06/29/18, TGIF

LOL! I filled out the paperwork here at home. Took it in to the department of permitting. Was greeted by smiling, happy people. Cute twenty something says to me after I explain why I'm there, "Oh, so you'd like to make the installation legal? Great!" More smiles.

Next a blonde and bronzed middle aged woman whisked me off to her computer station, offered me a sea****er, coffee??? (I'm like... am I in the Twilight Zone?) I sit there while she types in information, asks me about my plans for the 4th, tells me about her life with her Schipperkes, looks at my dog photos, oohs and ahs, say's "It's $174.52. Would you like to schedule an inspection now for next week? Yes? What day and time is convenient for you? Tuesday afternoon? Of course. All done! Just call this number in the morning to get your 2 hour window. So nice of you to come in today. Have a wonderful weekend and take care of the Mama dog. Hope you keep her stress free on the 4th!"

I kid you NOT! This is for real. I was in and out in under 15 minutes.

But, now the hill I drive every day to go to school is on fire. The regional open space backs up to state park. Dear God, I hope the fire fighters are able to contain and control that fire before it gets out of control!

That is a Twilight Zone!!!! How lovely though to have it go that way.

I'm sorry about the fire. They make me so sad as they are happening so close together that there is no chance for the plants to recover. Our beautiful CA landscape was meant to burn every 50-100 years, not every 2-5. Our latest local one they just counted 450 trees in one small area that were lost and will be cut down - mostly oaks and sycamores. Our trees were made to withstand occasional fires, not repeated ones.

Where's the broken heart emoji when you need it?

But, nice to see you posting. You are out of that blasted chair, right? If so, did you burn it?

Out of the hospital bed at least! Sitting in the blasted chair for the moment, but have taken the dog on three little walks. Just took my first dose of Eliquis. So much nicer to take pills than shots!

Absolutely! And Eliquis is so much easier to work with than the older alternative oral med.

Anticoagulation care is so amazingly standardized.....the protocols are set in stone, docs need only follow the rules.

So very different than surgeons and their non-standardized approach to .....well, just about everything.

Have you noticed that your chest pain has subsided? (Not that it necessarily should....just curious)

The scary part is, all pain disappeared BEFORE I saw my doctor or had my DDimer and CT scan. It must have just moved enough to let more air in or something. It only lasted 31 hours, then fine ever since. The CT report said "large pulmonary embolism involving right pulmonary artery extending into proximal upper lobar, interlobar, and lower lobar arteries."

Do you know why they might chose something like Eliquis over Xarelto? My Dad is on Xarelto. He's so stubborn, the once a day aspect of that is good for him.

When I read usual signs/symptoms of PE's I was pretty surprised. I think most patients have experiences more similar to yours....weirdness that was hard for them to put their finger on.

Eliquis and Xarelto have the same mechanism of action. Both drugs are relatively new and we don't know everything about them. They are in a battle for market share.

But, for now, Eliquis seems to have slightly less bleeding associated so that is the usual reason cited for preference.

But, effectiveness of both meds quickly diminishes if the patient forgets to take a dose so obviously this is twice as likely on Eliquis. At my clinic, we tend to prefer Xarelto for this reason unless the patient has a prior history of unusual bleeding.

(By the way, Xarelto is dosed twice daily for the first 21 days for PE but then drops to daily after that)

But honestly, the real reasons doctor chooses between 2 very similar drugs are:

1) habit

2) formulary (both hospital's and patient's insurance).

You are so helpful, thank you Shel!! I don't mind the twice a day thing as I already have to take my anti-thyroid meds twice, plus bariatric vitamins. I'm a pill popping machine...

The Eliquis ad makes me shake my head with the lady next to a motorcycle wearing biker garb talking about her PE. And at the bottom of the screen it says clearly she had to give up motorcycle riding because of the Eliquis.

Once I saw a woman wearing a helmet while hiking steep. I so dearly wanted to ask if she was on a blood thinner.

you know they nice thing about being at a healthy weight? You were eligible for all drug options. The new ones weren't approved above a certain weight when they first launched. (That might have changed over time. I will have to look that up sometime.)

I am sorry that the fire happened at all tho it seems to be under control now?

Somewhere, there is a manager that turned that dept of permitting into a true public service department. I love that efficiency was delivered with style and a smile. We must vote that person into office.