valeskathecat

[valeskathecat]

I’m seeing a bunch of posts that make me think most USAmericans don’t know about The No Surprises Act.

It was passed in 2021 (thank you Biden) and essentially states that if you don’t have insurance or your insurance doesn’t cover a service you need (or want) you are entitled to a Good Faith Estimate of the cost of care. (If your insurance does cover the service, you should be able to estimate the cost of care based on your deductible and co-pay.)

As a healthcare provider who does not accept any insurance, I am very careful to not violate The No Surprises Act. Why? Because for every penny more than $400 that the Good Faith Estimate was “off” (or if it wasn’t provided), you are entitled to a refund for that amount.

Y’all. Ask for a Good Faith Estimate. Get it in writing. Compare it to what you are paying. If you are not provided an estimate or if it’s wrong by more than $400, demand a refund.

[valeskathecat]

Hi! This is kind of a weird question but how/why was influenza (and other diseases that we have vaccines for now) so deadly 100-200 years ago? Obviously vaccines help tremendously, and probably immunity over time, but are there other reasons that the flu was a much bigger deal a century ago? Sorry if this is oddly specific, but my current project is historical. Thank you!

This is a very interesting question and there are a couple of different ways of looking at it.

Let's start with influenza:

[Note: it's surprisingly difficult to get good worldwide flu data, so I'm going to use US numbers for the purposes of this post.]

I think the first thing to understand is that unlike many other infectious diseases, influenza is substantially different every year. That means that the immunity that you build in 2017 from either the flu or the flu shot won't necessarily help prevent you from getting the flu in 2023. By then it will be a different enough virus that your previous immunity won't be as helpful. Though it might make it a little milder. But keep reading, I'll give you some fun facts to share at parties:

We name flu (A) viruses based on two different proteins on the surface of the virus. The proteins are "H" and "N". There are 16 different "H" proteins, and 9 different "N" proteins that we currently know of. The combination of the two forms the "name" of a particular flu virus. Think H1N1, or H5N6, or any other combination. Each combination has their own attributes, which contributes to how infectious or deadly they are in any given year. And which ones circulate are different every year.

Just mathematically, that's a lot of substantially different flu viruses. Hundreds of them, in fact. And you have to build immunity to each one individually. You could, say, build immunity to H2N5, but that would do little to save you from next year's H4N3. And not only that, but within a single type there are many smaller variations. For example, say you got H5N3, but then it went and mutated. If you then got exposed again, you might have some immunity to new!H5N3, but it could also be just different enough that you still get sick.

Like I said above, different types of flu virus are deadlier or spread faster than others. H5N1 (a type of avian flu with a human mortality rate of 52%) is terrifyingly deadly but fortunately doesn't spread particularly well, while H1N1 (the star of both the 1918 and 2009 flu seasons) spreads rapidly and kills primarily young adults (weird, since flu usually kills babies and old people).

This is why in 2009 we did the whole "close the schools vaccinate the teens hide the president" routine. Because if it was *that* H1N1 we were all about to be screwed in ways we had never experienced before. Fortunately it wasn't, but thank goodness we did it. Also if you got vaccine #2 in 2009, you are also protected against the 1918 strain of H1N1. You're gonna be a hit at parties with that one.

Now, if you look at only deaths (not the best measure, but one with some emotional punch), within the last decade alone we have years where 12,000 people died of flu in the US (2011-2012) and years where that number is as high as 61,000 (2017-2018). These numbers are similar throughout recent history (relative to population), but then you get years like 1968 (where 100,000 people died in the US) and 1957 (where 116,000 died), and then sometimes you get these wild whopping years like 1918 where 675,000 died (equivalent to 1,750,000 people dying in today's US population). These fluctuations have happened since Hippocrates was around, and probably long before that, and there's really nothing to suggest it's getting any milder in any statistically significant way.

Now, outside of these natural fluctuations, we do have some ways of driving down these numbers. We do have a vaccine. It is different every year, based on our prediction of what the most likely or dangerous types of flus will be this year. Fortunately, you do get to keep this immunity for some time, so you can look at the flu vaccine as a personal collection of different flu viruses you have immunity to- you can collect 2-3 different ones every year in one shot and you didn't even have to catch them!! Yay! Unfortunately, since we never reach herd immunity with the flu vaccine, and we can't perfectly predict and incorporate all the strains that will circulate in a given year, while you do get some protection, it's not ever perfect. But it *is* still worth it.

We also have other feats of modern medicine as backup to the flu vaccine. We have oxygen, antiviral drugs like tamiflu, immune modulating drugs, and technology like ventilators to help keep people alive in ways we would not be able to in previous generations. So that's also an advantage. Unfortunately, these don't always work either, and we are still at the whim of those yearly fluctuations in influenza virus deaths.

And really, if you ask any epidemiologist, covid is just a little trial run for the next Big One. Which is both extremely likely to be a flu virus and which we're statistically overdue for.

TL;DR: The flu isn't getting milder so much as it varies wildly in severity every year. The next major flu pandemic is probably going to be in our lifetimes, so start collecting your flu immunity now if you haven't yet. New collections drop every August and are available until April. Get em' while they're hot. This year's included a 2009-like strain of H1N1 and a delightful H3N2 number from Hong Kong.

As for All the Other Vaccine Preventable Illnesses:

*ahem*

Yes, it's vaccines. It's obviously vaccines. Its basically only vaccines. Anyone who has ever told you it's not vaccines is lying. No other major discovery of modern medicine has ever saved as many lives, prevented as many disabilities, and created as many opportunities for a life well lived as vaccines have. No antiviral drug, no antibiotic, no ventilator can even hold a candle to vaccines. The answer is f*cking vaccines*.

I hope I have made myself clear.

Enjoy this table:

*Yes I do have a masters degree in public health and am a registered nurse that interacts with the public regularly, how did you know?

-Ross @macgyvermedical

[valeskathecat]

I do give almost all the credit for my love of Interstellar to theoretical physicist Kip Thorne who bullied Nolan at every turn into keeping the science as realistic as possible even when Nolan threw tantrums abt it because he wanted to sacrifice what was plausible for what was exciting and Kip Thorne just kept being like sorry is the theoretical capabilities of spacetime travel not exciting enough for you? Grow up.

[valeskathecat]

Well this is different

To be honest, I forgot about the blog I made just about days after I made it. But crawling through all my unread emails because I was bored beyond tears from quarantine, there was an email from Tumblr about this blog. So here I am again. 

So much has changed in the past two-ish months. Once I got back on my meds, things got a lot better and easier to handle. Which was good, because a lot came at me immediately following that. 

I met with a surgeon in late January to decide if he was going to recommend surgery for my extra severe GERD and deal with the potential precancerous tumor at the same time. I ended up having a Toupet fundoplication in the beginning of March, which meant I was knocked on my ass for the better part of a week, was on a liquid diet for two weeks, and as of now, the end of March, I can still only lift 30 pounds. 

Surgery at the beginning of March was a little scary, to be honest. The US was just really starting to talk about the spread of COVID-19 on the news and I was about to be cut open with fresh wounds and an out of whack immune system for weeks after surgery. 

Well, shit hit the fan about a week and a half after my surgery. I had missed the first week of the trimester at my university, but that Thursday, it decided to cancel classes for the next week, send everyone home, and have online classes at least through April 13th. Alright, neat. I can roll with this, it gives me a little extra time to recover before going back to classes. 

During the break week, while professors were learning how to use the internet, the president declared a state of emergency, Wisconsin declared a state of emergency, as did Milwaukee county. Cases throughout the US rose exponentially, and states started “shelter-in-place” orders. Wisconsin followed a few days after Illinois with a “Safer at Home” order, which is the same freaking thing, they’re just hoping not to panic people anymore than they already are. 

Both of my jobs are shut down now, so I don’t have any income. I filed for unemployment last week, we’ll see how that goes. 

This is neat, alright. I live alone, it’s just me and my cat. I live in a close-ish suburb of Milwaukee that’s about 20 minutes from downtown. So basically, it’s really freaking hard to get any human interaction. My friend group decided to video call once a week to make sure we catch up, which is good, but at this point, it’s been well over two weeks since I’ve had a hug from someone I know and that’s a little rough. 

I guess some good-ish news throughout all of this is that I met someone back at the end of January that I was talking to for a while and we went on a couple dates and hit it off really well. I haven’t seen him in person since mid-February due to my surgery and then the pandemic, but we’ve kept in contact and things still seem to be...I don’t know, good? I get little flutters in my stomach when I talk to him? It’s nice to have some tiny little sense of normalcy in the middle of all of this crazy bullshit that’s happening. 

Things are really strange. It really feels more like the Twilight Zone than anything else. I lose track of what time or day it is and my sleep schedule is completely screwed. 

Still rambling, as always. On my last post I ended with “Life kinda sucks but what’s the alternative?” I got my answer, apparently it’s the apocalypse. Welcome to history in the making. 

[valeskathecat]

What am I even doing on here?

Well hey guys. And by that I mean absolutely no one because I’m following no one and no one is following me. I’m really just doing this as a way to sort of track where I am in life and how I’m feeling. It will mostly just be a space for me to write shit out and vent. 

A little about me for the zero people who are reading: I’m a senior biomedical engineering student at Milwaukee School of Engineering (MSOE), but I won’t be graduating until May of 2021 because I dropped all of my classes last spring and decided to spread my last year out into two to lower my stress. I’m the VP of my professional sorority, and I love my cat, Penelope. I also have incredible depression and anxiety, but they tend to oscillate, almost like a teeter-totter. For the past couple years, the depression has been winning. 

I started seeing a therapist about a year ago, and my PCP referred me to a psychiatrist in April of last year. I think in September I was switched to a med that is actually doing good things for me, so that’s super great. 

Except. Over winter break, my (dad’s) insurance company decided that because my antidepressant was a “long-term med” it needed to be ordered from a mail-order pharmacy. In North Carolina. Because that’s where my dad lives and where the insurance is. Well, I had run out by the time the insurance told me this. It took almost a week due to the holidays to contact the mail-order pharmacy, and they said it would be 5-7 business days before they shipped it and who knows how long to get from NC to WI. Needless to say, I’m upset. I’ve been without my antidepressant for over a week at this point and looking at not having it for another week. I ended up calling my psychiatrist and asking for a bridge prescription for like 10-14 days that I’d just pay out of pocket while I wait for the prescription to come in the mail and started taking that a week ago. 

It’s been a week from hell. It’s like my emotions are on a roller coaster that I can’t get off of. Examples include: dropping my drink at work and bursting into tears, soldering something backwards at my internship, fixing it, and then being so anxious about it I ended up leaving early, and completely failing a quiz and an exam because I failed to study for them (because I forgot they existed) then crying about failing said quiz and exam. Clearly, I’m doing great.

Which brings me to another point. Today, my therapist asked me why I always say something sarcastic instead of what I really feel. Right now, I don’t know. Maybe because I don’t know how to put how I feel into words. Maybe because I’m angry and don’t like showing that. I don’t know and I don’t care right now. I’m just trying to pay attention to my attitude, which includes how I respond to things (Like when something goes wrong, big or small, my response is usually “my life is garbage/a trash fire” or “it’s fine, guess I’ll die now.”) 

Today started out pretty decently, I made myself lunch for the first time since before winter break, wrote my notes for my Linguistics midterm, and went to therapy. I later got my exam grade back for the test I took last week and promptly found a nice, private corner to cry in until it was time to go to class. 

All of this is super jumbled and extra rambly, but that’s kind of how life is, imperfect. Or something to that effect. Life kinda sucks but what’s the alternative?