My surgeries

 I’m not keeping the doctor away. Unfortunately, by the time you get this, I will have had surgery for carpal tunnel syndrome on my right hand. I will also have turned 88. On September 17^th, I’m having surgery for a pinched nerve in my spine.

As to carpal tunnel, my fingers are numb and I’m losing muscle in my hands (mostly right), and sometimes I have pain at night. Carpal tunnel syndrome occurs when irritated tendons swell or thicken and thus compress the median nerve, which passes through the wrist and on to the fingers. It can be caused by injury to the wrist, genetic predisposition (small tunnel), and other issues, such as an overactive pituitary gland.

The surgery consists of making about a two-inch cut and cutting the carpal ligament to make the carpal tunnel larger. It’s performed with a local anesthetic. I’ll have to wear a splint for ten days.

As to the pinched nerve in my back, it’s caused by a narrowing of the space in my spine where nerves pass through. For me, this results in sciatic pain running from hip to foot on my right leg. I’ve tried physical therapy, acupuncture, and steroid injections into the offending area. None of these methods worked. I’m not a candidate for a procedure (ablation) that uses radiofrequency energy to disrupt pain signals that travel from your spine to your brain. So I’m going to have a laminectomy, which enlarges the spinal canal to ease pressure on the nerves. Or as my neurosurgeon says, she’ll clean it up. This is also minimally invasive and I should go home the same day.

I’m not looking forward to any of this, but I’m tired of having numb fingers and pain in my leg.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Finger ratios and you

Look at your hands. Is your ring finger longer than your index finger? Or is your index finger longer than your ring finger? Some scientists believe that the amount of estrogen and testosterone we’re exposed to in our mother’s wombs can influence which digit is longer than the other.  The theory is that a longer ring finger is the male pattern (more testosterone); a longer index finger is the female pattern (less testosterone).

Unfortunately, because scientists can’t safely sample blood from early fetuses, they can’t confirm a correlation between fetal hormone levels and variations in finger lengths. The subject is controversial. Nevertheless, some studies on finger ratios have shown the following:

• Men’s running speed, skiing speed, and football ability are strongly linked to longer ring fingers.  Usain Bolt, “the world’s fastest man,” has exceptionally long ring fingers.
• Financial traders with longer ring fingers made more money than their short-ring-fingered colleagues. They're also thought to be more aggressive, and more likely to take risks.
• Lesbian women tended to have the more masculine (long ring, short index) finger arrangement.
• Women with longer ring fingers did better in a driving skills test than those whose ring fingers were equal to, or shorter than, their index fingers.
• Women who have a longer ring finger have higher grip strength. 

Apparently, genetics plays a role. 23andMe tells me, “Constance, the combination of your genetics and other factors makes you likely to have longer ring fingers than index fingers.” Well, yes and no. On my right hand, my ring finger is clearly longer than my index finger (male pattern). But on my left hand, my index finger is a tad longer than my ring finger (female pattern).

Maybe there’s something to this finger ratio theory. I’m not a very girly girl. I don’t own any jewelry and there are no dresses in my closet.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Senior moments

Psychologists divide general intelligence into two categories: crystallized and fluid. Crystallized intelligence consists of the knowledge and skills that accumulate over a lifetime, such as vocabulary, storehouse of facts, and how to do things, such as knitting and skiing. Fluid intelligence consists of our ability to reason, flexibly engage with the world, recognize patterns and solve problems. An emergency room doctor uses fluid intelligence to assess symptoms and make a diagnosis; she uses crystallized intelligence to treat the problem.

Crystallized intelligence accrues over a lifetime and may peak at about age 65 or above. Fluid intelligence tends to peak at about age 20, then decline with age. The rate of decline varies from person to person. Some people, such as ninety-three-year-old Warren Buffet, have managed to retain strong fluid intelligence. Morrie Markoff, who died at the age of 110, remained mentally sharp to the end. (His eighty-two-year-old daughter is donating his brain to science.) But these guys are outliers.

So what about that euphemism “senior moments? We old people—I turn 88 this month—say we’re having a “senior moment” when we can’t remember something. It seems less embarrassing than saying “I can’t remember.” I have lots of those moments. They consist mostly of an inability to remember a name, word, or phrase. Supposedly such moments are normal “age-related memory loss,” probably from decreasing neurotransmitters and brain size. I haven’t been able to find out where that fits in with the crystallized/fluid scheme. Maybe it doesn’t matter.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Pharmacy benefit managers: why drugs are so expensive

Pharmacy benefit managers (PBMs) are middlemen who are hired by employers and governments to negotiate prices with drug companies. The three largest PBMs—CVS Health, Cigna, and United Health Group—collectively process roughly 80 percent of prescriptions in the U.S. Each would rank among the top 40 U.S. companies by revenue.

When PBMs negotiate with drug companies, the drug companies start out with a sticker price. The drug companies then agree to reduce prices on brand-name medications by giving rebates to the PBMs. (Generic drugs don’t get rebates.) The PBMs share most of those rebates with employers, but they also pocket a portion for themselves. This adds up to billions of dollars.

But here’s the deal: Because the PBMs demand discounts from the drug companies, the drug companies often increase their sticker prices so they can maintain their profit margins. Thus, the patients’ out-of-pocket costs for that drug go up. Example: Bristol Myers Squibb more than doubled the sticker price of Eliquis, a blood thinner, making it possible for PBMs to deliver big rebates to employers. But because out-of-pocket costs are a percentage of the sticker price, many patients are now paying hundreds of dollars more per year for Eliquis.

Even when an inexpensive generic version of a drug is available, PBMs have a financial reason to push patients to take a more costly brand-name product. The higher the original sticker prices, the larger the discounts PBMs can finagle, the fatter their profits. Employers may prefer brand-name drugs because of the discount. (Employers often can’t understand or control how the system works. It’s complicated.)

PBMs also own pharmacies, such as CVS, including mail-order warehouses. PBMs push or force patients to use these pharmacies. To increase profits, such pharmacies may charge thousands of dollars more than what a drug costs. Example: CVS was charging an employer $138,000 a year for a patient’s prescription—the same drug the patient could buy elsewhere for about $14,000.

Finally, in 2018, PBS companies established subsidiaries—group-purchasing organizations (GPOs)—that receive the rebates from drug companies and pass on the rebates to the PBMs, which in turn send the savings to employers. To increase their earnings, the GPOs began imposing new fees on drug manufacturers. Because those were fees, not rebates, and because the fees were technically collected by a different company (the subsidiary), the PBMs weren’t contractually obligated to share them with their clients. Employers are none the wiser. They receive rebates, but they can’t see the billions of dollars in fees that the GPOs take for themselves. In 2022, PBMs and their GPOs pocketed $7.6 billion in fees, double what they were bringing in four years earlier.

Because this subject is complicated, this blog post was no fun to write. It’s probably no fun to read either. Sorry.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.