THE RUMOR IS THAT WE DON'T NEED HEALTHCARE REFORM IN THE USA

NOTE: If you're a right-wing conservative Republican you probably won't like this post. Just an FYI.

THE COST OF A TOTAL KNEE REPLACEMENT IN THE UNITED STATES:

From the hospital:
Room - Two beds or more: $3695.34
Drugs: $3465.78
Drugs: $2563.25
Drugs: $157.68
Drugs: $83.97
Medical/Surgical Supplies: $871.20
Medical/Surgical Supplies: $20,745.63
Lab Services: $1459.32
Lab Services: $966.40
Lab Services: $626.88
X-Ray Services: $520.77
X-Ray Services: $376.41
Operating Room: $20,755.78
Anesthesia Supplies: $4894.06
Blood Processing: $1075.70
Blood Administration: $808.89
Physio/Mech Therapy: $1013.41
Physio/Mech Therapy: $225.97
Therapy: $709.38
Therapy: $184.83
Recovery Room: $4211.30

TOTAL: $69,411.56

From the surgeon:
Surgery: $3400.00
Surgery: $936.00
Surgery: $600.00
X-Ray Service: $50.00

TOTAL: $4936.00

From the Anesthesiologist:
Anesthesia: $2660.00
Anesthesia: $2660.00
Anesthesia: $1680.00

TOTAL: $7000.00

From the rehab hospital following my knee replacement:

Room - Two beds or more:  $26,568.00
Drugs: $3033.76
Drugs: $1956.16
Drugs: $1900.06
Lab Services: $1681.05
Lab Services: $364.68
Lab Services: $1134.02
Lab Services: $202.32
Physio/Mech Therapy: $5441.09
Physio/Mech Therapy: $514.29
Therapy: $2346.38
Therapy: $539.64

TOTAL: $45,681.99

GRAND TOTAL: $127,029.93

Okay, so we have $13,160.66 just for drugs alone. Note, these are my day-to-day prescriptions that I take every day and pay about $150/month for. The only additional meds I had was the Dilaudid for pain and several over-the-counter supplements such as iron, potassium, and vitamin C. This is truly unbelievable! I mean, I am shocked. $13,160.66 is about what I paid for my car.

I am so effin' grateful for our health insurance. But to say that our country doesn't need immediate and drastic health insurance reform is INSANE. In my opinion, all doctors should be held to the same standard of excellence and the costs of health care should be regulated. Pharmaceutical companies should not be allowed to financially devestate consumers who may have no choice between taking certain medications and serious illness or death, while our legislators reap the financial benefits of campaign contributions from the pharmaceutical companies. It's morally wrong.

And you know what? Jesus Christ would not have charged money to heal the sick. Why can we not look out for our fellow man? My husband's Canadian step-mother had the exact same surgery as I did in Saskatchewan, and her cost was $0.00.

These opinions are mine and mine alone. Your mileage may vary.

O NEW KNEE! WHERE FOR ART THOU?



Oh, my friends, what a difficult road it’s been! I’ll give you the lowdown on my surgery -- I have had a full knee replacement. Yep, that's my brand spanking new knee in the picture above.

I should warn you that this entry is super long. Well, it's a long story, so please indulge me! Anyhow.  

My surgery was on Monday the 27^th. I arrived at the hospital at 5:35 a.m. and sat in a waiting room with a bunch of other people who there also waiting for surgery. There was an elderly man who was wandering around the waiting area asking (to no one in particular) where he could pick a number, as if we were at the deli counter at King Soopers. “Yes, I’ll take half a pound of the shaved gruyere, a pound of maple ham, and a full knee replacement please . . . “ Finally we were all herded into the pre-surgical suite and made to strip down nekkid and put on a very glamourous hospital gown that was ten times too big.

I was having a huge amount of anxiety by this point. The nurse came over and was very nice. She asked me to go pee in a cup because they had to ensure I was not pregnant (I am not pregnant, fwiw), so I took the cup to the bathroom to try. Well, I tried. I  really did. At one point some other nurse flung the bathroom door open while I was perched on the loo, which of course made my bladder close in on itself like a frightened sea anemone. I burst into tears. My nurse came over and patted me on the back. “Don’t worry,” she said, “We can do a blood test.” And then the usual brou-ha-ha regarding me, my little hands and veins, and how deeply my veins are in my hands and arms are set.

Nurse:  I’ve been doing this for 45 years – I’ve never met a vein I couldn’t eventually coax into compliance.

ME: [THINKING] First, you just had to say it out loud (it’s probably not even truthful really; I mean no one is perfect) didn’t you? Second, you have never met me – I am not overly known for being generally compliant.

Nurse: [Searching for a  vein] Wow, you really do have tiny veins!

Me:  Yup!

Nurse: [Searches more] Huh!

Me: I know, right?

Nurse: I think I’ve found one. [flicks top of my hand with her finger]. Okay . . .

So she shoots it up with lidocaine and inserts the IV. Thank GOD she used lidocaine because, as expected, she missed my vein, and then had to start fishing around looking around for a vein in my hand. Finally she gave up and put the IV in the crook of my arm by the elbow. Suprisingly, this did not turn out to be problematic during the entire hospital stay and I did not blow my vein.

Then I had a panic attack. I could not stop crying – I  told my nurse that I was scared of the anesthesia and that I was scared of this particular surgery. Karen, the nurse, was very nice about it and patted my hand until the anesthesiologist came along. Poor man – he was probably insulted because when he introduced himself I really began to bawl! God, I was like a baby on its way to a bris. Dr. Anesthesiologist was also very nice and very patient with me and my blubbering. He then proceeded to put in a nerve block. A nerve block is a small tube that is strategically placed down the leg where large doses of pain medication is injected into whatever particular part of the body that is being operated on. So getting the nerve block put in was very uncomfortable because I could feel the tube being inserted. I was really upset, so the doctor said to the nurse, “Let’s give her five ccs of Ativan.” To which I said, “Like on House MD.”

The next thing I remember is . . . WAKING UP after the surgery and it was all done! The recovery nurses don’t mess around. They were shaking my head and calling my name: “Julie . . . Julie . . .you have to wake up now. Show us that you’re awake.” Seeing as I was NOT awake, I drooled and made honking noises or somesuch to prove that I was at least alive, if not awake. As well, to prevent nausea, Dr. Anesthesiologist had given me Phenergan and Zofran, and Phenergan is like a horse tranquilizer to me. It makes me exceedingly groggy; I ended up sleeping until 4:00 p.m., while occasionally moaning and bewailing my lot in life to yet again demonstrate my presence among the living.

At this point my pain was okay, as the nerve block had not yet worn off. They clipped the PCA pump to my gown and curled my fingers around the button and made me push it several times to show that I knew how to use it. The PCA pump has never been an effective form of pain management for me. Because it uses morphine most often, the PCA pump tends to put me to sleep almost immediately. So I would push the button a few times, and then would nod off. Meanwhile, because I wasn’t treating my pain regularly, it would spiral into waves of massive pain that took a long time to bring back under control. It’s always easier to keep pain under control if you use continuous pain medication than if you let the pain get really bad and then try and bring the pain down from an acute state. I think all doctors need to plan for their patients to have breakthrough pain, too, because nothing sucks more than having breakthrough pain and being told you can’t have any more pain control for four more hours. So, anyhow, I had a lot of pain the first day and night.

By the end of the second day I was, like, crying and openly demanding more pain meds. At this point I was ENRAGED at having to suffer. I had specifically informed all my doctors prior to the surgery and the nurses afterward that I had been on pain management for two years, and that subsequently my tolerance to pain meds was going to be higher than the average patient’s. It’s like no one listened to me on this very important issue. I mean, it was essentially like recovering from surgery ala Civil War style – Here, woman, bite down on this belt strap while I saw your leg off . . . may I offer you some whiskey? *banjos duel* Except no one even offered whiskey!

Finally, this wonderful nurse, Tammy, took the time to ask who my pain management doctor was and what his contact info was. PRAISE ALLAH, JESUS, BUDDHA, EVERYTHING AND EVERYONE!!!! She tracked down my pain management doctor and talked with him about my situation and that’s when my pain meds were finally adjusted to add IV Dilaudid every two hours to control breakthrough pain. I would also stick to my usual regime of morphine and oxycodone three times per day. That finally brought my pain down to a 4-5, which is fantastic compared to being at a 10. A 10 means I’m literally writhing and crying and calling for my mommy and rocking back and forth, etc. I used to say that on a scale of 1 to 10, with one being the least amount of pain and ten being the most painful pain ever, that my kaput gallbladder was like a 15, it was just that painful.

I know now that I was wrong. A knee replacement is like a 20 on a 1-10 scale and is easily the most painful procedure I’ve ever had done (including childbirth)

On the day after I had the surgery, the physical therapy team came to get me out of bed. They were brutal, man.  They pried me out of my Big Bird nest kicking (with my good leg) and screaming about how I didn’t want to stand up and that surely my leg would now fall off.  I actually wasn't able to specifically verbalize this beyond snarling and making the Chewbacca noise. They finally got me into a walker where I managed to take one step. One. Step. I couldn’t go any further. The pain was just too great. The physical therapy team felt that I had accomplished a lot by taking a step; I thought I had too, considering what the actual knee replacement procedure entails.

I won’t detail every day of trying, and failing, to walk, but what happened was that I was deemed unsafe to go home because of the lack of handrails on the outside stairs, plus the bedroom and only full bath being up a flight of 20 hardwood, narrow stairs. Also, I couldn’t get out of bed alone, or get dressed, or go to the bathroom, prepare a meal, or answer the front door. I couldn’t do anything for myself and they were also concerned about the tremendous amount of pain I was still experiencing. It was apparently excessive and beyond the scope of the average patient. So that’s when the decision was made for me to be transferred to Spalding Rehabilitation Hospital out in Aurora.

Spalding almost didn’t accept me because they don’t normally take such short-term rehabilitations cases. They deal with individuals who are recovering from stroke, TBI, serious accidents, etc. They accepted me because I had had cervical (spine) surgery only two weeks prior and that made them feel that I was an appropriate candidate for their program. Otherwise I would have had to have gone to a nursing home to convalesce and OMG just no. So I was grateful I was able to get into Spalding.

Upon release from the hospital, it took nearly fifteen minutes to figure out how to get me into the car without bumping my left leg or getting it turned the wrong way and inducing waves of stabbing, shooting pain. Finally, DH, the kids, and the CNA managed to get me into the car. We drove from the hospital to Spalding in about 20 minutes (it would have been less time but we got lost), and then it took an additional ten minutes to get me out of the car. We were met by an aide who wheeled me up to my room. It was spacious and very clean. The whole hospital was super clean, which was a big plus for me. Anyone who’s ever had to experience the smell of a nursing home will never forget it. The daily schedule was very regimented, which was a good thing. It means everyone got the physical and occupational therapy that they needed. For example, here is my schedule for a typical day:

7:00 a.m. Occupational Therapy

9:00 a.m. Physical Therapy

9:30 a.m. Physical Therapy

10:30 a.m. Occupational Therapy

4:00 p.m. Physical Therapy

4:30 p.m. Physical Therapy

Breakfast was from 8:00 to 9:30. Lunch was from noon to 1:30. Dinner was from 5:30 to 7:00. I had Cream of Wheat for breakfast every morning – I had forgotten how much I love Cream of Wheat with sugar and milk! Mmm, yummy goodness! My appetite was actually extremely poor following the surgery. It was no surprise, I guess. Things were disrupted; I was away from my husband and children; I missed my house; I missed my pets; etc. I’ll take advantage of a poor appetite for as long as possible, though. It's been about three weeks since the surgery and I've lost about 10 pounds I'm guestimating (the battery in our scale has died).

Anyhow, the nurses were all very, very kind. They were happy to get you a glass of ice, help you to the bathroom, bring crackers, and bring pain meds without encouraging you to “tough it out just a little longer” when you’re already hurting at a level 9. When I first arrived at Spalding, I was greeted by the PAC of the facility, Miguel, who couldn’t have been nicer. He was the first medical professional to tell me that their facility was not there to question my pain or the legitimacy of my pain. They were there to ensure that their patients’ pain is managed and that no one goes on being in pain when they don’t have to. He spent about 20 minutes talking with me about my pain management – what meds did I take? What were my dosages? What was my pain management like in the hospital? Exactly how did I take my pain meds – in what combo, at what times, in what order? What worked? What didn’t work? How long had I been on these medications? Etc. They did a full medical history – both the PAC and the nurse on duty, which I felt was  professional and thorough.

I can’t tell you much I have come to empathize with individuals who have permanent physical disabilities. Upon my arrival at Spalding, I could not shower, change my clothes, get in or out of bed, or get onto the toilet without physical assistance. I could not, and still cannot, lift anything heavier than five pounds. Showering and  getting  dressed takes about an hour; I have to shower using a special chair that comes partially out of the tub that I sit on to get undressed. Then, I have to manage to lift my leg fifteen inches over the tub wall and into the tub and then maneuver my body and other leg into the tub WITHOUT getting water everywhere! DH installed a shower wand and a shower chair. I have a looped gadget to lift my leg off the floor and put it onto the bed or couch, a grabber claw that picks things up, a ginormous shoe horn, a sock put-er-onner thing that is extremely cool, and a pair of crutches.

The only negative thing that happened while I was at Spalding was that for one night I had a terrible nurse. I called for pain meds at 1:00 a.m. She came into my room, apparently in a foul mood or something, and when I requested medication she snarked that I take too much pain medication and that she was not willing to give me more, even though my meds order called for oxycodone every four hours and morphine three times per day. I had had a really painful day due to physical therapy and other factors that are so random and nebulous that I can't really explain them well. Some days the pain is just worse than other days; that night it just happened to be pretty bad. Anyhow, this nurse said to me, “Pills! All you want are more pills, pills, pills.” I objected to this and reiterated that I was asking for pain meds as per my schedule and that I was hurting, which was why I was asking for pain meds to begin with. She left my room without giving me my pain meds, which left me in a lot of pain for an additional three hours, when she was finally willing to give me my medication.

I am planning on lodging a formal complaint. It is completely inappropriate to withhold medication from a patient, and it was inappropriate for her to make judgments of my character by implying I was narcotics-seeking and that all I want to do is get more pain meds as if to get high. I was not asking for medication outside the parameters of my prescription. I have never tried to get my pain management doctor to give me meds that I don’t need. (Now screaming for more meds immediately following surgery is different – that was acute and I had an immediate need for significant pain relief). I won’t go on and on about the thousand other ways in which this nurse was irritating and inappropriate, but suffice it to say it is my opinion that she should not be in nursing, a helping profession. Also . . . she kind of looked like a Hobbit. Really, really weird, with the most odd, stubby fingers I’ve ever seen on a person. Not that that had anything to do with her being unprofessional, but it was jarring all the same. Talk about Nurse Ratchett!

I was able to eat either in the dining room or in my room. I almost always ate in my room. I liked the down time and the opportunity to have some time to myself. The food was awful the first day, but subsequently improved. I liked that they used fresh vegetables instead of canned. They had me on a protein supplement; apparently my protein levels are low. I’m also really anemic again. I ended up having to have two transfusions in the hospital to boost my iron levels. This time the levels got down to 23 (normal for a woman my age is 37.5) and 6 (normal is 8-12). The attending physician said he had not seen some sort of level – iron protein? Something like that – as low as mine. I need to call my hematologist and make an appointment. Maybe IV iron treatments would be appropriate again. I’m back on iron supplements. 

Truthfully, I have not been overly careful with my diet for some time now. And I’m sure the anemia is due to this. It’s definitely iron-deficiency anemia, rather than pernicious anemia, which is anemia due to a lack of vitamin B12. Now that I don’t have as many stressors in my life, I think it’s time for me to give my attention to my health. That means keeping a food diary. I have an account at MyFoodDiary.com; maybe there’s a way to set it to monitor iron intake specifically. And, of course, there’s the gym.

The gym. *sigh*

I watched more television at Spalding than I had in, well, quite a long time. I liked TNT the best for mindless background TV, with shows that I generally like: Law and Order; Cold Case; The Closer;  Angel; Bones. It also carries what could possibly be the worst show ever produced for television: Charmed. Holy cow, what a jackwagon of a show Charmed is! I love how the girls just do *jazz hands* and this ridiculous burst of bad CGI lightning bursts from their fingertips, and that is how they demonstrate their magic. It’s just so awful, LOL! The storylines are like bad!Buffy to the nth degree. It’s so bad it’s amusing. It’s tying The Secret Life of the American Teenager for worst TV show ever.

Anyhow, I made a lot of progress at Spalding. I went from being completely unable to walk to being able to walk rather well with a walker and an immobilizer. My need for pain medications went down, which was wonderful, considering the whole point of this surgery is to be able to regain my mobility and get off the pain meds, right?

I stayed at Spalding for ten days -- I really needed the rehab and am glad I was afforded the opportunity to stay there and receive such intense therapy. Three weeks out and I can walk without assistance! I am able to go without the immobilizer more and more frequently. Sleep is becoming comfortable again, as I am able to roll onto my side now. I have a really funny in-home physical therapist who I enjoyed working with for the first time yesterday. He fixed my CPM machine for me (a CPM is a Continuous Passive Motion machine, which gently moves your leg and knee to loosen it up and prevent scar tissue. All you have to do is strap your leg into it and turn it on and away it goes!), but Murphy's Law would prescribe that the morning after the machine was finally fixed, the home health care agency would arrive to take the machine back because insurance would only pay for a three week rental. Alas!


I do have, though, this awesome continuous cooling machine which I get to keep. Essentially, it's a small cooler of ice and water connected to a set of pads that wrap around the knee. It pumps the ice cold water through the pads continuously for up to, like, five or six hours. It's fantastic! Nothing feels better on a sore knee than a good ice pack, especially after physical therapy or walking for extended periods of time.


So, you may be asking yourself, when will FATG attempt to actually step inside her 24 Hour Fiitness? Well, FATG has a physical therapy session set for Thursday and she will ask her physical therapist, Tom, when she can safely go to the gym and begin working on the treadmill. Depending what he thinks, FATG will attempt to enter the gym ASAP. It's a new year, my friends. Time to leave the fear behind, yes?

HERNIATED DISC, KNEE REPLACEMENT, NARCOTICS . . . OH MY!

Ladies and gentlemen, a doom-ish date draws nigh. Until now I have neglected to share with you that this holiday season does not hold for me visions of sugarplums dancing in my head (Mmm, sugarplums!). No, instead this holiday season will be spent recuperating from two separate surgeries. Allow me to share with you an MRI of my neck, taken last Monday 11/29/10. For your convenience I have labeled the sideslice view of my noggin for greater clarification:



 
If you can’t read the font, the vertical text reads “spinal cord,” the first horizontal text reads “bulging disc,” and the second horizontal text also reads “bulging disc.” As you can see, C5 has fully herniated and is pressing against my spinal cord. C4 is bulging slightly.

One thing about me: my health is infuriatingly testy. For some reason, I am prone to orthopedic injuries and weird, random ailments that perplex my doctors and myself. Subsequently, I have no idea how I turned up with a herniated disc. Seriously. There was no injury, no fall, no accident, no one thing that would have overtly led me to believe that I had herniated a cervical disc. Well, okay, let's back up.

In August, I noticed that the baby toe and the fourth toe on my right foot were completely numb. I chalked it up to a pinched nerve, from me sitting Indian-style on the couch when I'd be laptopping, because I kind of tuck my right foot up under my left thigh. But then I noticed the pinky finger and ring finger on my right hand was starting to feel numb, but it was really faint and very transitory numbness. However, I found it odd that it was the same digits on both the right foot and the right hand that were experiencing the numbness.

In September, I woke up one morning and couldn’t turn my head to the left without a lot of pain, and suddenly there was a severe burning sensation in my neck, going all the way down my left shoulder blade. There was no comfortable position I could find to sit in, and this lasted for about a week. By the time that week was over, my neck was kinked into this bizarre position that made me look like a turtle poking its head out of its shell. I kept thinking, you know, that it would get better, that I had just pulled my neck or whatever (don't ask me why I didn't realize how serious this was) and finally my mother was like Get thee to a doctor for thy neck is in the shape of a pretzel. So, yeah, the MRI revealed the herniated disc.

I'm having what's called an ACDF procedure on the 14th, where my surgeon will go in and remove the ruptured disc and place a small prosthetic device in between the cervical bones to hold the spine steady and to keep the cervical bones from grinding together.

I’m freaking out, one, because it’s spinal surgery and that squicks me out. Two, the surgeon goes in through the throat so the incision will be in the front of my neck and I’ll have a scar there where everyone will be able to see it. I won’t be able to hide the scar unless I wear a turtleneck, and I don’t wear turtlenecks (they’re so 1990!). I’ll be in the hospital overnight.  

Following the surgery I won’t be allowed to lift anything. I can move things that are less than five pounds, but I’m not going to be allowed to do very much, including bending and stooping, making rapid side to side motions, or moving my neck around excessively. I guess the upside is that this will include doing things like laundry or cooking (Hey, Mom’s got a few weeks off!). The downside is that on December 27^th . . .

. . . I am having a full left knee replacement done.

Yeah.

Why am I not postponing the knee surgery, you may be asking? Simple. We’ve met our $5000 medical deductible for the 2010 calendar year; if I wait to do the knee surgery until after the first of the year, then we will have a whole new $6000 deductible to pay (it went up for 2011) and I would like to avoid that. So I’m pushing this through and am plunging ahead with two major surgeries within two weeks time.

The knee replacement has been a long time in coming. I’ve had bad knees since I was a teen – I had my first knee surgery for plica syndrome when I was fifteen, and my second when I was sixteen. For some reason my knees have deteriorated much more quickly than one would expect for someone my age, and here I am at 41 needing two full knee replacements. Aside from my two earlier knee surgeries, I’ve done physical therapy, massage, exercises, stretching, icing, heat, lidocaine patches, and pain management. As I don’t want to live the rest of my life on pain management, I made the decision to go ahead and start the knee replacement process. I’ll do my left knee first, as it’s far more deteriorated, and then will do the right knee at a later date. The whole idea of having an entire joint replaced seriously grosses me out – I don’t even have words for how squicky I find the prospect to be. But, you know, it’s this or pain management.

I don’t like pain management; I don’t like pills or medications; I don’t like the side-effects of pain medication. Pain meds don’t make me feel dopey or anything, but they do affect my mood (WHEE! BooHiss). I’ve had people tell me I’m lucky that I have access to pain management because – unbelievable!  -- “those are the good drugs.” They are not the “good” drugs, especially if one is sensitive to opioids – who wants to spend their time nauseated and popping Zofran?

Fear of the surgery has kept me from having my knees replaced until now (I’ve been on pain management for three years), but now I feel like I’m on a hamster wheel of pain management and unless I do something, I will be stuck in this narcotic rut forever! I mean, pain management is highly regulated, as it should be. By saying “narcotic rut” I make it sound far more insidious than it really is. When you’re on pain management, basically you have a contract with your pain physician that you will only use him or her for your pain needs; this is to prevent people from doctor shopping, i.e. going from doctor to doctor to doctor seeking pain meds (this is an addictive behavior, though, not the behavior of a legitimate pain patient).

I’m required to bring in my medications once per month so the clinic can monitor them; I have to go in person to get a new prescription every month, and they do random urinalysis to ensure I am taking only the prescribed dose or less. I have no problem jumping through their hoops. A month hasn’t gone by that I haven’t had leftover medications – I never end up taking as much as I’m prescribed. Typically I will need a dose of pain meds at the end of the day or after I’ve been on my feet for a protracted length of time. I will sometimes need a second dose before bed because the pain can actually be severe enough to keep me from sleeping or to wake me up out of a dead sleep. Most days I just require one dose, though.

I went through a lot of trial and error to find the right combination of medications. Some medications worked really well, but only via IV or intramuscular (Demerol, which is not frequently used anymore anyway, because it apparently has a high risk for seizures). Some medications made me excessively itchy and really nauseated (Dilaudid). Some medications made me COMATOSE OMG *ZOMBIE* (Fentanyl). Some weren’t strong enough (Vicodin). So I’m currently prescribed Oxycodone* 15 mgs three times per day and 30 mgs Morphine three times per day.  I typically take one dose of Oxycodone and one dose of Morphine.

This reminds me of something I’ve ranted about to friends before. Any of you watch House? I grudgingly watch House, and while I’ll save the meta critique for TWOP as to why I find it to be an imperfect show with an unredeemingly unlikeable character (House) who is in fact not endearing, I will criticize House here for one major faux pas: You cannot tell me that an addiction to Vicodin is plausible. Here we have a man with a serious leg injury and ongoing chronic pain. As well, he is a physician. Not in a million years do I buy the premise that a physician with regular access to narcotic medications would stop at Vicodin, a low level narcotic pain reliever. It’s like trying to get me to believe that an Afghani poppy farmer has an addiction to extra-strength Tylenol. Whatevs, House. Whatevs! You know as well as I do that House, if plausibly written, would have been hitting the morphine, the dilaudid, the fentanyl, the oxycontin, the soma, etc, in the position he’s in with the access to drugs that he has. Vicodin? Oh, please. House may as well be gnawing on a candy necklace, as plausible as Vicodin is. Writers? FAIL.

And there’s the possum in the bathtub incident, but that’s a whole ‘nother post.

*Please note that Oxycodone is not Oxycontin, the latter being an extremely powerful and highly addictive narcotic.

**Wow, you may be thinking, you sure are long-winded. The answer to this is: Yes. That, and I type really fast.

AND THERE WAS . . . RAMAKI! THERE WAS RAMAKI! OH, 70s, WHERE HAVE YOU GONE?

It’s fitting that I ought to report in on Thanksgiving, seeing as it’s the biggest eating holiday of the year.

I have an interesting family. My parents divorced when I was eight. My father, Ken – who I shall refer to on this blog as . . . Ken  --  remarried to a woman named Barbie, no joke. After the divorce, my mother and I moved from San Diego to Albuquerque, where my mother had grown up. Going from San Diego to Albuquerque is like moving from the US to Cambodia or something. The two states could not be more disparate from another. Naturally I hated New Mexico upon arrival. I missed my father – who was, to be truthful, an unpleasant alcoholic who was never invited back to parties, but I was eight and didn’t understand these things – and I missed my friends, and the beautiful California weather and the ocean. When we arrived in Albuquerque, mom and I put up in a Howard Johnson’s next to a Denny’s until mom could find a suitable home. I still remember how the menus at Denny’s had masks on them when you turned them over. Each week there was a different animal.

We found a nice little condo in the northwest valley, off Rio Grande and Montano, and moved in. My mother had a lot of friends in New Mexico, so we were never hurting for company. One of mom’s good friends was Joe. Joe was the pastor at the youth fellowship at the University of New Mexico back in the late 50s/early 60s; he performed my mother and father’s wedding ceremony. When mom and I moved to Albuquerque, she and Joe became very close because Joe was also going through a divorce and they could commiserate, etc. They fell in love! Joe became my step-father about a year after my parents divorced – he used to joke about how he married my mother twice! Here, on this blog, I shall refer to Joe as my dad, because he was my dad. He earned the title and raised me like his own. Unlike Ken, but that’s a different story that, frankly, probably no one wants to read.

Anyhow, Joe had been married twice before. His first wife was Ruth and they had two daughters, Jodee and Marsha. Joe’s second wife was Christine, and she had a son and a daughter, Scott and Heidi. So, Jodee, Marsha, Scott, and Heidi became my step-sisters and step-brother. Joe was twenty-two years older than my mother, so all my siblings were older than I was. The youngest next to me was Scott, who is eight years older than I am. Anyhow, Marsha married Doug back in the early 70s and they had one son, Ethan. Unfortunately, Ethan was tragically murdered by a drunk/drugged driver in 1996. Marsha and Doug had split in the mid 70s and Marsha met Mark, whom she has been with since the 70s. After Ethan died, Marsha and Mark adopted Rima, my niece, from Russia. Rima came to the US when she was eleven, not speaking a word of English.

Jodee has one son, Gene – we don’t see Jodee or Gene anymore. When Joe married my mother, Jodee was very angry. She had never forgiven Joe for leaving Ruth, so for the duration of my parents’ marriage, Jodee referred to my mom as “my father’s current wife.” After my dad died in 2002, Jodee made it very clear that she wanted nothing to do with my mother or me, or our side of the family, and that’s the way it’s been since then. This, after my parents had been married for twenty-five years! Jodee is a strange egg. I always felt badly for her because she is just so angry all of the time, and when you’re angry all of the time, you can’t experience the joys in life. One year, during Thanksgiving dinner, she randomly announced that she had given up a baby girl for adoption – and this was after she had had my nephew Gene. Everybody froze; you could have heard a pin drop; forks stopped in midair. What do you say to that? “Oh, really? Well, hmm, wow! That’s a really big thing . . . ”

Scott married Karla, who is the loveliest woman in the entire universe; she is a school psychologist, but also an extremely accomplished musician. She plays flamenco guitar beautifully. My brother Scott is also a guitarist. Heidi married Joe (our other Joe!), who died far too young of Hepatitis C. Heidi is awesome – she used to work as a Volkswagon mechanic, and she hotwired her classic VW bus’s ignition to turn on and off using a light switch. That was a rad vehicle, totally. I was going to say It smelled like . . . but you can guess what it smelled like, yes?

My dad died in 2002; my mother was heartbroken and was convinced that she would spend the rest of her life alone. Joe was the love of her life. So when she became reacquainted with Dave, a friend of hers from high school, and they fell in love, she couldn’t have been more surprised. Dave is a wonderful man – a former math professor at Colorado College – and through Dave I have two new step-brothers, Bryan and Mark. Mark is my age, Bryan is three years younger. I can no longer claim to be the baby of the family!

Anyhow, so, yes, Thanksgiving. Because of our family history of amicable divorces, we all gather together, even though so-and-so is not married to so-and-so anymore, etcetera blah blah. We gathered at Doug’s house, as we’ve been doing for the past five years or so. He’s got a beautiful farmhouse out in Henderson, Colorado. Doug is a professional carpenter, so the woodwork in his home is stunning. I love going there just to see his beautiful work. Doug’s partner is Lois, and Doug’s sister Linda was also there, with her daughter Courtney and Courtney’s boyfriend Dane. Rima’s husband, Eddie, is a long-distance truck driver, and he was stuck in Phoenix for the holiday unfortunately, but his family made it to dinner. There was probably about twenty-five people total.

There was an enormous amount of food. I brought fingerling potatoes roasted in olive oil and whole garlic cloves, salt, pepper, and Penzey’s Mural of Flavor seasonings, and British mushy peas, made with baby peas, butter, crème fraiche, salt, and pepper. I used Nigella Lawson’s recipe (Nigella Lawson is my straight-girl crush, by the way) for the mushy peas.

I’ve blogged before about my gastric bypass and how I have to be careful about the types of foods that I eat because I can get dumping syndrome. OMG, I dumped about four times during Thanksgiving dinner. I totally did not control myself, so I would go from Hungry to Eating Now to Have Eaten Too Much to Dumping Now to Nauseated/Sleepy.

There was this wonderful brie – it had some kind of carmelized cranberries topping it, along with pecans, and it was just to die for. I absolutely must have the recipe. I also had Marsha’s ham salad, various crackers, a piece of fool’s toffee, and mushroom caps. By the time I got to the table  -- because these were just hor d’ouerves, mind  --  I was feeling totally dumpy; it was all I could do to not faceplant right there into the Hallmark turkey decor. I nodded off despite myself, chin to chest. Shawn nudged me under the table to keep me awake. It took about 30 minutes and two cups of coffee (of which I subsequently found out was decaf) until I felt normal again. So then it was time to fill my plate with dinner.

My mistake was the carmelized yams.

I got dumpy for the second time, and Shawn kicked me under the table for another 20 minutes. Then came dessert.

My mistake was the pecan pie.

This time I totally fell asleep, nauseated, at the table and Shawn couldn’t keep me awake no matter the amount of kicking. It took yet another 20 minutes plus 15 minutes in a rocking chair over by the fire until I felt normal again.

Then it was time for Bingo! Our family plays bingo every year at Thanksgiving and it’s terrific fun (I just sounded like a Dick and Jane reader there, didn’t I? How keen!). Everyone is required to bring 5-10 gifts wrapped in plain brown paper or newspaper, marked Woman, Man, Child, or Gender Neutral. This year I won a Christmas tea light lantern, a Santa Claus candy dish (CANDY! *is a zombie now*), and this fantastic clock made from an old CD – it’s totally Steampunky. Very cool. But my step-brother Mark won this amazing, giant stuffed chicken that was, like, the best thing ever, and Courtney won a replica of the leg lamp from A Christmas Story, so I can’t help but feel completely jealous. THE LEG LAMP! Ladies and gentlemen . . . THE LEG LAMP.

There is a can of Spam that has been making the rounds of the family for, oh, the past five or six years. It expired in 2007, that’s how old it is (and really, can Spam expire? You know that some s***’s old when SPAM expires). Yeah, it’s the family gag gift. I got the can of Spam in 2008; my step-brother Mark won it in 2009, but promptly gave it back to me for Christmas, so I’ve been the keeper of the Spam since 2008. UNTIL NOW! This year the Spam went to my step-brother Bryan, who was, I think, terribly disappointed to get the can of Spam. Not only is a can of Spam NOT the leg lamp, but it is also a can of TURKEY Spam, which is somehow even more vile than regular porky Spam.

For the record, I have never had Spam. Spam has never crossed my lips. Not holding the moral high ground, though, I admit that as a kid I used to love Underwood deviled ham and Vienna sausages, which is probably just as awful. Vienna sausages are, like, bologna with an extra odd flavor forced into a cylindrical shape. Speaking of sausages, have you ever noticed that Combos are the human form of Snausages?

And that, my friends, is the story of my Thanksgiving. Yes, I stole leftover pecan pie to bring home, and yes I obsessed about the pecan pie until it was all gone. You can take the fat off the girl, but you can’t take the fat girl out of the fat girl.

If you have read this far, I appreciate your attention to my long-winded family history and various anecdotes.

IT'S AMAZING WHAT SITTING ON FATG's ASS WILL DO

Fat At the Gym now weighs 206 pounds. This is totally legitimate because I weighed both times (216/206) at my doctor's office. I discontinued a medication that has weight gain as a side effect in September and I suspect my weight loss might be in part due to that. Also, well, I have been trying to watch what I eat. I'm not perfect (hello Starbucks and Taco Bell . . . OMG venti white chocolate mocha, iced, with whipped cream . . . that sucker has 762 calories in it, UGH). But, yeah, ten pounds down! Yippee ki-yay mother father!

MEET FIRE TRUCK

Friends, meet Fire Truck, my new Kitchen Aid Professional 600 Series 575 Watt MIXER:

Ain't she a beaut? Why "Fire Truck"? One, obviously, because she's red. Two, my pug dog howls at sirens, so whenever one goes by, we always good-naturedly tease him about the fire trucks. Well, when I turned it on for the first time, Oliver howled at the mixer.

My inaugural recipe? Pumpkin spice muffins. See previous post.

FIRE TRUCK - THE KITCHEN AID MIXER

Hello, friends! Yesterday the Kitchen Aid Mixer – promptly named “Fire Truck” – arrived via my w00bie UPS man. Preeeeeeeeeeeeecious, yes, preeeeeeeeeeeeecious! I mean, yes. I am thrilled. So to break in my new mixer, I made perfect pumpkin spice muffins:

(Double Batch)

4 cups flour

4 tsp baking powder

1 tsp baking soda

2 scant tsp cinnamon

1 tsp ginger

1 tsp nutmeg

1 tsp salt

1 29 oz can of pumpkin puree

⅔ cup melted butter

1 cup evaporated milk or half and half (I've used milk before, or vanilla-flavored yogurt)

1 cup brown sugar

½ cup white sugar

4 large eggs, beaten

4 tsp vanilla

Combine ingredients in large mixing bowl. In separate bowl combine wet ingredients. Fold wet ingredients into dry; stir until moistened. Do not overstir/mix. I only mix enough to moisten the ingredients. The baking powder and soda will start activating the gluten in the flour pretty quickly, so the batter will start getting puffy/fluffy -- this is good! Add raisins or pecans if desired. Spoon ½ cup batter into each muffin tin; tin cups should be almost full, but not quite. Sprinkle top of dough with cinnamon sugar prior to baking.

20-25 minutes in a 375° oven, or until toothpick or knife tests clean. (I use a metal kabob skewer to test my muffins -- bigger than a toothpick, but not as big as a knife)

Perfect muffins, inside and out! The texture should be moist and fluffy on the inside. Comparable to: pumpkin muffins at Starbucks, but not sickly sweet. Just the perfect amount of sweetness!

I thought about going to the gym this week. I could have gone. I chose not to. I know if I just go, I will fall back into a routine. Why am I not going? I have enough workout clothes. I have new Saucony trainers. I have socks that don’t irritate my feet (Old Navy plain white anklet socks – most comfortable socks IN THE WORLD). I am not physically incapacitated. I can’t even say that I hate exercising because I don’t. In fact, I feel accomplished after a successful workout. Okay, so my plan is to go to the gym Monday, November 29^th, following a doctor’s appointment I have scheduled for that morning. That will give me enough time to do a workout and to check out the gym. Previously I set a goal to just walk into the gym, but I feel like that would make me look nutty, if I just walk in and then turn around and walk back out. I do not want to be fat and nutty at the gym. 

Part of my aversion to going to the gym – especially a huge gym like 24 Hour Fitness – is that I have a medical condition called lymphedema, which causes swelling in the lower legs. One of my maternal aunts has the condition, too – it can be genetic. People stare, which I guess I understand. I expect that some people are thinking, “Damn, girl, lose some weight! Get rid of those cankles!” Unfortunately, lymphedema doesn’t respond to weight loss; it’s a dysfunction of the lymphatic system. You can look it up on the Wiki if you’re interested. That doesn’t mean I can’t lose weight, but it does mean that my legs won’t ever look totally normal. It’s easy to hide with pants, but not with workout clothes. And since people obviously don’t understand at first glance what it is they’re looking at, many decide that it’s a weight loss issue. I mean, don’t get me wrong – I have weight loss issues! It’s just that I have another issue on top of needing to lose some weight. It’s hard to not be self-conscious of the lymphedema. I suppose I could always wear track pants: LIKE SUE SYLVESTER!!!!