WOW: Choosing a Family Physician for Better Health

image of punctate keratophathy

my right arm

The biggest disadvantage of the full time RV cruising lifestyle that we had in the past 4 years was inconsistency of healthcare.  And, more than Bill who has needed specialists, my chronic urticaria, especially, has badly needed a family physician who knows my history. This is one of the reasons we are in Phoenix for 6 months. I want to find a good family physician to be the foundation of my healthcare.

In Orlando, Florida I found the Filipina Dr. Concepcion, referred to us by Bill’s cardiologist Dr. Siddiqui, to be a good one. Unfortunately, we had to leave Florida. In Pittsburg, Kansas, Bill’s hometown and where his sister Rosemary lives, I was fortunate to see Dr. Carlson, Jack’s family doctor, for a while. And, in Seattle, I consulted with Bill’s family doctor, Dr. Chen. Prior to these health issues I had not been used to seeing a family care physician. We had no such a system in the Philippines or I was just not aware.

Cornerstone Family Medicine

Dr. Crawford

From a web search of Health Grades, Health Ratings, etc. Bill chose Dr. Rustin Crawford, D.O., 47, of Cornerstone Family Medicine. He has earned good ratings from his patients (3 out of 4) and has 11 years solid experience. His clinic is part of the Banner Health System, winner of the 2013 Top 5 Health Systems in the US, large health system category (Banner is a network of 22 hospitals in the region, based in Phoenix). My early consultations have resulted in reducing my medications for my chronic urticaria to just OTC drugs, with special aids only upon the incidence of flare ups.

Arizona Optical

Lab results from blood draws has also revealed mild hypothyroidism which is now currently under treatment with thyroid hormones. Good news is that  my mammogram is normal! Dr. Crawford has also referred me to Dr. Jackson, an ophthalmologist who is monitoring my dry eyes (old age and dry desert environment) that has also revealed I have Thygeson's superficial punctate keratopathy (TSPK) in both eyes, a condition where tiny lumps can be found on the cornea. In 3 weeks she will install a punctum plug so that natural tears can lubricate my eyes longer, easing the symptoms of blurred vision.

But the best news is that, beginning November 1, I am covered by Medicare. With a smaller amount for Plan F and Plan D as supplemental plans, my coverage shall even be greatly expanded, both for prevention and care. Together with Social Security benefits, this makes me feel very comfortable about retirement here in America.  Good and affordable healthcare is such a boon for old age.

Primary care is given by a provider who acts as the principal point of consultation. Such a professional can be a general practitioner or a Family Practice physician. It includes maintenance of optimal health and care of all kinds of acute and chronic physical, mental and social health issues. Consequently, the provider must possess a wide breadth of knowledge in many areas, exercise continuity of care, and develop collaboration with other specialists. This results in better health outcomes and lower spending.

A family physician is a primary health care provider devoted to the care of the individual and his family across all ages, genders, diseases, and parts of the body. It is based on knowledge of the patient in the context of his family and his community, emphasizing disease prevention and health promotion. Nearly one in four of all office visits are made to family physicians, 208 million office visits each year, 83 million more than the next largest specialty.

It was in 1969 when family medicine was recognized as a distinct specialty in the US. After World War II, medical specializations became increasingly popular. At the same time, the many medical advances raised the concern that four years of medical school plus a one-year internship for general practitioners was no longer adequate. A residency program added to their training not only gave additional knowledge and prestige, but also board certification, which had been increasingly required to gain hospital privileges.

Family physicians complete an undergraduate degree, medical school, and three more years of specialized medical residency training of rotations in internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and geriatrics. The specialty focuses on treating the whole person, acknowledging the effects of all outside influences, through all stages of life. A program called the "Maintenance of Certification Program for Family Physicians" (MC-FP) requires family physicians to continuously demonstrate proficiency.

yourhalthfile.com

Family physicians perform their mission as a patient’s central person for referrals, records, and history through regular visits and good patient history. Thus we will stay in Phoenix for 6-8 months in a year to give our family physician a basic context of working with us. Cornerstone Family Medicine has uploaded and is maintaining our records in YourHealthFile.com so that it can be accessible from any part of the country (or the world). Not just a database of records, it provides a place for continuing dialogue

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The bad news, however, is that by 2020 the demand for family physicians will exceed their supply. In 2006, when the nation had 100,431 family physicians, a workforce report indicated the US would need 139,531 family physicians by 2020. To reach that figure 4,439 family physicians must complete their residencies each year, but currently only half that is being achieved. The waning interest in family medicine is likely due to several factors, including less prestige, lower pay, threat of malpractice suits, and the increasingly frustrating practice environment which forces them to try to take care of patients in just 10 minutes. 

the pumpkins we carved!

Obamacare will even exacerbate this problem. As it seeks to expand health insurance coverage by 32 million people by 2016, the success of the program depends largely on the availability of primary care physicians. Unfortunately, according to the Association of American Medical Colleges (AAMC) without it the United States would have been short roughly 64,000 physicians by 2020; with it, 91,000. Hopefully, Bill and I would have become established patients of Dr. Crawford before then.

@ Halloween Dance

OLA: Getting to Viewpoint, Our Home for the Season

our neck of the woods, with a little orange tree

the big scissors

From Santa Monica, we moved on to my sister Cherry and her husband Rick’s new home in San Diego. Rick had accepted a job offer there and the couple was eagerly awaiting our arrival. The two men quickly sat down to watch the Chargers (the couple’s team) football game with the Raiders while Cherry ordered Round Table Pizza for us to devour during the expected riotous game…not (it was a disappointing loss for the Chargers!

The following day, while Rick was at work, Bill, Cherry and I shopped for the meals for our three other dinners: chili relleno, chicken afritada, and chicken tikka masala. Actually, they had only transferred to San Diego last Sept. 14 and many more boxes are therefore still unpacked. In fact Rick’s right foot was inadvertently hit by a heavy box while bringing them out of the trucks and is still suffering from the hairline fracturest. But the two girls had lots of fun taking turns cooking.

Cherry also had her much desired pixie cut retouched but not before we took pictures of the biggest pair of scissors in the world. Meanwhile I had my hives quickly eradicated by a great doctor in an exceptional urgent care facility. But we had to cut our stay short because my Silhouette glasses had to be repaired in Palm Springs where I bought them last April. Friday was our last bet for I had doctors’ appointments on Monday, Tuesday, and Wednesday the following week in Phoenix.

So it was a hurried departure and fortunately, Cherry, a very good cook, did very well, with lots of compliments from Rick, with the chicken tikka masala recipe I left her. But we were not able to make the banana cream pie, a favorite of both Bill and Rick. Our pictures, of Cherry hugging her two dogs, Kea and Charger (what else!) and me hugging Cherry, was our sweet goodbye.

The two vacations were not as grand as we expected them to be. The 21- year olds Krishna and Tracy had definitely different notions of party than 50-year olds Rick and Cherry. But we had our chance to relive both our 20’s and 50’s and now we are back in Phoenix, back to reality and back to our 60s! On the way, the bright Arizona sky was host to a very interesting find in our travels, Cloud Lab, the largest air ship in the world. It is in the air searching for life in the clouds, on an expedition across the US funded by the British Broadcasting Corporation.

Unfortunately the work on our home was not yet finished when we arrived, so we had to stay in a motel for 4 days. But now we are ensconced in our very own semi-annual campsite #5520, just a short walk from one of the clubhouses and the ball diamond, at Viewpoint RV Golf and Tennis Resort. We even have a little orange tree in front, semblance of a home!

Viewpoint Layout

Here is the layout of the campground, with all of 1,900 sites, close to half of which are park model and manufactured homes. There are 2 golf courses, 10 tennis courts, a ball court, three swimming pools and hot tubs, 2 clubhouses, a bar/grill, a country store, etc. It is already buzzing with activity even if only a third of those expected for this snow birding season have arrived.

There are also a ton of concerts, dinner/dances, shows, and other events:

·         7 Concerts (tributes to Celine Dion, Bob Seger, Rolling Stones, Chicago, Nashville Road Show, and Journey),

·         8 performances, 3 each of Concert Band and Classic Chorale, 1 each of Choraliers and Goodtime Singers,

·         11 Tuesday Night Dinner Shows (from solo artists, quartets, magicians, comedians, and hypnotists to Mariachi Band, Vocal Ensemble, Orchestra, Saddle Strings, Swing Sisters, and Jerry Breeden),

·         8 Friday Night Dances with different themes (Halloween, Welcome Back, Christmas, New Year, Sadie Hawkins, Valentines, Sock Hop, and Going Away),

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 and a host of Special Events like the Fall and Spring Yard Sales, the Winterfest, a Super Bowl Party, 50^th Anniversary Celebration, annual photography exhibit, arts and crafts festival, and St. Patrick’s Day Celebration, and an Annual Cookie Bake, Veterans, Day, etc. 

at the Resort entrance

And with 50 clubs to choose from (I have chosen painting, photography, yoga, tai chi, dancing, bridge, mahjong, poker, scrabble, and karaoke) I will have my hands full! It will be a very different half year for us:  no long road tips, just staying put, making new friends, partying and chillaxin’. So from the next post on, I will be writing WOWs, Wonderings on Wanderings. Because chillaxin’ will give us time to reflect.

OLA: Reliving Our 20s in Santa Monica, California!

dusk at the famed Santa Monica Pier of California

view of the valley from Prescott

We spent our first month in Arizona at Verde Valley TT Resort in Cottonwood, Arizona . Remember Ann? Our first week was spent with her (please see http://rvcruisinglifestyle.blogspot.com/2013/09/ola-visiting-with-bff.html).

Sunday Farrner's Market in Cottonwood

After her visit, we spent every Saturday at the several series of her books based in Seattle, WA and Bisby, AZ. Her newest, which Bill bought and she signed, is the prequel to one of the series Bill had read.  What fun for the fledgling author in me!

Book Signing Event with J. A. Jance

Clubhouse Dinner Dance. We also enjoyed the Community Library where I was able to borrow 7 classic travel books to help with my final edit and the Community Fitness Center where we worked out every other day. There was even a little Farmers’ Market one Sunday after mass. A trip through the other side of the mountain from Jerome, so we could watch Eysium at an IMAX in Prescott, gave us an unforgettable view of the valley. But the highlight of our stay was the Community Center’s Book Signing Event of the best-selling author of Arizona and Washington (our 2 states!), J.A. Jance.  Bill had read

being towed into Phoenix at almost midnight

the tire and the tread

 All set to go to our 6-month winter hibernation in Phoenix, at just about 20 miles after leaving camp at about 1 pm, the whole tread of the inside rear dual on the passenger side blew out. Good Sam again came to our assistance and new tires were installed to all four on the tandem axle. It turned out, however, that we could still not drive the RV because the tread had damaged the drive shaft when it blew out.  Finally at 9 pm we were towed into the Deer Valley Diesel, stressed, hungry, and exhausted.

The next day Bill and I decided to bring the RV to the Collision Center of Camping World. Some unfortunate happenings hurt our RV through the thousands of miles we had taken her: the orange pylons set up for road repair (they hardly make them wide enough for RVs!) and a campsite with huge rocks that you cannot see when you check in at night. Well, it will be there for 2+ weeks (paperwork for insurance included!) so we decided to visit my granddaughter Krishna who has relocated to Santa Monica and my sister Cherry who has also just relocated to San Diego.

Krishna receiving me at her Salon de Nesou post

 Krishna is my 21-year old first apo (grandchild) who has recently completed her Cosmetology Course in the Seattle Gene Juarez Academy immediately found a job at Salon de Nesou. She was off on Oct. 3 to 5 so I thought we would be able to take her around the city. But it didn’t turn out to be what we thought it would be. 

Unfortunately, she landed with a creepy landlord who was often at their apartment. The lone man who lived in the other room invited a girl (cousin he said) and asked Krishna and her friend Tracey to accommodate her in their room. Several days passed and soon it became three weeks, definitely against their lease agreement. So the man ‘cousin’ lodged a complaint against the landlord who then gave them an eviction order for 3 days and refused to give back their deposit.

@ her fave sushi place

with Grandpa eating on the sidewalk

The 3 days were almost consumed taking their belongings to our motel (luckily we had a 1 bedroom suite so they could use the sofa bed at the living area) and looking for a new place.  And we were also able to have some fun with her, shopping for international food items at the food trucks in Venice, California, where they are all parked every Friday evening, eating at her favorite sushi place, revisiting El Pollo Loco and Pinkberry frozen yoghurt. But the highlight of the visit was the oath I was able to make as a dual citizen of the United States and the Philippines! I truly have become an American without losing my Filipino roots!

@ the Philippine Consulate in LA, taking my oath as dual citizen

their new apartment, upper floor

On the last day, we were able to find and negotiate terms with the new landlord and transferred all their stuff from the motel to their new apartment. Then we celebrated with Soc, a Miss Computer Girl finalist when she was 21 back in the Philippines.

the Happy Misfits

We had dinner in an appropriate place…the Misfits…at the famous Promenade of Santa Monica. After dinner we found a café with lots of cake and that was my BIG mistake. I ate half of Soc’s cheesecake and my whole tiramisu. I suffered heavily that night! But everyone had a riot. Krishna has a new Tita. Her new apartment is just 4 blocks from her Salon. Sometimes, grandparents have the most fun reliving their 20s through their grandkids and friends. But, unhappily, my hives flared up all over again. Stress is not one of my good friends!

Bill having dinner with the girls

WOW: Becoming an American without Losing My Roots, Part 2

my favoiite teepoee at an Indian Village

In Part 1, I asked 'Who is an American'. The common answer is anybody who has been able to come to or was born on American soil. But, for late-age migrants like me, an American should be much more. He 1) has come to America to achieve a dream that was difficult to achieve in his or her home country, 2) is legally accepted into the country, regardless of race, 3) knows her history, upholds its constitution, appreciates her natural beauty, and accepts the diversity of her people and culture 4) takes pride in its products and institutions, and 5) has something to contribute to the nation.

@ the Missouri Arch

Living here for the past 10 years, my dancing has changed from disco and ballroom to country and rock, songs I sing from pop to country, and my attire from blouses and skirts to tank tops and jeans or shorts. My kitchen is shifting from cooking adobo, pancit and lumpia to grilling steaks and baking pies, my snacks from turon and suman into pretzels and chocolate chip cookies. My every day expressions are turning into American English instead of Tag-lish; when hurt I now cry ‘Ouch’ instead of ‘Aray!

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With Ann at the RV

But I quickly and animatedly shift to Tagalog when I am with my kababayans (country mates).  As Bill has noticed, my English quickly brings on a Tagalog accent which is not the case when I am with Americans.  Actually, I still think in Tagalog and that’s why I shift genders, conspicuously, because there is hardly such a thing in Tagalog (the word for son or daughter is the same, anak; the word for wife or husband is the same, asawa; the word for a brother or sister is the same, kapatid; words of respect, however, connote gender: kuya is for older brother and ate is for elder sister. Expletives are more easily shown by repetition  (pretty, pretty, pretty or ganda, ganda, ganda for very pretty).

with q cowboy

My yearning for Filipino food became even stronger as I partake of more American meals. A sandwich is not a meal, it doesn’t have rice! For Filipinos, pan de sal is merienda (snacks) or almusal (breakfast). Even as I felt pride in American products and institutions, my pride when Megan Young was crowned Miss World, making the Philippines the only country with all 5 of the most coveted beauty titles, became uncontrollable; even when Jessica Sanchez almost made it as the American Idol. And I am proud to tell fellow Americans that July 4 is not just the day for American independence but also the day for Filipino-American friendship for on that day in 1946 America finally gave us our own independence!

with the Lincolns at hix Presidential Museum

In another sense, however, I feel sorry that the Philippines does not, enjoy a lot of the good that I see here in America, like electoral processes, library systems, community centers, and transportation systems. The parents of students in elementary and high schools see the progress of their kids online! Better funded school districts provide high school students their own laptops. And many Outer Lab Education Programs augment the children’s education for greater appreciation of astronomy and wildlife and plant life, like the one we inspected with Suzanne in the foothills of Colorado, for Cassie’s completion of Grade 6. But then I remember, the Philippines is only 58 years old, America, 238! There is time and room for my home country to grow, in a daang matuwid (righteous, staight line)!

car art like the Philippine Jeepney

Throughout our travels, I became keenly aware of the kinship the Philippines holds with the story of America. My home country shares not only the Pacific Ocean with the US west coast but also the treacherous Pacific Ring of Fire. Spain colonized the US southwest and the Philippines for the same number of years until the US won those territories after their victory in her Spanish-American War. Filipinos fought side by side with Americans in WWII. And now, countless Filipino nurses and teachers are an integral part of the backbone of many US hospitals and schools.And much more American business processes are outsourced to Philippine shores.

US Cleawater beach in Tampa Bay, Florida

But there are also many differences. The Philippines is a tropical archipelago of 7,107 islands while the US is a vast contiguous (except for Alaska and Hawaii, etc.) temperate land. Thus wildlife and plant life species are very different, except in southern US. I miss tropical fruits so much that I sometimes have to pay top dollars for their occasional availability in Asian stores. Mountains, plains, and rivers are grander, wider, and stronger in America. Beaches may extend for miles in the US but island beaches in the Philippines are more exotic. And when you step into the wide vistas of Wyoming, Montana, and the Dakotas, the beautiful desert landscape of Colorado, Utah, Arizona, and Nevada, and the glaciers of Alaska, you know that you have entered a world many moons away. And in the Northeast, especially, fall and winter paint the differences loud and clear. 

 

Charlie and Lucy in equal partnership

under the New Year  Ball in Times Square 

Anyway, the other question is ‘What is the American dream’? For me it was to have an equal partnership with a spouse. But, like most others, I also find it in all the modern facilities made available to everyone who dares to ask. America is where, if you put your heart to it, you can be whatever you want to be. I now want to be a good writer!  My mother, a product of American innovation (as a scholar in teaching the deaf to speak) herself, taught me those early values.

enjoying the fruits

Capitalism is not evil, greed is. Capitalists give opportunities to those who have the drive to excel. In a sense I lived the American dream, albeit in my home country. The foundation for the Philippine’s highways, schools, public administration systems, was laid by America. And many of the multinationals that do business in the Philippines contribute to the continuing education of the Filipino. I was born to parents who fought side by side with Americans in WWII. I was schooled in the Philippines’ American School. As an adult I was trained by American multinationals. Now, as a naturalized American citizen, I enjoy the fruits of her early leaders’ genius and sacrifice right here in its vast lands, with a handsome Caucasian by my side.

Pinoy Pride

In four short years I have gotten an intense American education. But I am so glad I did not get boiled into the thick soup melting in the pot. Instead, I got included in a colorful chunky stew, contributing to the taste, but retaining enough of my own essence. I attribute that to the unique eternal elasticity of American culture. Founded by immigrants from the UK, followed by successive waves of immigration from every corner of the world, America has become uniquely innovative.  I am proud that I have become an American without losing the Filipino in me and extremely happy for the last third of my life!