between turning firewood into beautiful things and beautiful things into firewood.

rooster 58

Sounds like MM needs to go elk hunting again.....

WV Sawmiller

Rooster,

   My daughter gets married in 2 weeks in Glacier Nat'l Park (weather and fires permitting). Wife made her wedding dress and she included pockets (I guess for bear spray). Wife setting up lodging there and at Yellowstone and the guy we are lodging at says the elk are bugling like crazy. Maybe I should take my bow?  Oh well, bow season will be in full swing back here when we return.

   Best to all.
Howard Green
WM LT35HDG25(2015) , 2011 4WD F150 Ford Lariat PU, Kawasaki 650 ATV, Stihl 440 Chainsaw, homemade logging arch (w/custom built rear log dolly), JD 750 w/4' wide Bushhog brand FEL

Dad always said "You can shear a sheep a bunch of times but you can only skin him once

sandsawmill14

Quote from: redprospector on September 04, 2015, 10:26:52 PM
Sounds to me like as we get older we will have to really start trusting God to do for us what He said, and believe totally in what Jesus did for us.
I wonder if that was their intention when all the "health care" rules got changed? I kinda doubt it.  ;)

x2  well said smiley_clapping smiley_clapping smiley_clapping
hudson 228, lucky knuckleboom,stihl 038 064 441 magnum

pine

Quote from: Magicman on September 03, 2015, 09:24:11 PM
My thoughts are that in 5 years I will be 77 years old and by then I will be deemed to be dispensable.  I will either have no problem, or I will be at an age where I am no longer worth treating. ??  I suppose that my life then will have value only to myself and my family.
Quote from: Ianab on September 04, 2015, 12:33:43 AM
One thing they have to consider with older patients is the increased risk from even "routine" procedures. Even going under anaesthetic becomes risky as you get older. If you knock out a hundred 80 year old patients, chances are one wont wake up.

Then it becomes a matter of weighing up the risk vs the benefits. Risk killing you now to check for something that might kill you in 20 years time? Or just leave it alone and maybe you die of a stoke @ 90, with some random polyps. So you risk the procedure, but don't actually gain any real benefit. It's like backing a race horse that only pays 90 cents to win.

When you are younger there is less risk to treat, and more to be gained. So when you are 50, and they treat some polyps that might have killed you by now, it was a good bet. Low risk, high return.

I have debated on contributing to this thread and if my input was worth anything.

While I do not have first hand knowledge my knowledge comes directly from my sister who not only has first hand knowledge but was very involved in the group conference that established the ground rules  that they were tasked with doing.  She is a very talented medical doctor that is highly sought after for her expertise and she has multiple specialties in which she is board certified.

What Ianab stated is a true and accurate issue that the medical community has to evaluate on any procedure with the elderly, however...............

The issue that my sister communicated to me was the pressure that they were put under to identify and establish ages and conditions as to whether a person was a candidate for a procedure or not. One example that she discussed with me was a person was X years of age and needed Y procedure.  The cost of the procedure was a set amount and they had to establish how much "useful" life the generic patient had left and if they could have a positive "cost benefit analysis" for the cost of the procedure. 

It is really easy to say that makes sense as a person that has been diagnosed as 6 months terminal with cancer and needs a knee replacement is not a candidate.  The person that has dementia and can not grasp or understand what is required to do the PT required after a hip replacement or knee replacement would not be a good candidate.

That is not what they were being required to establish.  Instead while it was based on different factors one, the biggest, was just simply age.  At a given age the patient did not have any useful return for the procedure.  It did not take into account the patient's overall health.  It created "buckets" of patients that were clumped regardless of any other conditions and everyone was treated as the same regardless of any other issues.

This clumping of everyone being the same regardless of overall health would be like the life insurance companies clumping everyone the same for establishing life insurance premiums.  The long term smoker that weighed 300 lbs with a cholesterol of 280 with a heart condition would pay the same life insurance premium as the person that never smoked, weighed 170 lbs and cholesterol of less than 130.  Everyone is the same at the same age no differences.

This group was tasked to evaluate the cost benefit based on an age determination for a given procedure as the population ages.  Basically you would not be a candidate for a given procedure after a specific age.  The ages that were being used was not 90+ nor was it the 80+ population either.

My sister described to me just how challenging it was for them, the group, to accomplish the assigned task.   They were basically tasked to say the patient has no value after a certain age and thus will not be a candidate for a procedure.  They did not like it at all.

Chuck White

Quote from: Ianab on September 04, 2015, 12:33:43 AM
One thing they have to consider with older patients is the increased risk from even "routine" procedures. Even going under anaesthetic becomes risky as you get older. If you knock out a hundred 80 year old patients, chances are one wont wake up.

Then it becomes a matter of weighing up the risk vs the benefits. Risk killing you now to check for something that might kill you in 20 years time? Or just leave it alone and maybe you die of a stoke @ 90, with some random polyps. So you risk the procedure, but don't actually gain any real benefit. It's like backing a race horse that only pays 90 cents to win.

When you are younger there is less risk to treat, and more to be gained. So when you are 50, and they treat some polyps that might have killed you by now, it was a good bet. Low risk, high return.

You don't want the good news, bad news thing.
Good news - no polyps.
Bad news - MM didn't wake up....


I remember when I had my first colonoscopy, I was not put under, I was a little groggy but still coherent and conversed with the Dr and watched the whole procedure on the video screen!
~Chuck~  Cooks Cat Claw sharpener and single tooth setter.  2018 Chevy Silverado and 2021 Subaru Ascent.
With basic mechanical skills and the ability to read you can maintain a Woodmizer  LT40!

pine

Quote from: Chuck White on September 06, 2015, 11:22:32 AM
I remember when I had my first colonoscopy, I was not put under, I was a little groggy but still coherent and conversed with the Dr and watched the whole procedure on the video screen!

I did not know that they put anyone "under" for a colonoscopy.  I suppose it depends on the definition of "under" however.  Conscious sedation is a lay term that is used, 

My first and second colonoscopies were with nothing. Fully conscious.

The third they insisted the protocol required drugs.  Not knowing better and since the primary reason why the first two were without drugs no longer existed, I consented. The drug cocktail was Demerol and Versed. 
I will just say that after that, Versed will never ever be administered to me again!  It has no real purpose other that to create an amnesia type result for the patient of the procedure.  For me it was oh so much more.

Came time for the fourth colonoscopy and I was very, very specific that Versed was not authorized to be used under any circumstance.  The admin nurses insisted that I had to sign the anesthesia consent form.  I had already detailed, pre-scheduling, that Versed was not to be used.  I did not have a problem with the form (as I modified it) but they had a conniption when I wrote on the form that Versed was not authorized under any circumstance.  The protocol this time was for a cocktail of Fentanyl and Versed.  I am not a fan of Fentanyl (due to its side-effects) but was willing to tolerate it, but as a single drug only.  They IV'ed me up and I went on the table.  The Doc came in and I again repeated that no Versed was allowed but that I would accept the Fentanyl. She asked me if I wanted to go with nothing.  Of course I said yes and off we went.  She was a great gastroenterologist.  It was even less uncomfortable than the first two were. (Of course they were with the military and may not have had her level of expertise (military doc doing hundreds vs her thousands).  I will not say I enjoyed the prep but the actual procedure was fun.   I learned a lot and the doctor was a great. Ran my colon up to the Cecum, then explained to me what the Cecum does in most mammals and how it has "devolved" in humans.  Kind of like a teaching physician.  I just hope she is still available on the next iteration as I want her again.

doctorb

OK, let's look at the other side of things.

First, Ian was absolutely correct.  Risk / reward should be measured as best as possible in all medical decisions.  The chance of contracting Colon cancer INCREASES as we age.  So, on first blush, it makes no sense to stop having this screening test at age 80, but that is the current guideline.  IMO, the thinking here is that most people with a positive family history and evident polyps on previous exams should be checked more frequently.  Once you fail to develop the disease by age 80, overall survivorship begins to enter the picture.  What percentage of men will live past 85 or 90?  The cause of death in that age group is not going to be colon cancer on a frequent basis.  Many other organ failings creep up on you in your 80's.  So the risk of a complication from colonoscopy, which is very low, but real, becomes more of a factor versus the likelihood that colon cancer will kill you, especially if you have a scope that's clean at age 80.  So it's not that the value of your life is being diminished, it's that the reality of your death makes the procedure much less necessary.

Secondly, I would not advise anyone to have a colonoscopy without some form of sedation.  To adequately see inside the colon, pressurized gas is used to dilate and inflate the organ.  This hurts.  So while you can "tough it out", most of the time that stoic patient will create a situation where the doc is moving faster and seeing less because the patient is moving and uncomfortable and complaining.  If you're going to go through this screening test, I would opine that you want the doc to get a good look.  I have no idea what happened to pine with versed or fentanyl.  While versed was commonly used a few years back, most colonoscopies are performed under propofol sedation.  (yes, that's the Michael jackson drug).  Works well, very few side effects, very short acting.  Biggest problem is that it burns a little bit when running through your IV.  The purpose of any sedation here is to relax patients that are understandably uneasy with this scope, providing the best environment for the test..  Having them not remember the procedure is a bonus of these meds, not the purpose of them.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Larry

Who is making the decisions that a colonoscopy will not be done on old folks?  Is it up to the Doctor?  Maybe AMA guidelines or a Medicare directive?
Larry, making useful and beautiful things out of the most environmental friendly material on the planet.

We need to insure our customers understand the importance of our craft.

beenthere

Obamacare.  It was in the critiques of the plan long before it was passed.

Likely procedures like Mammograms will be, or already are, included in what the insurance will not pay for after a certain age.

I went in for a heart echosound scan due to Dr. hearing a slight heart murmur. I got a clear-to-go result and when I commented to the tech running the equipment that I've been pushing for some early check of my heart for a long time, she commented "we used to do it as normal procedure, but mostly now only if there is a heart attack".

On another note, I heard in Feb that my 98 yr old Aunt was hospitalized with a stroke, and having movement problems. Then the end of March, I heard that she passed away during a knee replacement surgery.  ::) ::)  Made no sense, but was confirmed by her daughters to be true. Had to have boiled down to a business decision that the knee surgery money was available, so go for it.

I asked Dr. about checking on my prostate as so far there had been no apparent problem. His response was "at your age, we don't check on that any more".  So ... prolly have to get used to enjoying the good life as it has been and don't expect the medical support to prolong it any more than necessary.
south central Wisconsin
It may be that my sole purpose in life is simply to serve as a warning to others

doctorb

Wow, beenthere, lots of stuff in that post.

You are correct that the overall cost of screening tests, like mammograms and colonoscopy, is being weighed against the cost effectiveness.  The extreme hypothetical example is to run the ABC test on every male over the age of 65 every 5 years until they die.  The number and cost of that test to the healthcare system would be huge.  To have a guideline like that, you would need to reap a huge reward.  That reward would be in preventing more debilitating, life-taking, and more costly treatment of the disease entity, once it develops.   Now, not every guy over 65 is going to contract that disease, but, as a rule of thumb, the screening tests usually cost a lot, but can save a lot, in terms of life years and dollars, dependent upon the disease.  They government is trying to hold back on runaway screening, if little or no benefit has been demonstrated.

This discussion goes into other areas, like the relatively new vaccine to prevent cervical cancer.  If you vaccinate all young women in the country, the rate of cervical cancer, which is a real killer, would drop to close to zero.  So, one side says, "Let's do it!".  The other side says, "Hold on.  There are only 15000 new cases of cervical cancer diagnosed every year in the USA.  The cost of treating those 15000 women is way less than the cost of vaccinating every 12 y.o girl.  Why are we doing this?".  This battle between prevention / cost / right to all medical care will continue well into the future.

So now there are clear and required clinical or laboratory guidelines for performing some tests, especially costly ones like an echocardiogram or colonoscopy.  Which is why, when a patient "pushes" for a complete heart evaluation, the echo is no longer included.  We are moving from a system that used to permit all the medical attention the patient desired, coupled with all the medical treatment I want to provide, to a system that tries to justify the costs of tests and treatment based upon the outcome of those tests and their effect upon patients.  So you can't just ask to get your heart checked, too expensive.  But they can draw some bloodwork to see if you are pre-diabetic.

I am surprised about your prostate request.  In most cases, men die with prostate cancer, not from it.  But the screening test, a blood test, and a manual exam, are pretty cheap and pretty routine.  I would think that you could get that done.  I did hear a few years back that the screening test was not shown to be terribly effective in diagnosing the problem because the value is commonly high, so a whole slew of other tests and procedures kick in, resulting in high costs of falsely negative tests.  My understanding is that the test is specific to the organ, the prostate gland, and not specific for prostate cancer.

Regarding the 98 y o with the total knee, usually that requires a special circumstance.  If an elderly patient is healthy and losing mobility due to extensive arthritis, it's not crazy to consider the TKR, if the patient can not live the way they have become due to the arthritis.  In most cases, however, nobody performs an elective surgery, including a TKR, that close to a recent stroke.  Probably need more info on that one.
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Larry

Quote from: beenthere on September 07, 2015, 03:36:53 PM
Obamacare.  It was in the critiques of the plan long before it was passed.

What I figured, but was trying to be PC and left that choice out.  We had our own prescription drug plan far better than Medicare Part D and it has morphed into something we no longer recognize, complete with a donut hole.

Not having a colonoscopy in old age may well be the right choice as already pointed out.  Just hate to see the decision being made by an out of control government.

I was told I have to have a Medicare wellness checkup which is free of charge, before getting my next scheduled normal checkup.  I've tried to understand the wellness checkup, but so far the explanation is less than satisfactory.

BT, I think my Doctor is a prostrate expert, as he gives the test even if I come in just for a flu shot. :D :D





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We need to insure our customers understand the importance of our craft.

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