Day 2 & 3 brought a ton of visitors for Harper, and began to reinforce to us how special this little girl is to so many people. I won't recount all the names, as I'm sure I would forget someone, but it was a steady stream of friends and family, a ton of cards and gifts, and things to keep Harper occupied.
The end of Day 2 got interesting (as if we needed more excitement). The nurses kept checking and re-checking Harper's blood pressure. They didn't believe the results they were getting with the automated BP monitors. They even brought in the old fashioned manual ones to make sure the automated machine was accurate. Unfortunately, it was.
Her blood pressure was way up. One reading was 210/140. They called in a nephrologist (because the growth is on the kidney) who started administering intravenous meds to try to control her HP. Based upon the extremely high readings, and the multiple meds it was taking to bring it down, they decided to transfer us to the Pediatric Intensive Care Unit (PICU).
After moving, we came to realize just how lucky we were to be in the Oncology unit at Kosair. In the PICU we don't have a private room, and there is noise coming from everywhere. The nursing is more intensive, which is what we need, but that means they are in every hour, there are beeps and alarms, etc. Also, all we have is 1 convertible chair for both Melissa and I. Since we're now used to a King bed, this takes us back to College days...
There have been more needles since we go down to the PICU as well, which has not been fun. But, Harper is slowly adjusting. She is still fighting us, but she's getting braver, and her fight is more verbal - we don't have to lay on top of her and hold her down anymore. I hate holding her down.
The girl in the next bay has been pretty noisy too (understandable) and that has been freaking Harper out. The continual crying out and screaming is starting to wear her down. I think the little girl goes back to surgery today, which will at least offer Harper a short reprieve. Right now she has headphones in and is watching a movie to block out the noise.
We are this morning (Day 4) waiting for them to come get Harper and take her for her biopsy. We've been avoiding talking with her about the fact that they take tissue through a needle. Fortunately, she'll be under anesthesia, so she won't see, hear or remember anything.
We're expecting her to be away from us for something like 3 hours. It will be excruciating, but we are so anxious to know for sure what we're dealing with.
Monday, May 13, 2013
Sunday, May 12, 2013
Perspective
I imagine, as I've been tempted to do so myself over the last 48 hours, it would be very easy to feel very put upon, downtrodden and sorry for myself and our situation. And while I'm scared to death and have no clear picture what the future holds, I've come to have some perspective.
First, even though we're in the ICU, it could certainly be worse. On one side of us, in what appears to be a semi-permanent room, a boy, a few years older than Harper, sits, strapped into his bed, with braces all around his body and IV tubing everywhere. He may be paralyzed, or neurologically damaged. Harper, while drowsy and droopy from the BP meds, is alert, has full function of her body, and has even smiled a little today (when her school principle visited of all things :) ).
Second, the little girl on the other side of us in the ICU was in surgery most of the day (more than 8 hours), and returned back with a haggard looking family in tow and a head with rolled gauze that replaced the hair she left with. I imagine she underwent brain surgery. I have no idea her likelihood of a full recovery from whatever it is they were treating. Her family left just before 9pm, to try to reach the Ronald McDonald House in time to get a room for the night. We, on the other hand (at least the foreseeable future) have nothing quite so radical or invasive to fear, and we have been surrounded by an outpouring of love from family and friends from near and far. And, we have the opportunity to go home and get a shower and a brain break (and an emotional rest) in our home. What a blessing.
We have such wonderful and giving friends and family, who have already mobilized to provide meals, offer assistance at a moments notice, and just be available to talk. We have an incredible children's hospital that has been so warm, welcoming, and full of support since we arrived. We are so blessed, and we want to help make sure that others get the chance to receive blessings as well.
So, we have established a fundraising page, in Harper's honor (The Incredible Harps - credit to Tim Beam for that one) that benefits the Children's Hospital Foundation (supporting Kosair Children's Hospital). While we so appreciate any and all gifts to Harper to make her comfortable and entertained during this time, we also would appreciate any donation to the hospital that is hosting Harper's recovery journey.
Click Here to donate.
Thank you for everyone's love, support, prayers and encouragement.
First, even though we're in the ICU, it could certainly be worse. On one side of us, in what appears to be a semi-permanent room, a boy, a few years older than Harper, sits, strapped into his bed, with braces all around his body and IV tubing everywhere. He may be paralyzed, or neurologically damaged. Harper, while drowsy and droopy from the BP meds, is alert, has full function of her body, and has even smiled a little today (when her school principle visited of all things :) ).
Second, the little girl on the other side of us in the ICU was in surgery most of the day (more than 8 hours), and returned back with a haggard looking family in tow and a head with rolled gauze that replaced the hair she left with. I imagine she underwent brain surgery. I have no idea her likelihood of a full recovery from whatever it is they were treating. Her family left just before 9pm, to try to reach the Ronald McDonald House in time to get a room for the night. We, on the other hand (at least the foreseeable future) have nothing quite so radical or invasive to fear, and we have been surrounded by an outpouring of love from family and friends from near and far. And, we have the opportunity to go home and get a shower and a brain break (and an emotional rest) in our home. What a blessing.
We have such wonderful and giving friends and family, who have already mobilized to provide meals, offer assistance at a moments notice, and just be available to talk. We have an incredible children's hospital that has been so warm, welcoming, and full of support since we arrived. We are so blessed, and we want to help make sure that others get the chance to receive blessings as well.
So, we have established a fundraising page, in Harper's honor (The Incredible Harps - credit to Tim Beam for that one) that benefits the Children's Hospital Foundation (supporting Kosair Children's Hospital). While we so appreciate any and all gifts to Harper to make her comfortable and entertained during this time, we also would appreciate any donation to the hospital that is hosting Harper's recovery journey.
Click Here to donate.
Thank you for everyone's love, support, prayers and encouragement.
Hurry up and Wait (Day 1)
A common saying and reality from my days in the Army was "Hurry up and Wait." We were constantly moving very fast for a short period of time, followed by long stints of sitting and boredom. Our experience so far with Harper at the hospital is very similar.
After being told there was a "growth" on her kidney by the pediatrician, we moved quickly to get to the hospital. Once we arrived, we went through "Admit Express" which bypassed the ER. (Thank goodness). But there we sat for a couple of hours as we waited for someone "upstairs" to be discharged and the room to be cleaned. We were happy to wait for that... I've checked into a dirty hotel room before - I can only imagine a dirty hospital room.
While in admit express, they put in Harper's (first) IV catheter. Harper was lucky enough to inherit a healthy fear of needles from both sides of the family. In fact, when we first told her she was sick and needed to go to the hospital, her only worry was about needles. It hasn't changed much since...
So, her first IV was put in by a nurse who was incredible. She'd obviously been working with peds for a long time, and she was confident, commanding and gentle all at the same time. She talked Harper off the ledge several times, all while prepping the site and putting in the catheter. Harper took it quite well, and demonstrated her internal strength, as Melissa stood outside demonstrating the good genes she'd given that helped provide Harper with her needle anxiety.
Once the room was ready, we were shuttled up stair. Harper was actually pretty thrilled to ride in a wheelchair for the first time. (Something tells me she'll be pretty much over it by the time we get out of here). There was a flurry of activity as we settled into the room, met the nurses, the doctors rounded through, etc.
There was lots and lots going on, people in and out, but little information about what we should expect to happen next. My guess is that, well honestly, they didn't know. There was talk of surgery. Then discussion of a biopsy. We met at least 6 different doctors - surgical team, oncology team, etc. A central line? It all starts to blur a little. Maybe something over the weekend. More imaging studies? Something happening on Monday? (This was Friday night.)
The first night was rough. Not much sleep was had by anyone. As comfy as the waterproof convertible chair looked, it certainly didn't have the comfort of my bed at home. And the every hour or two wake up was reminiscent of having just brought a newborn home (but at least I wasn't changing diapers).
The first day brought choked tears, incredible anxiety, and exhaustion that was followed by little sleep. Lets hope the coming days are better. Lets hope it can only go up from here. Lets hope the days get better. I'm gonna hurry up and wait.
Middle Child Syndrome
Whether you believe Middle Child Syndrome exists or not really doesn't matter. What matters is that most middle children, including our Harper, believe it to be a real condition. Cadence is always first - first in line, fastest in a race, etc. Finley is the center of attention - because she makes it so. Harper often, I believe, feels a little left out.
Well, today, and for the past few days, she has taken center stage, and not for a reason she or any of us would like.
This Mother's Day morning (Happy Mother's Day to my mom, my step-mom and my beautiful wife, btw) we sit in the Critical Care Unit of Kosiar Children's Hospital in Louisville. Not where I had expected to be.
We've been here since Friday, after a CT scan ordered by our incredible pediatrician showed a mass on Harper's kidney. Further reads have shown several other masses in her liver and lungs as well. On top of that, her Blood Pressure has been elevated since we arrived (likely because of her kidney tumor) and was rising out of control. After some intravenous meds, we ended in in the Critical Care Unit.
I never imagined we would be here. Our kids are so healthy. They are active, and Harper is especially spunky. It's such a shock to see her here, quiet.
At this point, we have no definitive diagnosis. A biopsy that will occur (hopefully) tomorrow should shed some light on what we're dealing with and what we have in front of us.
I'm not ashamed to say it - I'm scared. We're surrounded by incredibly talented doctors and nurses, family coming and calling from everywhere, friends clambering to get in to visit - but I'm still scared. This is something I can't fix. I feel powerless. My beautiful daughter's life is in danger.
I've joked for years that we had 3 kids so we had spares. That comment feels so heartless now. Before they were here, I couldn't imagine life with kids. Now that they're here, I can't imagine a happy life without them.
Harper and I have had our moments. We're both a bit hard-headed. But she is one of the primary lights in my life. I would do anything to help her. Would give anything to save her.
There are so many unknowns and nothing to do, at this point but to pray and wait. And we're doing plenty of both.
Wednesday, June 27, 2012
Coming into turn 4
So, my period of mourning over the sad fate of my Maui Jims is done. Still sad, but I guess it's time to update here on how our trip is finishing out.
So, the biggest thing to say about Chincoteaque is that I was not sad to see it in the rear view mirror. After our donation of blood there, I was glad to be back on the road, headed towards Williamsburg.
The crossing of the Chesapeake Bridge-Tunnel was pretty uneventful. Excepting for very skinny lanes in the tunnels (there were two tunnels) and having to turn the propane off (resulting in less than frozen popsicles in the freezer) the crossing was easy. No traffic to speak of there. The idea of the bridge-tunnel is pretty cool, and made for some great views of the bay. Normal car toll is less, but our rig cost $20 to cross.
The roads through the Norfolk area were pretty rough. We were bouncing around from all the dips and bumps and Melissa was pretty freaked. It was so rough, in fact, that just a few miles from our campground near Williamsburg we were flagged down by a passing pickup, and told to stop and check our rear. Turns out we were inches from losing the bikes. The bouncing had knocked them loose. Lesson? I need to be more diligent in making sure the bikes are loaded and tied down well. We moved one bike to the back of the truck, tied down the rest, and were back on the road. Re-entering I-64 there was interesting, as traffic was heavier and it was a downhill grade. But, we finally caught a small break, and a few cars moved over for us as we merged in.
Turned out the KOA in Williamsburg had a Jumping Pillow, just like here in Niagara. I didn't jump this time, but Melissa did!
What was very different at Williamsburg from Niagara is that in Niagara, the spots were flat. The spot in Williamsburg was anything but. Not sure what the "grade" was, but it was steeper than we'd seen anywhere else. In fact, we ended up using all of our leveling blocks just to get the tongue high enough. With no leveling blocks left (and none for sale in the camp store) we ended up using stacked firewood under the jacks (our neighbor gave us the idea, as they'd done the same thing), and it STILL wasn't completely level. But, it was good enough.
There was a movie showing that night at the campground (Over The Hedge) and the campground had a nice outdoor theater, with stadium style seating (wooden benches), and a huge blow-up screen. All enjoyed it, and bedtime was quiet.
The next day, we ventured to Colonial Williamsburg where, since I had purchased tickets from the KOA, and they didn't ask the kids ages, I overpaid and paid for Fin when she should have been free. Next time, Melissa handles the tickets.
Williamsburg was neat, though it was quite warm. There were less "characters" roving about than we had expected. We had lunch at a tavern, and the food was good. Cadence and Finley had fried chicken strips and Harper had fried shrimp. Melissa had a roasted vegetable stuffed ravioli, and I had a chicken pot pie.
After a visit to the Apothecary, a tour of the Capital building, and the Gaol (thats how they spell jail), a storm hit. A big one. Things were blowing all over the place, branches were breaking out of trees, and Harper was screaming. So, of course, instead of seeking shelter, we walk through all that towards the visitors center where we parked the truck. We were soaked. Power was out at the visitors center (so couldn't buy postcards) and we had left the windows cracked (which we were wet from the rain anyways).
When we got back to the camper, luckily everything was ok. We were fearing there might be damage, especially to the awning, which we had left extended. Save a few limbs on the ground and no power at the campground for a couple hours, everything was fine.
That night we got to know the family in the spot next to us. They were from just outside NYC. They had a couple of kids similar in age to ours, so they got along great, and we sat around the fire and talked until after 11. They were nice and shared their beer. :)
The next day we headed towards The Natural Bridge in VA. This time, our lack of planning didn't work out as expected. We had made it so far through the trip without having any issue with campground availability, even without making any advance reservations. But, the KAO at The Natural Bridge didn't have any availability. So, when we stopped at a rest area, we looked up alternative campgrounds. Our friends from NY had said they were headed to a Jellystone in PA, so we found one nearby Natural Bridge and they had room. Turns out it also has a small water park, with a regular pool, a splash park and even water slides. They also have a jumping pillow and a mini-golf course. So, we spent the next day playing at the campground. Never did actually see the natural bridge, though we did visit the gift shop.
Tomorrow, we'll be heading towards Milford. Our journey will be just about over.
So, the biggest thing to say about Chincoteaque is that I was not sad to see it in the rear view mirror. After our donation of blood there, I was glad to be back on the road, headed towards Williamsburg.
The crossing of the Chesapeake Bridge-Tunnel was pretty uneventful. Excepting for very skinny lanes in the tunnels (there were two tunnels) and having to turn the propane off (resulting in less than frozen popsicles in the freezer) the crossing was easy. No traffic to speak of there. The idea of the bridge-tunnel is pretty cool, and made for some great views of the bay. Normal car toll is less, but our rig cost $20 to cross.
The roads through the Norfolk area were pretty rough. We were bouncing around from all the dips and bumps and Melissa was pretty freaked. It was so rough, in fact, that just a few miles from our campground near Williamsburg we were flagged down by a passing pickup, and told to stop and check our rear. Turns out we were inches from losing the bikes. The bouncing had knocked them loose. Lesson? I need to be more diligent in making sure the bikes are loaded and tied down well. We moved one bike to the back of the truck, tied down the rest, and were back on the road. Re-entering I-64 there was interesting, as traffic was heavier and it was a downhill grade. But, we finally caught a small break, and a few cars moved over for us as we merged in.
Turned out the KOA in Williamsburg had a Jumping Pillow, just like here in Niagara. I didn't jump this time, but Melissa did!
What was very different at Williamsburg from Niagara is that in Niagara, the spots were flat. The spot in Williamsburg was anything but. Not sure what the "grade" was, but it was steeper than we'd seen anywhere else. In fact, we ended up using all of our leveling blocks just to get the tongue high enough. With no leveling blocks left (and none for sale in the camp store) we ended up using stacked firewood under the jacks (our neighbor gave us the idea, as they'd done the same thing), and it STILL wasn't completely level. But, it was good enough.
There was a movie showing that night at the campground (Over The Hedge) and the campground had a nice outdoor theater, with stadium style seating (wooden benches), and a huge blow-up screen. All enjoyed it, and bedtime was quiet.
The next day, we ventured to Colonial Williamsburg where, since I had purchased tickets from the KOA, and they didn't ask the kids ages, I overpaid and paid for Fin when she should have been free. Next time, Melissa handles the tickets.
Williamsburg was neat, though it was quite warm. There were less "characters" roving about than we had expected. We had lunch at a tavern, and the food was good. Cadence and Finley had fried chicken strips and Harper had fried shrimp. Melissa had a roasted vegetable stuffed ravioli, and I had a chicken pot pie.
After a visit to the Apothecary, a tour of the Capital building, and the Gaol (thats how they spell jail), a storm hit. A big one. Things were blowing all over the place, branches were breaking out of trees, and Harper was screaming. So, of course, instead of seeking shelter, we walk through all that towards the visitors center where we parked the truck. We were soaked. Power was out at the visitors center (so couldn't buy postcards) and we had left the windows cracked (which we were wet from the rain anyways).
When we got back to the camper, luckily everything was ok. We were fearing there might be damage, especially to the awning, which we had left extended. Save a few limbs on the ground and no power at the campground for a couple hours, everything was fine.
That night we got to know the family in the spot next to us. They were from just outside NYC. They had a couple of kids similar in age to ours, so they got along great, and we sat around the fire and talked until after 11. They were nice and shared their beer. :)
The next day we headed towards The Natural Bridge in VA. This time, our lack of planning didn't work out as expected. We had made it so far through the trip without having any issue with campground availability, even without making any advance reservations. But, the KAO at The Natural Bridge didn't have any availability. So, when we stopped at a rest area, we looked up alternative campgrounds. Our friends from NY had said they were headed to a Jellystone in PA, so we found one nearby Natural Bridge and they had room. Turns out it also has a small water park, with a regular pool, a splash park and even water slides. They also have a jumping pillow and a mini-golf course. So, we spent the next day playing at the campground. Never did actually see the natural bridge, though we did visit the gift shop.
Tomorrow, we'll be heading towards Milford. Our journey will be just about over.
Monday, June 25, 2012
Tragedy
A beautiful morning. Coffee. Cereal. One more trip to the beach before packing up and heading to the next stop.
A bike ride through carnivorous mosquito-infested wildlife refuge. A kamikaze attack on the mosquito strong-hold (another story for another time).
A different beach. Secluded. No vehicle access. Almost deserted.
Waves. Bigger waves. Girls riding the waves in their life vests. I'm standing with them in the water. A good time.
Go deeper. Marine life at my feet. A rogue wave. (ok, maybe not a rogue wave, but bigger and caught me off guard)
I'm under. I'm up. Fun! Sure is bright out though. Shock. Realization.
Search in the water. Scrape the bottom. Another wave. Another.
They're gone. Search the surf. No use. Gone. Gone forever.
..........
Above is a description of how we lost a close family friend - my Maui Jim sunglasses. The victim of a ill-fated beach experience. May they rest in peace.
Saturday, June 23, 2012
The Birds
Have you ever seen the Hitchcock film The Birds? Remember the iconic scene that may, occasionally, visit you in your dreams, the sky black with wings? Well, that's Chincoteague.
Alright. So, it's not birds, per-se. But, the Mosquitos at Chincoteaugue are just about as thick, and can, I believe, strip your bones just like a large flock of carnivorous birds.
We started our day at the beach. It was a beautiful morning, and we got to the beach early. And fortunately Harper didn't go to the restroom before we left. I say fortunately, because as Melissa walked her to the restroom, they came upon a turtle laying eggs. Melissa came back and got the other two (and she let me tag along). We ended up seeing 3 different turtles laying eggs, covering them, and then scurrying back to the water. The stop at Chincoteague was worth it right there.
After the beach, we got some lunch (just sandwiches at the camper) and then headed out biking. We decided to bike a trail in the National Refuge Area. This was apparently a poor choice.
Not a poor choice because of the trail we chose, which was actually a nice, paved path, and had an overlook to the wild pony area. But, do you remember The Birds? Well, we will always remember The Mosquitos.
Imagine biblical swarms of locust, but Mosquitos. They. Were. Everywhere. They chased us. I think they may have even barked. We could have leashed a few.
After escaping with a few drops of blood left in our bodies, we got some dinner. Last night was Don's Seafood. Tonight we tried Bill's. It was a nicer restaurant, and the girls were pretty well behaved. They even tried oysters (fried and Rockefeller) and liked them!
We ended our evening with the first campfire of our trip.
Someone gave us the wood, so I felt obligated. Unfortunately, the Mosquitos get even more aggressive once the sun goes down.
Alright. So, it's not birds, per-se. But, the Mosquitos at Chincoteaugue are just about as thick, and can, I believe, strip your bones just like a large flock of carnivorous birds.
We started our day at the beach. It was a beautiful morning, and we got to the beach early. And fortunately Harper didn't go to the restroom before we left. I say fortunately, because as Melissa walked her to the restroom, they came upon a turtle laying eggs. Melissa came back and got the other two (and she let me tag along). We ended up seeing 3 different turtles laying eggs, covering them, and then scurrying back to the water. The stop at Chincoteague was worth it right there.
After the beach, we got some lunch (just sandwiches at the camper) and then headed out biking. We decided to bike a trail in the National Refuge Area. This was apparently a poor choice.
Not a poor choice because of the trail we chose, which was actually a nice, paved path, and had an overlook to the wild pony area. But, do you remember The Birds? Well, we will always remember The Mosquitos.
Imagine biblical swarms of locust, but Mosquitos. They. Were. Everywhere. They chased us. I think they may have even barked. We could have leashed a few.
After escaping with a few drops of blood left in our bodies, we got some dinner. Last night was Don's Seafood. Tonight we tried Bill's. It was a nicer restaurant, and the girls were pretty well behaved. They even tried oysters (fried and Rockefeller) and liked them!
We ended our evening with the first campfire of our trip.
Someone gave us the wood, so I felt obligated. Unfortunately, the Mosquitos get even more aggressive once the sun goes down.
Friday, June 22, 2012
Trying Something New
One of the big reasons for spending so much in diesel this summer for this crazy long summer adventurcation is to let our girls experience as many new, memorable experiences as possible. Niagara Falls. Hershey Park. Gettysburg. (so far)
Today we arrived in Chincoteague, VA. We expected the drive from Gettysburg to be brutal, since we were traveling through Baltimore, but it turned out to be pretty tame.
We checked into our campsite, which turned out to be a pretty nice one:
We then headed for a local seafood restaurant, Don's Seafood. Here's where the "experience" comes in. All three girls selected cab legs for dinner. Fortunately they had a kids portion (saved $). Now, I don't think any of them had had crab legs before, so this was new.
I was expecting at least one of them to say "yuck" once dinner was delivered, but I was pleasantly surprised. They liked them, and each cleaned their plate.
Now, we could have gotten crab legs at a Red Lobster anywhere, but they got to try them in a different town at a local restaurant. A neat experience (and they were pretty well behaved!).
We finished the day with another experience... We went out and scoped out the beach for tomorrow. Harper experienced the joy of sand in your shorts where it doesn't belong... Couldn't have happened to a better kid... :)
Today we arrived in Chincoteague, VA. We expected the drive from Gettysburg to be brutal, since we were traveling through Baltimore, but it turned out to be pretty tame.
We checked into our campsite, which turned out to be a pretty nice one:
We then headed for a local seafood restaurant, Don's Seafood. Here's where the "experience" comes in. All three girls selected cab legs for dinner. Fortunately they had a kids portion (saved $). Now, I don't think any of them had had crab legs before, so this was new.
I was expecting at least one of them to say "yuck" once dinner was delivered, but I was pleasantly surprised. They liked them, and each cleaned their plate.
Now, we could have gotten crab legs at a Red Lobster anywhere, but they got to try them in a different town at a local restaurant. A neat experience (and they were pretty well behaved!).
We finished the day with another experience... We went out and scoped out the beach for tomorrow. Harper experienced the joy of sand in your shorts where it doesn't belong... Couldn't have happened to a better kid... :)
Thursday, June 21, 2012
2 Day Update
Hershey having thoroughly exhausted the Wehneman clan yesterday, I failed to provide an update as to our adventures. So, this will be a double header.
Hershey Park was much better than I had expected. The park appears to be very well maintained, and the ride layout is excellent. Specifically, the small kid rides and big kid rides are intermixed, so that little ones (like Finley) have something to do nearby as their bigger siblings ride their rides.
Also, the rides are coded for very easy identification of what height is required to ride. And all the height groupings are named after Hershey candy (duh, of course). Cadence and Harper (Harper just barely) were Hershey Milk Chocolate Bars. Finley was a Hershey Kiss. Other groupings included Hershey Mini's (smaller than Fin), Reese's Peanut Butter Cups, Twizzlers and Jolly Ranchers.
A little surprising to me, the roller coasters were the favorite all around. Harper seemed to prefer the wooden ones, while Cadence preferred steel. Finley liked the one she was big enough to ride (we rode it 5 times I think).
I also got Cadence to go down a big waterside, The Whirlwind. We went down in a two-person tube.
We wrapped up the day with a visit to Hershey's Chocolate World (inside thankfully) which is a huge shrine to chocolate. I believe I gained 10 pounds and contracted diabetes on the tour. But, we did do something pretty cool. We did the "Create Your Own Candy Bar" experience, where we each designed and watched them make (via automated equipment) our own candy bar. The girls thought it was great.
Exhausted, we returned to the campground for a quick dip in the pool, followed by bed.
Melissa awoke this morning with a very sore and tight neck. Can't tell for sure if she hurt it at the park or just slept on it wrong. Probably a combination of both. It bothered her all day, and if I had to guess, will continue tomorrow.
We decided to alter our fairly loose plans, and instead of heading straight for Virginia, we went SW instead towards Gettysburg. I'd never been, and others told me they've enjoyed it.
It's actually a pretty short drive, so we arrived mid-day at the Gettysburg National Park visitors center. After checking out our options, we declined Harper's begging to go on a 3.5hr bus tour (costing us $80) and instead chose to purchase a 3-disc Auto Tour set which takes you on a tour of the battlefield. Likely just as long as the bus tour, but at our own pace and in our own vehicle.
We then figured out where we were going to stay the night. I made 3 calls to the campground which was our first pick, but kept getting voicemail. So, onto our next choice, who happened to have availability. We showed up 10 minutes later, picked out our spot (the one with trees, so we were NOT out in the open sun), and set up shop. I wisely shut my hand in the door of the truck as we began to unpack. I had to be hurt so Melissa isn't the only one getting sympathy.
After a quick lunch, it was off to the pool, where the girls swam, Harper getting back to actually swimming, which she can do, but often lacks the confidence. Finley was showing all sorts of confidence in her flotation device, falling backwards into the pool from the side.
After the pool, we headed out on our Auto Tour. First, Harper was crazed and non-cooperative. But she settled down when we reached a spot where a film crew was using a flying camera - it had a series of helicopter-like rotors on top of it and was radio controlled. It was pretty awesome, and I'm sorry I didn't get a picture of it.
Next Finley lost her mind at Little Round Top, where she refused to stay with us and kept running off.
Finally, as we neared the end, Cadence's bladder invaded her mind, and we finally quit, just 1 stop from the cemetery and the conclusion of the tour. If we can, we'll try to finish it tomorrow morning before heading out.
Not 10 minutes after returning to the camper, everyone is in bed, quiet and/or asleep. I'm about to join them.
Tomorrow, we embark on a challenging trip to the coast of Virginia to get our beach on. I'm (naively) hoping for sleeping in the truck. I'm (wisely I think) going to seek out a route that avoids Baltimore.
Hershey Park was much better than I had expected. The park appears to be very well maintained, and the ride layout is excellent. Specifically, the small kid rides and big kid rides are intermixed, so that little ones (like Finley) have something to do nearby as their bigger siblings ride their rides.
Also, the rides are coded for very easy identification of what height is required to ride. And all the height groupings are named after Hershey candy (duh, of course). Cadence and Harper (Harper just barely) were Hershey Milk Chocolate Bars. Finley was a Hershey Kiss. Other groupings included Hershey Mini's (smaller than Fin), Reese's Peanut Butter Cups, Twizzlers and Jolly Ranchers.
A little surprising to me, the roller coasters were the favorite all around. Harper seemed to prefer the wooden ones, while Cadence preferred steel. Finley liked the one she was big enough to ride (we rode it 5 times I think).
I also got Cadence to go down a big waterside, The Whirlwind. We went down in a two-person tube.
We wrapped up the day with a visit to Hershey's Chocolate World (inside thankfully) which is a huge shrine to chocolate. I believe I gained 10 pounds and contracted diabetes on the tour. But, we did do something pretty cool. We did the "Create Your Own Candy Bar" experience, where we each designed and watched them make (via automated equipment) our own candy bar. The girls thought it was great.
Exhausted, we returned to the campground for a quick dip in the pool, followed by bed.
Melissa awoke this morning with a very sore and tight neck. Can't tell for sure if she hurt it at the park or just slept on it wrong. Probably a combination of both. It bothered her all day, and if I had to guess, will continue tomorrow.
We decided to alter our fairly loose plans, and instead of heading straight for Virginia, we went SW instead towards Gettysburg. I'd never been, and others told me they've enjoyed it.
It's actually a pretty short drive, so we arrived mid-day at the Gettysburg National Park visitors center. After checking out our options, we declined Harper's begging to go on a 3.5hr bus tour (costing us $80) and instead chose to purchase a 3-disc Auto Tour set which takes you on a tour of the battlefield. Likely just as long as the bus tour, but at our own pace and in our own vehicle.
We then figured out where we were going to stay the night. I made 3 calls to the campground which was our first pick, but kept getting voicemail. So, onto our next choice, who happened to have availability. We showed up 10 minutes later, picked out our spot (the one with trees, so we were NOT out in the open sun), and set up shop. I wisely shut my hand in the door of the truck as we began to unpack. I had to be hurt so Melissa isn't the only one getting sympathy.
After a quick lunch, it was off to the pool, where the girls swam, Harper getting back to actually swimming, which she can do, but often lacks the confidence. Finley was showing all sorts of confidence in her flotation device, falling backwards into the pool from the side.
After the pool, we headed out on our Auto Tour. First, Harper was crazed and non-cooperative. But she settled down when we reached a spot where a film crew was using a flying camera - it had a series of helicopter-like rotors on top of it and was radio controlled. It was pretty awesome, and I'm sorry I didn't get a picture of it.
Next Finley lost her mind at Little Round Top, where she refused to stay with us and kept running off.
Finally, as we neared the end, Cadence's bladder invaded her mind, and we finally quit, just 1 stop from the cemetery and the conclusion of the tour. If we can, we'll try to finish it tomorrow morning before heading out.
Not 10 minutes after returning to the camper, everyone is in bed, quiet and/or asleep. I'm about to join them.
Tomorrow, we embark on a challenging trip to the coast of Virginia to get our beach on. I'm (naively) hoping for sleeping in the truck. I'm (wisely I think) going to seek out a route that avoids Baltimore.
Wednesday, June 20, 2012
Norfolk Southern is Following Us
At home, there is an active Norfolk Southern line that runs right down through Georgetown. I can honestly say you get used to it - the sounds doesn't bother me (or anyone else in the family) anymore. In fact, Finley still yells "Thomas" when she sees one.
Right next to the campground here at Hershey, there's an active train line. Guess who??? Norfolk Southern of course!
It appears we're being followed.
Today we're off to Hershey Park. We'll be waking the girls up shortly.
Pray for me... :)
Right next to the campground here at Hershey, there's an active train line. Guess who??? Norfolk Southern of course!
It appears we're being followed.
Today we're off to Hershey Park. We'll be waking the girls up shortly.
Pray for me... :)
Tuesday, June 19, 2012
Long Drive = Short Post
Drove from Niagara to Hershey today. Girls did quite well, though there was less napping than I would have preferred.
Biggest memory for today? Pennsylvania has a series of road sign encouraging good driving. They are bright yellow and say things like "Stay Alert." We laughed about them most of the way, because if you go more than 2 or 3 miles, you'll see them.
Tomorrow is Hershey Park. Wish us luck!
Biggest memory for today? Pennsylvania has a series of road sign encouraging good driving. They are bright yellow and say things like "Stay Alert." We laughed about them most of the way, because if you go more than 2 or 3 miles, you'll see them.
Tomorrow is Hershey Park. Wish us luck!
Niagara Take 2
Our second day in Niagara Falls started off pretty relaxing. After a night of heavy rain (could use some of that at home) we took the bikes off the rack and took a riding tour of the campground.
We came across a Jumping Pillow. I recall seeing these things online or on TV, but I'd never seen one in person or tried one. As I posted mid-day here, this thing was pretty cool. Seems like it would be a lot safer than a trampoline. I know everyone enjoyed it - even me as evidenced here.
After that workout (stiff today due to it, I think) we headed for some lunch. I enjoy local places, versus always frequenting the chain restaurants you know. We located a little sub shop called John's Pizza & Subs. The girls were a bit worked up, so we sat outside. Harper got wings (of course) and the stain on her shirt for the rest of the day attested to her approval.
While we're eating out a lot, we are still keeping the camper stocked with food for when we need it (snacks, meals on the road, etc.) which necessitated a stop at a local supermarket (the only one on Grand Island, apparently). Our errands done, we stopped quickly at the camper and then headed back to the Falls.
We began The Falls v2.0 at The Aquarium of Niagara. This was a tiny little aquarium (probably the smallest I've ever been to) but it was very nice. Well kept, and the we got there at an apparent lull, as we had no issue getting to and seeing all the exhibits. Things crowded up around 2:30 when the sea lion show started, which lasted about 10 minutes - but it was the quietest 10 minutes for Harper for the whole trip - she was amazed and loved it.
Upon exiting, we logged a Did Not Find geocache (too many muggles). For more info on THAT see one of my first blog posts here. After conceding defeat, we headed for Rainbow bridge.
So, traveling from New York into Canada at Niagara Falls is not what you would necessarily calls an "international" experience, but we DID cross an international border AND we got our passports stamped. So, we'll take it for what it's worth, and Cadence and Harper will be able to claim they were in Canada over the summer.
Several things we learned in Niagara Falls on the Canadian plan:
1. Parking at Niagara Park is VERY expensive. We paid $18 to park, versus $5 we saw later...
2. Clifton Hill (where a lot of the more commercial, touristy, Gatlinburg-ish stuff is) is a LONG walk from Niagara Park. And after paying $18 for parking, we weren't in a hurry to un-park. (we never made it to Clifton Hill on foot - btw)
3. IHOP at the Sheraton closes at 3pm on weekdays. This is, of course, after talking Hungry Harper (she's a different person when she's hungry) into pancakes. Uggh. We ate at an Italian place in the Sheraton. Why - because it was right there, and it was OPEN.
4. There is a geocache located very close to the top of the incline railway (which we rode) which got us our first international geocache!!! (here's a clue for those who geocache and might be there sometime)
Our Canadian adventure coming to an end, we headed back towards Rainbow bridge. The signage isn't all that good to get to the bridge, but due to that we DID get to drive up Clifton Hill, which showed Melissa I was NOT crazy, and there was a lot of stuff there, if we had just been able to keep going and get there...
Crossing back into the USA, we all (individually) recounted our country of citizenship to the border agent, told him 4 times we lived in Indiana, etc. Feeling safe and protected from dangerous Canadians, we headed back to the camper.
We came across a Jumping Pillow. I recall seeing these things online or on TV, but I'd never seen one in person or tried one. As I posted mid-day here, this thing was pretty cool. Seems like it would be a lot safer than a trampoline. I know everyone enjoyed it - even me as evidenced here.
After that workout (stiff today due to it, I think) we headed for some lunch. I enjoy local places, versus always frequenting the chain restaurants you know. We located a little sub shop called John's Pizza & Subs. The girls were a bit worked up, so we sat outside. Harper got wings (of course) and the stain on her shirt for the rest of the day attested to her approval.
While we're eating out a lot, we are still keeping the camper stocked with food for when we need it (snacks, meals on the road, etc.) which necessitated a stop at a local supermarket (the only one on Grand Island, apparently). Our errands done, we stopped quickly at the camper and then headed back to the Falls.
We began The Falls v2.0 at The Aquarium of Niagara. This was a tiny little aquarium (probably the smallest I've ever been to) but it was very nice. Well kept, and the we got there at an apparent lull, as we had no issue getting to and seeing all the exhibits. Things crowded up around 2:30 when the sea lion show started, which lasted about 10 minutes - but it was the quietest 10 minutes for Harper for the whole trip - she was amazed and loved it.
Upon exiting, we logged a Did Not Find geocache (too many muggles). For more info on THAT see one of my first blog posts here. After conceding defeat, we headed for Rainbow bridge.
So, traveling from New York into Canada at Niagara Falls is not what you would necessarily calls an "international" experience, but we DID cross an international border AND we got our passports stamped. So, we'll take it for what it's worth, and Cadence and Harper will be able to claim they were in Canada over the summer.
Several things we learned in Niagara Falls on the Canadian plan:
1. Parking at Niagara Park is VERY expensive. We paid $18 to park, versus $5 we saw later...
2. Clifton Hill (where a lot of the more commercial, touristy, Gatlinburg-ish stuff is) is a LONG walk from Niagara Park. And after paying $18 for parking, we weren't in a hurry to un-park. (we never made it to Clifton Hill on foot - btw)
3. IHOP at the Sheraton closes at 3pm on weekdays. This is, of course, after talking Hungry Harper (she's a different person when she's hungry) into pancakes. Uggh. We ate at an Italian place in the Sheraton. Why - because it was right there, and it was OPEN.
4. There is a geocache located very close to the top of the incline railway (which we rode) which got us our first international geocache!!! (here's a clue for those who geocache and might be there sometime)
Our Canadian adventure coming to an end, we headed back towards Rainbow bridge. The signage isn't all that good to get to the bridge, but due to that we DID get to drive up Clifton Hill, which showed Melissa I was NOT crazy, and there was a lot of stuff there, if we had just been able to keep going and get there...
Crossing back into the USA, we all (individually) recounted our country of citizenship to the border agent, told him 4 times we lived in Indiana, etc. Feeling safe and protected from dangerous Canadians, we headed back to the camper.
Monday, June 18, 2012
Sunday, June 17, 2012
A Physio-Electric Power Plant
After a day at Niagara Falls, it has become apparent to me that, while electricity is generated at Niagara Falls, it is not hydro-electric power, but physio-electric power. While the amount of energy contained within flowing water is substantial, the amount of energy released by tourists in the area is of a higher level of magnitude. I believe they extract it from you as you"tour."
I'm beat.
We began the day at the campground in Pennsylvania, on Lake Erie. Nice spot, really, and for $43 a night for a lake-front full hook up, a very good deal. I was up at the crack of dawn, and it took a couple hours for the rest of the brood to burrow out from under their blankets.
Coffee in our $9.24 Target coffee maker was passable. Not as good as Alan's at the farm, but better than the percolating pots we used to use camping. I love electrified campsites - if for no other reason than to have decent coffee in the morning.
We did a quick visit to the playground (3 swings and a slide), and then started to pack up to head out. That weather forecast that predicted dry weather? They were apparently smoking something of the fungicide family. It rained on us the whole time we were putting things away.
Finally on the road around 10:30, and we made decent time to Grand Island. We're staying at the Grand Island, NY KOA. We didn't get a premium spot, though. Next time I'm thinking we splurge. We're parked directly next to someone, and while it's ok, it would be nicer to have more room.
We set the camper in park (put down the jacks, put in the tire chock, hooked up water, electric and sewer) and then went to get some lunch. Harper needed it. You can always tell when Harper is hungry - because she becomes even MORE unreasonable.
We found a hot-dog shop. Now, I'm not the biggest fan of hot dogs, but we were just looking for something quick, relatively inexpensive, and nearby. Name was Theodore's Red Hots. It was very good. I had a foot long with chili, cheese and pickles. Finley had fries.
From there, we headed to Niagara Falls, and the extraction of energy began. It took some time to find a place to park. The nearby parking was full, so we ended up a few blocks away. Then we fought our way to where I THOUGHT we could buy Maid of the Mist tickets, only to find out that THAT spot only sells package deals at $70 a person. No thanks.
Found the Maid of the Mist ticket counter, and we were in luck. The ride on the Maid of the Mist was a blast. The girls loved it, and were pretty soaked, despite the ponchos. We took lots of pics, but they are on Melissa's camera. The iPad (thankfully) stayed dry in Melissa's purse under her poncho.
After the Maid, we did the "crows nest" that is right nearby there. You disembark from the Maid (USA side) and then walk towards the American Falls. You can then climb concrete steps into the mist. Well, let's call it a drenching.
So, now we're twice wet, and we started towards the Cave of the Winds area. Harper really wanted to go. We walked, and walked, and walked, and then we rested, before we walked, and walked some more. Finally arriving, we doled out nearly as much for the Cave as we did for the Maid.
One thing I will say for the Cave. You get some pretty nice shower shoes. One thing I can't say for the Cave - It's a Cave. Because it's not. It's a bunch of decks. Granted, you get pretty wet (with "free" water, by the way), but there is no cave. And this is not explained until a sign at the END of the walk. Apparently the cave collapsed in 1920. Hungry Harper (we're hours since our last meal by now) is not pleased. And since she can't see the cave (that no longer exists) she wants to go through AGAIN.
The promise of food finally draws her away from the (non)Cave (which has a TON of baby seagulls nesting on that rocky hillside, BTW) and we walk some more. TGI Fridays is seen in the distance (notice distance - not close) and we're off walking again.
Dinner was good. Children were crazy. Beer was needed and was ingested.
Back to the camper. Sleep is near (I hope). Another day down. And you can thank me for the electricity you are expending reading this post.
I'm beat.
We began the day at the campground in Pennsylvania, on Lake Erie. Nice spot, really, and for $43 a night for a lake-front full hook up, a very good deal. I was up at the crack of dawn, and it took a couple hours for the rest of the brood to burrow out from under their blankets.
Coffee in our $9.24 Target coffee maker was passable. Not as good as Alan's at the farm, but better than the percolating pots we used to use camping. I love electrified campsites - if for no other reason than to have decent coffee in the morning.
We did a quick visit to the playground (3 swings and a slide), and then started to pack up to head out. That weather forecast that predicted dry weather? They were apparently smoking something of the fungicide family. It rained on us the whole time we were putting things away.
Finally on the road around 10:30, and we made decent time to Grand Island. We're staying at the Grand Island, NY KOA. We didn't get a premium spot, though. Next time I'm thinking we splurge. We're parked directly next to someone, and while it's ok, it would be nicer to have more room.
We set the camper in park (put down the jacks, put in the tire chock, hooked up water, electric and sewer) and then went to get some lunch. Harper needed it. You can always tell when Harper is hungry - because she becomes even MORE unreasonable.
We found a hot-dog shop. Now, I'm not the biggest fan of hot dogs, but we were just looking for something quick, relatively inexpensive, and nearby. Name was Theodore's Red Hots. It was very good. I had a foot long with chili, cheese and pickles. Finley had fries.
From there, we headed to Niagara Falls, and the extraction of energy began. It took some time to find a place to park. The nearby parking was full, so we ended up a few blocks away. Then we fought our way to where I THOUGHT we could buy Maid of the Mist tickets, only to find out that THAT spot only sells package deals at $70 a person. No thanks.
Found the Maid of the Mist ticket counter, and we were in luck. The ride on the Maid of the Mist was a blast. The girls loved it, and were pretty soaked, despite the ponchos. We took lots of pics, but they are on Melissa's camera. The iPad (thankfully) stayed dry in Melissa's purse under her poncho.
After the Maid, we did the "crows nest" that is right nearby there. You disembark from the Maid (USA side) and then walk towards the American Falls. You can then climb concrete steps into the mist. Well, let's call it a drenching.
So, now we're twice wet, and we started towards the Cave of the Winds area. Harper really wanted to go. We walked, and walked, and walked, and then we rested, before we walked, and walked some more. Finally arriving, we doled out nearly as much for the Cave as we did for the Maid.
One thing I will say for the Cave. You get some pretty nice shower shoes. One thing I can't say for the Cave - It's a Cave. Because it's not. It's a bunch of decks. Granted, you get pretty wet (with "free" water, by the way), but there is no cave. And this is not explained until a sign at the END of the walk. Apparently the cave collapsed in 1920. Hungry Harper (we're hours since our last meal by now) is not pleased. And since she can't see the cave (that no longer exists) she wants to go through AGAIN.
The promise of food finally draws her away from the (non)Cave (which has a TON of baby seagulls nesting on that rocky hillside, BTW) and we walk some more. TGI Fridays is seen in the distance (notice distance - not close) and we're off walking again.
Dinner was good. Children were crazy. Beer was needed and was ingested.
Back to the camper. Sleep is near (I hope). Another day down. And you can thank me for the electricity you are expending reading this post.
Who needs a wake-up call?
When I was 12, I could sleep until noon. Or 1pm for that matter. Seems that has changed.
2 days into vacation - and my body/mind doesn't seem to know it yet. Between 5:30 and 6:00 my mind gets up. Day of the week, status of work/vacation etc. doesn't seem to phase it.
Perhaps it's age. Perhaps between the time I was 12 and now something physiologically changed that no longer allows me to sleep much past 6 (unless I was up until well after midnight the night before). Or, perhaps the realities of life weigh heavier on my mind (conscious and sub-conscious) than I realized.
While traveling cross country with 3 kids in a rig 50ft long doesn't sound relaxing to most, it IS my hope that on this trip I can find some time to relax.
Perhaps that time will be 6am.
2 days into vacation - and my body/mind doesn't seem to know it yet. Between 5:30 and 6:00 my mind gets up. Day of the week, status of work/vacation etc. doesn't seem to phase it.
Perhaps it's age. Perhaps between the time I was 12 and now something physiologically changed that no longer allows me to sleep much past 6 (unless I was up until well after midnight the night before). Or, perhaps the realities of life weigh heavier on my mind (conscious and sub-conscious) than I realized.
While traveling cross country with 3 kids in a rig 50ft long doesn't sound relaxing to most, it IS my hope that on this trip I can find some time to relax.
Perhaps that time will be 6am.
Saturday, June 16, 2012
Day 1 - Covington, Ohio to Erie, Pennsylvania
Surprisingly calm. That's the description of our first (and hopefully longest) day on the road. I hope all of our days go this smoothly.
We departed the farm at about 9:30am. Our dogs were sad to see us go. So was my uncle Alan, who will be watching the mutts during our extended adventure. While I'm sure Alan will miss us, I'm also pretty sure at least part of his emotions upon our departure were related to him having to deal with our animals...
We had planned to stop at a rest stop near Mansfield and make sandwiches for lunch. But as we approached, we saw a sign for Skyline. Knowing it was unlikely we would see another Skyline during our trip, we decided 4-ways was a better choice.
Now, most Skyline parking lots are not designed for big rigs, and my 50ft setup is pretty large. But, we did a drive-by and decided to chance it. In the end, we got our Skyline, and we left there staying on pavement the whole time.
Around 4 or so, we hit the Pennsylvania line. We stopped at the first rest stop, checked for geocaches, and none were listed close by. But, as we are learning, Cadence has an uncanny ability to find caches. In fact, as she walked toward the restrooms, she stopped and pulled a cache, apparently placed but not yet posted online, from a sign. We signed it (First to Find BEFORE even available!!!).
6 miles later we pulled off and headed towards a campground. Nice place actually. Without a reservation, we got a lakefront spot.
We checked in, setup, and headed for the "beach" which is more of a rocky shore. The girls got a good dose of Lake Erie water, without bathing suits, of course. Showers all around, and then movies. Thank goodness for TVs in our camper.
For 6+ hours in the truck on the road, it was a pretty good day. Tomorrow we'll check out of here and set off toward Niagara Falls.
We departed the farm at about 9:30am. Our dogs were sad to see us go. So was my uncle Alan, who will be watching the mutts during our extended adventure. While I'm sure Alan will miss us, I'm also pretty sure at least part of his emotions upon our departure were related to him having to deal with our animals...
We had planned to stop at a rest stop near Mansfield and make sandwiches for lunch. But as we approached, we saw a sign for Skyline. Knowing it was unlikely we would see another Skyline during our trip, we decided 4-ways was a better choice.
Now, most Skyline parking lots are not designed for big rigs, and my 50ft setup is pretty large. But, we did a drive-by and decided to chance it. In the end, we got our Skyline, and we left there staying on pavement the whole time.
Around 4 or so, we hit the Pennsylvania line. We stopped at the first rest stop, checked for geocaches, and none were listed close by. But, as we are learning, Cadence has an uncanny ability to find caches. In fact, as she walked toward the restrooms, she stopped and pulled a cache, apparently placed but not yet posted online, from a sign. We signed it (First to Find BEFORE even available!!!).
6 miles later we pulled off and headed towards a campground. Nice place actually. Without a reservation, we got a lakefront spot.
We checked in, setup, and headed for the "beach" which is more of a rocky shore. The girls got a good dose of Lake Erie water, without bathing suits, of course. Showers all around, and then movies. Thank goodness for TVs in our camper.
For 6+ hours in the truck on the road, it was a pretty good day. Tomorrow we'll check out of here and set off toward Niagara Falls.
Friday, June 15, 2012
Day 0.5
Started the day at a work function, which ended at approx. noon. Then, we were off. Re-packed the truck, waved goodbye to Milford and shot north for the farm, and our camper.
6 or so ours later, we're just about ready... for bed that is. Bikes are locked and loaded on the back.
Some food is in the fridge.
Clothes are put "away" (don't judge).
And, most importantly, the coffee maker is ready for the morning.
Tomorrow, we hook the wagon to the horses
and we'll be on the road. At least until someone has to pee.
6 or so ours later, we're just about ready... for bed that is. Bikes are locked and loaded on the back.
Some food is in the fridge.
Clothes are put "away" (don't judge).
And, most importantly, the coffee maker is ready for the morning.
Tomorrow, we hook the wagon to the horses
and we'll be on the road. At least until someone has to pee.
Thursday, June 14, 2012
Then, I Died
The vacation doesn't officially start until tomorrow afternoon, but this evening we drove from home to Cincinnati. We're staying with Melissa's parents for one night, with a work event in West Chester for me tomorrow, and then, we're off.
The drives on this "road trip" vacation could be very interesting in the cab of the truck, especially if Harper continues to tell her stories. Seems everything she tells a story (they were doing "dreams" at one point), it ends with "and then, I died."
Let's hope we all survive...
The drives on this "road trip" vacation could be very interesting in the cab of the truck, especially if Harper continues to tell her stories. Seems everything she tells a story (they were doing "dreams" at one point), it ends with "and then, I died."
Let's hope we all survive...
Wednesday, June 13, 2012
Let's get rotten luck out of the way
I'm hoping for good luck on our rather lengthy camping vacation. We don't need mechanical problems, overly hot, cold, or wet weather, poor navigation, road construction, etc... Of course it's inevitable that something will go wrong, but minor is better.
A few weeks ago, we finally bit the bullet and got Melissa some new tires. We'd put about 50k miles on her vehicle since we bought it at CarMax, and so her tires were pretty worn. There was slippage on wet roads and lots of squeaking on recently topped pavement. Finally one of them started to leak air - so we knew it was time.
It took me 3 stops to find a tire place with the right size (you wouldn't think that tires for a Ford Expedition would be hard to locate) - Sears didn't have them. Neither did Raben Tire. Finally found them at Ken Towery, and they only had 1 set (Cooper). Almost $1,000 later, I was headed home with 4 new tires and an alignment.
Today, flat tire. Come to find out there was a nail in the interior side wall of the passenger rear tire. And guess who DIDN'T buy the road hazard coverage for the new tires.... Uggh. Tire ruined - no plugging a hole in the side wall. So, another tire to buy...
Well, now we have road hazard on all of them, AND, instead of a buy 3, get the 4th free deal (which I DIDN'T get before) we are now sitting at a buy 5, get 4 tires deal. Plus, I've bought the road hazard (another $80).
Lets hope by buying the extra and insurance on those tires, I've satisfied our share of bad luck for awhile, and we can avoid any major issues on the road over the next 2.5 weeks. I guess we'll see.
A few weeks ago, we finally bit the bullet and got Melissa some new tires. We'd put about 50k miles on her vehicle since we bought it at CarMax, and so her tires were pretty worn. There was slippage on wet roads and lots of squeaking on recently topped pavement. Finally one of them started to leak air - so we knew it was time.
It took me 3 stops to find a tire place with the right size (you wouldn't think that tires for a Ford Expedition would be hard to locate) - Sears didn't have them. Neither did Raben Tire. Finally found them at Ken Towery, and they only had 1 set (Cooper). Almost $1,000 later, I was headed home with 4 new tires and an alignment.
Today, flat tire. Come to find out there was a nail in the interior side wall of the passenger rear tire. And guess who DIDN'T buy the road hazard coverage for the new tires.... Uggh. Tire ruined - no plugging a hole in the side wall. So, another tire to buy...
Well, now we have road hazard on all of them, AND, instead of a buy 3, get the 4th free deal (which I DIDN'T get before) we are now sitting at a buy 5, get 4 tires deal. Plus, I've bought the road hazard (another $80).
Lets hope by buying the extra and insurance on those tires, I've satisfied our share of bad luck for awhile, and we can avoid any major issues on the road over the next 2.5 weeks. I guess we'll see.
Sunday, June 10, 2012
4 Days and Counting
Our long awaited summer adventurcation will kick off in 4 short days. Much is already done and ready to go. But much is still to be done.
Today we've been discussing how much clothing to take. Its a foregone conclusion that we'll need to do laundry at some points, just a question of how much. The girls (especially Finley and Harper) tend to go through a lot of clothing if allowed. Now, we could take 2.5 weeks worth of clothing...
but I think we're looking at maybe a week's worth of clothes. Part of the reasoning is I'm not sure Melissa and I have much more than that (if we even have a week) in our wardrobes. Finley (being the youngest of three sisters) has what amounts to likely several months... With a week's worth we can stop and do laundry when convenient during each week. Smaller loads will be easier to deal with anyway.
Of course the most challenging thing I expect will be my patience with the girls while we're driving. The constant bickering, mixed with little girl screeches will be a true test for me personally. Distraction will be our number one weapon in that battle. Melissa has a list of games and activities she's been amassing... Let's hope they work.
Squirrel!!!
Today we've been discussing how much clothing to take. Its a foregone conclusion that we'll need to do laundry at some points, just a question of how much. The girls (especially Finley and Harper) tend to go through a lot of clothing if allowed. Now, we could take 2.5 weeks worth of clothing...
but I think we're looking at maybe a week's worth of clothes. Part of the reasoning is I'm not sure Melissa and I have much more than that (if we even have a week) in our wardrobes. Finley (being the youngest of three sisters) has what amounts to likely several months... With a week's worth we can stop and do laundry when convenient during each week. Smaller loads will be easier to deal with anyway.
Of course the most challenging thing I expect will be my patience with the girls while we're driving. The constant bickering, mixed with little girl screeches will be a true test for me personally. Distraction will be our number one weapon in that battle. Melissa has a list of games and activities she's been amassing... Let's hope they work.
Squirrel!!!
Saturday, June 9, 2012
A Summer Vacation Adventure
I haven't posted a blog post for quite some time. I could blame it on work... But really LIFE has gotten in the way.
In less than a week, our family will be embarking on what may prove to be an exhilarating or, alternatively, a disastrous experience. We will be hooking the camper (2011 Jayco JayFlight 2 32BHDS)
to my truck (2005 F250 Lariat CrewCab with 6.0L Powerstroke Diesel)
And hitting the great American "road." No reservations, just a directional plan. No timetable. We'll be going where the wind blows, so to speak.
While we've had the camper for a little over a year, it has spent all of its life at our family's farm, and has not, as of yet, ventured out on such an experience. Likewise, my experience pulling the beast (a little over 36 feet long including tongue, plus we'll be extending the bike rack off the back. Adding another 3 feet or so) is limited to moving it around on the farm and moving it from the dealership to the farm initially (quite an ordeal, which I may share someday).
So, the pulling of the camper itself will be an adventure. But, on top of that, we expect we will be spending hours in the truck cab (group of 5 - Melissa and I in the front, with all 3 girls in the back seat) driving. This will be our first trip of more than about 4 hours in the truck. It could be fun! (uh huh...)
But, the loose plan we do have should take us to some good spots for the girls. We're considering Niagara Falls, Hershey, PA, Chincoteague, VA, and Colonial Williamsburg, VA. In fact, we amassed that list of destinations based upon trying to include something for everyone. Cadence asked for a roller coaster (Hershey), Harper asked for a beach (Chincoteague), and Finley went back and forth copying them (she couldn't decide, apparently). Melissa has wanted to go to Colonial Williamsburg for some time, and I have been to Niagara Falls, but it has been some time, and I thought the girls would get a kick out of a ride on The Maid of the Mist (which I have never actually gotten to do).
If I can keep to it, I plan to try to log our "Adventures" here for others to share. These may include posts about enjoyable family experiences, or rants about excruciating disasters. Time will tell.
The good thing is, with no formal reservations, we can always just turn the rig around, and head home. But, we've been looking forward to this trip for some time, so I suspect we will keep to it, and enjoy it no matter what happens.
Wish us luck!
In less than a week, our family will be embarking on what may prove to be an exhilarating or, alternatively, a disastrous experience. We will be hooking the camper (2011 Jayco JayFlight 2 32BHDS)
to my truck (2005 F250 Lariat CrewCab with 6.0L Powerstroke Diesel)
And hitting the great American "road." No reservations, just a directional plan. No timetable. We'll be going where the wind blows, so to speak.
While we've had the camper for a little over a year, it has spent all of its life at our family's farm, and has not, as of yet, ventured out on such an experience. Likewise, my experience pulling the beast (a little over 36 feet long including tongue, plus we'll be extending the bike rack off the back. Adding another 3 feet or so) is limited to moving it around on the farm and moving it from the dealership to the farm initially (quite an ordeal, which I may share someday).
So, the pulling of the camper itself will be an adventure. But, on top of that, we expect we will be spending hours in the truck cab (group of 5 - Melissa and I in the front, with all 3 girls in the back seat) driving. This will be our first trip of more than about 4 hours in the truck. It could be fun! (uh huh...)
But, the loose plan we do have should take us to some good spots for the girls. We're considering Niagara Falls, Hershey, PA, Chincoteague, VA, and Colonial Williamsburg, VA. In fact, we amassed that list of destinations based upon trying to include something for everyone. Cadence asked for a roller coaster (Hershey), Harper asked for a beach (Chincoteague), and Finley went back and forth copying them (she couldn't decide, apparently). Melissa has wanted to go to Colonial Williamsburg for some time, and I have been to Niagara Falls, but it has been some time, and I thought the girls would get a kick out of a ride on The Maid of the Mist (which I have never actually gotten to do).
If I can keep to it, I plan to try to log our "Adventures" here for others to share. These may include posts about enjoyable family experiences, or rants about excruciating disasters. Time will tell.
The good thing is, with no formal reservations, we can always just turn the rig around, and head home. But, we've been looking forward to this trip for some time, so I suspect we will keep to it, and enjoy it no matter what happens.
Wish us luck!
Saturday, January 14, 2012
Sherman's Bridge
Anyone living in the Kentuckiana area (common naming for the greater Louisville, KY area, which includes a portion of Southern Indiana) has, since September 9, 2011, been experiencing the pain generated by the closure of the Sherman Minton Bridge. I could likely go on for hours about the pains of slamming all Interstate 64 traffic into an already often-times "full-to-the-brim" Interstate 65, but I will avoid that whining at this point. (though I will be INCREDIBLY thrilled when the bridge re-opens and life on I-64 can return to normal)
After months of avoiding a bridge that could, potentially, drop into the Ohio at any point, I've come to wonder who Sherman Minton was, to have had a major interstate bridge named after him (though I would argue not a very pretty bridge - not only is it apparently not safe, but it is in major need of a coat of paint)
Turns out, Sherman Minton was born in Georgetown, Indiana (shout out for the current hometown), was educated at Indiana University and Yale, was a US Senator, and went on to serve as a Federal Judge and then Justice on the Supreme Court, appointed by Harry Truman.
It's sad that someone with such an amazing career of accomplishments, would be (currently) associated with such a negative local event, because his name is on the bridge that is causing so many headaches. But, on the other hand, without his name on that bridge, most people likely would never even utter his name.
So, thank you, Sherman, for your contributions. And thank you (in advance), Hall Contracting, for finishing it EARLY!!!
Interesting fact. The bridge cost $14.8M to build in the late 50's and early 60s. It is costing an estimated $13.9M to fix it in 2011 and 2012. The $14.8M got us 50 years. The $13.9M is estimated to give us another 20. Money doesn't go as far as it used to...
After months of avoiding a bridge that could, potentially, drop into the Ohio at any point, I've come to wonder who Sherman Minton was, to have had a major interstate bridge named after him (though I would argue not a very pretty bridge - not only is it apparently not safe, but it is in major need of a coat of paint)
Turns out, Sherman Minton was born in Georgetown, Indiana (shout out for the current hometown), was educated at Indiana University and Yale, was a US Senator, and went on to serve as a Federal Judge and then Justice on the Supreme Court, appointed by Harry Truman.
It's sad that someone with such an amazing career of accomplishments, would be (currently) associated with such a negative local event, because his name is on the bridge that is causing so many headaches. But, on the other hand, without his name on that bridge, most people likely would never even utter his name.
So, thank you, Sherman, for your contributions. And thank you (in advance), Hall Contracting, for finishing it EARLY!!!
Interesting fact. The bridge cost $14.8M to build in the late 50's and early 60s. It is costing an estimated $13.9M to fix it in 2011 and 2012. The $14.8M got us 50 years. The $13.9M is estimated to give us another 20. Money doesn't go as far as it used to...
Been Awhile
It's been some time since I posted a new blog entry. Realistically, the demands of career and family have been prioritized over writing, which should come as no surprise.
I don't want to publish one of those "here's what's happened to us over the past year" christmas newsletters, so I won't.
But, I guess you could say I'm going to TRY to be back. We'll see how this goes.
I don't want to publish one of those "here's what's happened to us over the past year" christmas newsletters, so I won't.
But, I guess you could say I'm going to TRY to be back. We'll see how this goes.
Sunday, June 5, 2011
Why We Will Never Own A Pool
Yesterday I had what I believe was the scariest experiences of my life. Now, I've not seen what some have, but I'm pretty well rounded. I've rushed my bleeding children for medical care, I've had moments when I thought I had driven my beautiful now-wife away from me for good, and I've had to sign commitment papers for someone I love against their will. However, yesterday I experienced something that still today, after the adrenaline is gone, and I've had a night's sleep, is continuing to make my hands shake and my eyes tear (involuntarily) when I think about it.
The whole clan was over at another family's house. They have 3 kids as well, and they have a pool. We had swam a couple of hours earlier, and then had dinner. All the kids wanted to go swimming again after dinner, and I went out with them. (they range in ages from 2 to 7)
Another neighbor kid also ran over, so there were 7 kids total. Now, my kids do pretty well in the water. Spawn 1 (7) can swim without any assistance, and she loves the water. Spawn 2 (6) can swim as well, but she still often prefers a set of water wings. Spawn 3 (3) wears a vest. Friends' kids can't swim; the older 2 wear swim vests, with their youngest sitting in a float raft.
Friends' kid 2 didn't really want to swim after dinner, so he went to the swings. Friends' kid 3 was floating in his raft, but wanted out of the pool. He floated to the edge, and I proceed to pull him out and extricate him from his raft.
While I did this, friends' kid 2 apparently came over to the pool and, without me seeing him, fell in. He was not wearing his floatie vest, as he (and I) had not planned on him swimming.
My kids are screachers (girls...), so sometimes its hard to tell if they're happy, upset, hurt, etc. (as all the screaches sound pretty similar). Also, Spawn 3 is just really starting to talk well, and so our Spawn 1's name and their kid 2's names are "similar".
I heard Spawn 3 yelling what sounded like Spawn 1's name. I didn't think much of it, as Spawn 1 may have been splashing her, or something of that nature. However, being the father I am, I looked over to see what "torture" was befalling my youngest at the hands of my oldest, so I could yell at Spawn 1... (I do it more than I should)
What I saw was not what I expected. Spawn 3 was reaching into the water, holding onto friends' kid 2, who was struggling underwater - completely underwater - head and all. My heart stopped.
I jumped in (shoes, phone, wallet and all) and pulled him up. I delivered him to the side, where he crawled away from the pool.
He must have not been under long, as he was alert, breathing and just cried. I pulled myself from the water just as the other adults began filing outside. They looked at my oddly.
I think it was all more of an ordeal for me, as friends' kid 2 got back in the pool (with his vest) 30 minutes later.
So, my wallet is drying, and my phone is in rice (it's a company phone - so I'm hoping it isn't damaged). I was okay yesterday, once my heart stopped pounding. But today, my hands are shaky, and I can't stop thinking about it.
And so, even though everything turned out okay, we are NEVER gettting a pool.
The whole clan was over at another family's house. They have 3 kids as well, and they have a pool. We had swam a couple of hours earlier, and then had dinner. All the kids wanted to go swimming again after dinner, and I went out with them. (they range in ages from 2 to 7)
Another neighbor kid also ran over, so there were 7 kids total. Now, my kids do pretty well in the water. Spawn 1 (7) can swim without any assistance, and she loves the water. Spawn 2 (6) can swim as well, but she still often prefers a set of water wings. Spawn 3 (3) wears a vest. Friends' kids can't swim; the older 2 wear swim vests, with their youngest sitting in a float raft.
Friends' kid 2 didn't really want to swim after dinner, so he went to the swings. Friends' kid 3 was floating in his raft, but wanted out of the pool. He floated to the edge, and I proceed to pull him out and extricate him from his raft.
While I did this, friends' kid 2 apparently came over to the pool and, without me seeing him, fell in. He was not wearing his floatie vest, as he (and I) had not planned on him swimming.
My kids are screachers (girls...), so sometimes its hard to tell if they're happy, upset, hurt, etc. (as all the screaches sound pretty similar). Also, Spawn 3 is just really starting to talk well, and so our Spawn 1's name and their kid 2's names are "similar".
I heard Spawn 3 yelling what sounded like Spawn 1's name. I didn't think much of it, as Spawn 1 may have been splashing her, or something of that nature. However, being the father I am, I looked over to see what "torture" was befalling my youngest at the hands of my oldest, so I could yell at Spawn 1... (I do it more than I should)
What I saw was not what I expected. Spawn 3 was reaching into the water, holding onto friends' kid 2, who was struggling underwater - completely underwater - head and all. My heart stopped.
I jumped in (shoes, phone, wallet and all) and pulled him up. I delivered him to the side, where he crawled away from the pool.
He must have not been under long, as he was alert, breathing and just cried. I pulled myself from the water just as the other adults began filing outside. They looked at my oddly.
I think it was all more of an ordeal for me, as friends' kid 2 got back in the pool (with his vest) 30 minutes later.
So, my wallet is drying, and my phone is in rice (it's a company phone - so I'm hoping it isn't damaged). I was okay yesterday, once my heart stopped pounding. But today, my hands are shaky, and I can't stop thinking about it.
And so, even though everything turned out okay, we are NEVER gettting a pool.
Wednesday, January 19, 2011
Health Care Reform Treating Symptoms But Repeal Unlikely
Today the Republican-controlled House of Representatives passed a measure, widely considered symbolic, repealing the health care reform bill enacted by the previous Congress and signed into law by President Obama. There is little chance the Democratic-controlled Senate will bring the measure to the floor for debate, let alone a vote. Beyond that, there is even less chance that President Obama would sign a repeal of his signature domestic achievement. He would almost certainly veto such an effort if it would reach his desk.
There was much public debate regarding the bill which will not soon be forgotten. The main focus of the proponents of the healthcare reform bill was to attempt to build public support through the demonizing of the insurance industry, mostly with a focus on pre-existing condition exclusions. It was an interesting situation, where on one hand Democrats told of the "evils" of the insurance industry, while on the other hand pushed for the expansion of insurance to more Americans. Secondary to expanded coverage was the idea of cost controls, though much more muted than the outspoken attacks upon commercial insurers.
The Obama Administration and Congressional Democrats continue to extole the virtues of the law. Even yesterday, in advance of the House vote on repeal, Health and Human Services (HHS) released a report that claims up to 129 million Americans are threatened by repeal of the health care reform law's protections against denials of coverage for pre-existing conditions. It's an interesting report, but is clearly partisan in its authors' bias and should be considered thinly veiled propaganda.
What has unfortunately been lost in all the hoopla is the really necessary change to the health care landscape in America. (Yes, I DO mean health care, not health insurance) Health insurance and the associated socially distasteful practices that Democrats "fixed" are merely symptoms, and the fixes leave the root issue (the underlying pre-existing condition) untreated.
The root issue in health care in the United States today is cost. Overall cost, driven by a great many things, including increased utilization of new and continuously improving technology (which is *shock* expensive when new and novel), increases in the diagnosis of previously not understood or rarely recognized conditions, impacts of social/cultural choices (super size my fries please...), and the embedded cost of care for those without means to pay (which is spread across the remaining payers in the system), includes to rise, and eat up more and more of the country's GDP. It's unsustainable to continue to grow health care expense faster than the growth of GDP.
But the health care reform law did little to curb the overall growing expense. In fact, the expansion of coverage (especially Medicaid-like coverage which is generous in comparison to most private coverage) will potentially grow health care costs, by encouraging utilization. And the American taxpayer will foot the bill.
Insurance practices such as pre-existing condition exclusions (there are many less well known approaches) are a reaction by insurers as well as employer clients to the incredible, and unsustainable increases in overall medical expenses related to care. It's actually a natural, business-based reaction. It's not friendly, but it is good business.
Insurance companies make money by insuring people. If you fix the underlying issue of cost escalation, and prices/premiums are allowed to normalize, you would likely see the insurance industry focus on efforts to further increase enrollments, covering more people, not less. In the end, addressing costs (disease) versus industry practices (symptoms) would likely be much more efficient, allowing the symptoms to improve or resolve on their own.
There was much public debate regarding the bill which will not soon be forgotten. The main focus of the proponents of the healthcare reform bill was to attempt to build public support through the demonizing of the insurance industry, mostly with a focus on pre-existing condition exclusions. It was an interesting situation, where on one hand Democrats told of the "evils" of the insurance industry, while on the other hand pushed for the expansion of insurance to more Americans. Secondary to expanded coverage was the idea of cost controls, though much more muted than the outspoken attacks upon commercial insurers.
The Obama Administration and Congressional Democrats continue to extole the virtues of the law. Even yesterday, in advance of the House vote on repeal, Health and Human Services (HHS) released a report that claims up to 129 million Americans are threatened by repeal of the health care reform law's protections against denials of coverage for pre-existing conditions. It's an interesting report, but is clearly partisan in its authors' bias and should be considered thinly veiled propaganda.
What has unfortunately been lost in all the hoopla is the really necessary change to the health care landscape in America. (Yes, I DO mean health care, not health insurance) Health insurance and the associated socially distasteful practices that Democrats "fixed" are merely symptoms, and the fixes leave the root issue (the underlying pre-existing condition) untreated.
The root issue in health care in the United States today is cost. Overall cost, driven by a great many things, including increased utilization of new and continuously improving technology (which is *shock* expensive when new and novel), increases in the diagnosis of previously not understood or rarely recognized conditions, impacts of social/cultural choices (super size my fries please...), and the embedded cost of care for those without means to pay (which is spread across the remaining payers in the system), includes to rise, and eat up more and more of the country's GDP. It's unsustainable to continue to grow health care expense faster than the growth of GDP.
But the health care reform law did little to curb the overall growing expense. In fact, the expansion of coverage (especially Medicaid-like coverage which is generous in comparison to most private coverage) will potentially grow health care costs, by encouraging utilization. And the American taxpayer will foot the bill.
Insurance practices such as pre-existing condition exclusions (there are many less well known approaches) are a reaction by insurers as well as employer clients to the incredible, and unsustainable increases in overall medical expenses related to care. It's actually a natural, business-based reaction. It's not friendly, but it is good business.
Insurance companies make money by insuring people. If you fix the underlying issue of cost escalation, and prices/premiums are allowed to normalize, you would likely see the insurance industry focus on efforts to further increase enrollments, covering more people, not less. In the end, addressing costs (disease) versus industry practices (symptoms) would likely be much more efficient, allowing the symptoms to improve or resolve on their own.
Saturday, January 8, 2011
Verizon iSomething
The Wall Street Journal has predicted that a Verizon iPhone will be announced Tuesday Jan 11th. Invitations have been distributed to the media for an event to be held in New York, with no specific information divulging the specifics of what will be announced. Additionally, there have been reports of vacation bans at both Verizon and Apple retail stores that overlap. Hmmm...
The idea of a Verizon iPhone is new to no-one, and many have for years dreamed of the day of holding an iPhone free of chains from the AT&T network. That day may be at hand.
However, there's also been lots of recent talk and rumors about the release of a second generation iPad, which is also expected in the very near future. Some have predicted a release in April 2011, fitting with Apple's tendency to refresh products with annual timing (iPad originally went on sale in April 2010).
So, while WSJ reporting is likely accurate, I've got a more selfish hope for Tuesday. Perhaps Verizon will, instead of announcing an iPhone (which will undoubtedly happen at some point) on the Verizon network, will instead announce the second generation iPad, with exclusive US wireless broadband service on the Verizon network.
Personally, I never invested in the original iPad - timing of excess available cash mostly. But, with the impending release of iPad 2, I'm getting close. Additionally, I'd rather put my monthly $$ into data for an iPad than service for an iPhone.
So, WSJ's reporting may be absolutely accurate, but I'm still hoping for a Verizon-exclusive iPad 2. Even if I'm wrong, it sure will be fun to watch the mass exodus from AT&T once Verizon has the iPhone.
The idea of a Verizon iPhone is new to no-one, and many have for years dreamed of the day of holding an iPhone free of chains from the AT&T network. That day may be at hand.
However, there's also been lots of recent talk and rumors about the release of a second generation iPad, which is also expected in the very near future. Some have predicted a release in April 2011, fitting with Apple's tendency to refresh products with annual timing (iPad originally went on sale in April 2010).
So, while WSJ reporting is likely accurate, I've got a more selfish hope for Tuesday. Perhaps Verizon will, instead of announcing an iPhone (which will undoubtedly happen at some point) on the Verizon network, will instead announce the second generation iPad, with exclusive US wireless broadband service on the Verizon network.
Personally, I never invested in the original iPad - timing of excess available cash mostly. But, with the impending release of iPad 2, I'm getting close. Additionally, I'd rather put my monthly $$ into data for an iPad than service for an iPhone.
So, WSJ's reporting may be absolutely accurate, but I'm still hoping for a Verizon-exclusive iPad 2. Even if I'm wrong, it sure will be fun to watch the mass exodus from AT&T once Verizon has the iPhone.
Wednesday, January 5, 2011
Could Andrew Wakefield Lose Any More Credibility?
Anti-vaccine activists have been dealt another blow. Reported worldwide today is the news that the 1998 study, published by a group of authors led by Andrew Wakefield, originally published and last year retracted by the British medical journal Lancet, was based upon falsified data. It seems some of the subjects of the study, reported to be normal prior to their dose of MMR vaccine, had in fact shown signs of developmental problems prior to the vaccine.
Scores of other studies have found no link between vaccines and autism, though the outcome of those studies and the complete discrediting of the Wakefield study will likely not sway those that strongly believe autism and vaccinations are linked. Most of these people are driven to and keep their position out of fear. Fear is an extremely strong emotion, and fear for the safety of one's child is especially strong, in many cases stronger than a parent's own self-preservation instincts. Undoubtedly some parents already on the anti-vaccine path will not be moved to change their perspective, even when all potential evidence to support their fears is gone.
The fact is that vaccinations, after clean water, are one of the most impactful cultural and/or scientific developments to decrease mortality. Vaccines can ERADICATE diseases that would otherwise kill or maim scores of people, many of which are children. To deprive a child of potentially life SAVING preventative treatment is more scary in my mind than any vaccine.
Kids get vaccinations. Some kids (for some reason yet to be explained and incredibly unlikely to be vaccinations) are stricken with autism. Vaccines don't cause autism, just like high school doesn't cause pimples. Just because they happen at the same point in life, doesn't mean there is a causal relationship.
Monday, January 3, 2011
CVS to buy UAM - Good for Investors - Bad for RPh
Universal American (UAM) has announced that it will sell it's Medicare Part D business to CVS/Caremark (CVS) for $1.25 billion. It was just a few short years ago (2007) that UAM announced the acquisition of MemberHealth, a PBM that experienced significant success with the launch of Medicare Part D in 2006 with a retail-only Part D plan (CCRx). UAM paid only $630 million for MemberHealth on 2007, so it will turn a nice profit on a short 3 year investment.
Private equity firms actually helped finance the purchase of MemberHealth in 2007, so the return here for them is pretty quick, and substantial. Stock holders of UAM will receive about $13 a share in cash (stock was trading at just north of this amount before the announcement) plus 1 share of a new UAM stock, which will represent the remainder of the business (Medicare Advantage and traditional insurance). So, investors get to "cash out" on the stock, and get another set of shares, which will be in a company with no debt.
There are a few things to consider. The sale comes almost exactly a month after a CMS mandated suspension of marketing for UAM. Not a good thing to say the least. In fact, UAM was prevented from enrolling new members for almost half the Part D selling season for the 2011 plan year. There are undoubtedly major things wrong with the management of the Part C and D businesses for this to occur - likely compliance in nature. So, with compliance issues apparent and ongoing, CVS is buying damaged goods of sorts, paying a little more than $650 a head for the membership. I don't know what the annual "value" of a Part D member/life is on average, so hard to say if it's a discounted buy or not, but this added membership more than doubles CVS/Caremark's Part D business (currently about 1.2 million lives - UAM represents about 1.9 million lives), which they have struggled to grow like I'm sure they wanted to. In the end, good for both parties. CVS grows (taking eyes off, momentarily, the lack of synergies shown in the CVS/Caremark merger of a few years ago) and UAM gets rid of some of their CMS compliance issues.
But, don't forget UAM has the Medicare Advantage (MA) business as well. In fact, they have somewhere in the neighborhood of 240,000 MA members, and this business is also under the shadow of a "do not sell" restriction from CMS. What will become of this part of UAM? According to the news releases, this business will be part of the new UAM. More likely? I'd guess UAM will sell this business as well, once it finds the right buyer. The MA space is being squeezed by premium cuts mandated by healthcare reform, and consolidation is inevitable, expected to accelerate considerably in 2011. With plans flush with cash likely looking to buy membership (scale will help ensure profitability), and UAM management struggling under CMS scrutiny, a sale seems a likely outcome.
While UAM had other Part D plans, the majority of the membership on it's way to CVS is in the CCRx plan. This plan is unique (and popular with community pharmacists) due to the fact that is contains no mail-order benefit. CCRx was arguably successful due to the understandable, yet not quite allowable preference community pharmacist have for the CCRx plans. Community pharmacists have for years been fighting the growth of mail-order pharmacies, and the CCRx plan capitalized on this embedded marketing of sorts. Though pharmacists are not technically supposed to "steer" patients to one plan or another, it's easy to see that pharmacists would like the idea of not fighting mail order to keep their patients... and thus the success of CCRx. Combine that with the fact that CCRx also leveraged their pharmacist network for Medication Therapy Management (MTM) services, where other plans may use call centers of company-employed nurses or pharmacists, and you get a double-whammy of preference.
The 2011 Part D plan year benefits are not really modifiable at this point, and the CVS/UAM management will likely keep the ship steady-as-she-goes for 2011. However, I can see major changes on the horizon for 2012 - or at least whatever changes CVS thinks they can get away with and not piss-off the membership directly. What will be changed is obviously a guess at this point, but I would suspect a close review and possible modification to the CCRx stances on mail-order and MTM, both of which are counter to CVS/Caremark culture. This will be bad for community pharmacists, and in the short term, it will be hard for pharmacists to "suggest" other plans and have a huge impact (membership in CCRx was built over 5 years - it won't disappear in one Part D selling season, no matter how upset pharmacists are about the changes). It's also hard to say there are really any viable "pharmacist-friendly" options left. That is, unless someone else partners a plan with community pharmacists for 2012.
So, if you bought stock in UAM as late as last week, you could really make out - especially if UAM sells the MA business and cashes out further. If you're a community pharmacist, that previously quietly (or not so quietly) supported the CCRx Medicare Part D plan, you're likely not going to make out quite as well, and in fact should be looking for a new partner in the Part D space. Based on the National Community Pharmacist Association's (NCPA) feeling about the Humana/Walmart plan for 2011 (here's another blog that I often read that speaks about it), I'm pretty sure who I would bet it won't be...
Private equity firms actually helped finance the purchase of MemberHealth in 2007, so the return here for them is pretty quick, and substantial. Stock holders of UAM will receive about $13 a share in cash (stock was trading at just north of this amount before the announcement) plus 1 share of a new UAM stock, which will represent the remainder of the business (Medicare Advantage and traditional insurance). So, investors get to "cash out" on the stock, and get another set of shares, which will be in a company with no debt.
There are a few things to consider. The sale comes almost exactly a month after a CMS mandated suspension of marketing for UAM. Not a good thing to say the least. In fact, UAM was prevented from enrolling new members for almost half the Part D selling season for the 2011 plan year. There are undoubtedly major things wrong with the management of the Part C and D businesses for this to occur - likely compliance in nature. So, with compliance issues apparent and ongoing, CVS is buying damaged goods of sorts, paying a little more than $650 a head for the membership. I don't know what the annual "value" of a Part D member/life is on average, so hard to say if it's a discounted buy or not, but this added membership more than doubles CVS/Caremark's Part D business (currently about 1.2 million lives - UAM represents about 1.9 million lives), which they have struggled to grow like I'm sure they wanted to. In the end, good for both parties. CVS grows (taking eyes off, momentarily, the lack of synergies shown in the CVS/Caremark merger of a few years ago) and UAM gets rid of some of their CMS compliance issues.
But, don't forget UAM has the Medicare Advantage (MA) business as well. In fact, they have somewhere in the neighborhood of 240,000 MA members, and this business is also under the shadow of a "do not sell" restriction from CMS. What will become of this part of UAM? According to the news releases, this business will be part of the new UAM. More likely? I'd guess UAM will sell this business as well, once it finds the right buyer. The MA space is being squeezed by premium cuts mandated by healthcare reform, and consolidation is inevitable, expected to accelerate considerably in 2011. With plans flush with cash likely looking to buy membership (scale will help ensure profitability), and UAM management struggling under CMS scrutiny, a sale seems a likely outcome.
While UAM had other Part D plans, the majority of the membership on it's way to CVS is in the CCRx plan. This plan is unique (and popular with community pharmacists) due to the fact that is contains no mail-order benefit. CCRx was arguably successful due to the understandable, yet not quite allowable preference community pharmacist have for the CCRx plans. Community pharmacists have for years been fighting the growth of mail-order pharmacies, and the CCRx plan capitalized on this embedded marketing of sorts. Though pharmacists are not technically supposed to "steer" patients to one plan or another, it's easy to see that pharmacists would like the idea of not fighting mail order to keep their patients... and thus the success of CCRx. Combine that with the fact that CCRx also leveraged their pharmacist network for Medication Therapy Management (MTM) services, where other plans may use call centers of company-employed nurses or pharmacists, and you get a double-whammy of preference.
The 2011 Part D plan year benefits are not really modifiable at this point, and the CVS/UAM management will likely keep the ship steady-as-she-goes for 2011. However, I can see major changes on the horizon for 2012 - or at least whatever changes CVS thinks they can get away with and not piss-off the membership directly. What will be changed is obviously a guess at this point, but I would suspect a close review and possible modification to the CCRx stances on mail-order and MTM, both of which are counter to CVS/Caremark culture. This will be bad for community pharmacists, and in the short term, it will be hard for pharmacists to "suggest" other plans and have a huge impact (membership in CCRx was built over 5 years - it won't disappear in one Part D selling season, no matter how upset pharmacists are about the changes). It's also hard to say there are really any viable "pharmacist-friendly" options left. That is, unless someone else partners a plan with community pharmacists for 2012.
So, if you bought stock in UAM as late as last week, you could really make out - especially if UAM sells the MA business and cashes out further. If you're a community pharmacist, that previously quietly (or not so quietly) supported the CCRx Medicare Part D plan, you're likely not going to make out quite as well, and in fact should be looking for a new partner in the Part D space. Based on the National Community Pharmacist Association's (NCPA) feeling about the Humana/Walmart plan for 2011 (here's another blog that I often read that speaks about it), I'm pretty sure who I would bet it won't be...
Thursday, December 30, 2010
And You Wonder Why Medicare Is Bankrupt
There are lots of problems with the Medicare program, but here's another one (beyond the entitlement mentality baggage, and the ease of committing fraud against it). The program is currently designed to pay out MORE to you in benefits than you put into it...
An interesting AP article (picked up here by Forbes) points out this fatal flaw. The quote from the article -
"Consider an average-wage, two-earner couple together earning $89,000 a year. Upon retiring in 2011, they would have paid $114,000 in Medicare payroll taxes during their careers.
But they can expect to receive medical services - from prescriptions to hospital care - worth $355,000, or about three times what they put in."
FOR COMPARISON
"The same hypothetical couple retiring in 2011 will have paid $614,000 in Social Security taxes, and can expect to collect $555,000 in benefits. They will have paid about 10 percent more into the system than they're likely to get back."
Much of the problem is the rapidly rise in healthcare costs. According to the study referred to in the AP article, an average woman, who earned an average wage who retired in 1980 could have expected to have $74,800 in healthcare expenses between retirement and passing through the Ivory Gates (keeping a positive outlook here). Same woman retiring in 2010 will likely see $181,000 (both numbers are 2010 dollars, so overall inflation is not a factor here).
To me, that's staggerring. Granted, healthcare has come a long way since 1980, but that represents more than a doubling of per-retiree healthcare costs in 30 years...
And the reality is, Medicare was NOT built to cover that. In the next 20 years, the number of Medicare recipients will almost double, and the ratio of people paying in to those receiving benefits will drop from 3.5 today to closer to 2.3.
Read the full article here. Not a rosy picture. Seems we probably should have focused some more effort on cost savings during healthcare reform, at least for Medicare.
An interesting AP article (picked up here by Forbes) points out this fatal flaw. The quote from the article -
"Consider an average-wage, two-earner couple together earning $89,000 a year. Upon retiring in 2011, they would have paid $114,000 in Medicare payroll taxes during their careers.
But they can expect to receive medical services - from prescriptions to hospital care - worth $355,000, or about three times what they put in."
FOR COMPARISON
"The same hypothetical couple retiring in 2011 will have paid $614,000 in Social Security taxes, and can expect to collect $555,000 in benefits. They will have paid about 10 percent more into the system than they're likely to get back."
Much of the problem is the rapidly rise in healthcare costs. According to the study referred to in the AP article, an average woman, who earned an average wage who retired in 1980 could have expected to have $74,800 in healthcare expenses between retirement and passing through the Ivory Gates (keeping a positive outlook here). Same woman retiring in 2010 will likely see $181,000 (both numbers are 2010 dollars, so overall inflation is not a factor here).
To me, that's staggerring. Granted, healthcare has come a long way since 1980, but that represents more than a doubling of per-retiree healthcare costs in 30 years...
And the reality is, Medicare was NOT built to cover that. In the next 20 years, the number of Medicare recipients will almost double, and the ratio of people paying in to those receiving benefits will drop from 3.5 today to closer to 2.3.
Read the full article here. Not a rosy picture. Seems we probably should have focused some more effort on cost savings during healthcare reform, at least for Medicare.
Boy Smacked Who Won't Turn Off Cell Phone
According to this CNN report, an Idaho man was arrested for slapping/hitting a teenager who refused to listen to crew member instructions about turning off his phone while a Southwest jet was taxing in Las Vegas, heading for Boise, ID. According to the report, the man claimed to have smacked the boy with the back of his hand to get his attention, though it apparently left a mark on the boys shoulder. The man is quoted to have said he "felt he was protecting the entire plane and its occupants."
So, the boy was certainly wrong for refusing to turn off his phone. In fact, I was under the impression it was illegal to fail to comply with crewmember instructions. And while I suspect the chances of a phone truly interfering with airliner operations/communications (I've seen it happen, and in fact once left my phone on the whole flight, which I forgot was still on), the negative impacts could be cataclismic for passengers and crew if it were to truly occur.
But, did the man do the right thing? Was this a worthy event to lay a hand upon another person, especially someone under the age of majority? Depends on your perspective? Protective parent? Nope - wrong thing. Absolutely unacceptable. Passenger concerned about your personal welfare? Tougher call...
In any event, I hope this event continues to get coverage. I'd be interested in listening to flight experts debate the safety impacts of cellphone use during taxi, take-off, flight and landing.
So, the boy was certainly wrong for refusing to turn off his phone. In fact, I was under the impression it was illegal to fail to comply with crewmember instructions. And while I suspect the chances of a phone truly interfering with airliner operations/communications (I've seen it happen, and in fact once left my phone on the whole flight, which I forgot was still on), the negative impacts could be cataclismic for passengers and crew if it were to truly occur.
But, did the man do the right thing? Was this a worthy event to lay a hand upon another person, especially someone under the age of majority? Depends on your perspective? Protective parent? Nope - wrong thing. Absolutely unacceptable. Passenger concerned about your personal welfare? Tougher call...
In any event, I hope this event continues to get coverage. I'd be interested in listening to flight experts debate the safety impacts of cellphone use during taxi, take-off, flight and landing.
Limited Prescription Transfers in Ohio - Unfair Advantage for Chains?
I’m originally from Ohio (and hope to someday get back there and build a house on the family “homestead”). I even maintain my license to practice pharmacy in Ohio (though I’ve resisted the urge to reciprocate and get multiple state licenses as I’ve moved about the Midwest in non-dispensing roles). So, I tend to try to keep an eye on the goings-on in Ohio related to pharmacy.
Effective Jan 1, 2011, a new rule, promulgated by the Ohio State Board of Pharmacy, will restrict patients to a single transfer of a prescription. The DEA already restricts the transfer of controlled substance prescriptions (those substances that fall under the Controlled Substance Act) to a single transfer, but this will expand the reach of that particular restriction to all prescriptions that are filled within the State of Ohio.
The DEA restricts the transfers of controlled substances in order to help control or prevent potential diversion and/or abuse. The State Board in Ohio is apparently concerned with patient safety (as they should be), as there is an increased risk of errors when a prescription is transferred.
Here is the scenario –
Ms. A goes to her local (potentially independent) pharmacy, and has her prescription for Lasix (actually furosemide) filled (using an example product that is rarely “abused”, except by thoroughbred racehorses, but that’s a different story). She happily pays her $4 (very inexpensive generic drug, and this price likely includes a 300+% margin), is dispensed her medication, and departs. 25 days later, Ms A is reading the Sunday paper, and planning her week, which includes a refill of her medication (which her pharmacist instructed her to take in the AM, to avoid troublesome interruptions to her sleep visiting the toilet), when she spies a coupon in an advertising circular (could be a traditional drug store chain, a mass merchandiser, or a grocery chain, all of whom use this technique). The coupon offers her a “gift card” (of varying value, depending on the competitiveness of the geography in which she resides) in exchange for transferring a prescription to their pharmacy. “Hmmm” she says to herself. “My prescription is only $4, which is less than the gift card. I could make money on this deal!”
So, throwing caution and loyalty to the wind, she takes her almost empty pill bottle into said chain store, and asks to have the prescription transferred. Depending on the store, she could be told anywhere from a 15 minute to a 2 day wait. But, in any event, at some point, the pharmacist from the recipient store calls the pharmacist at the pharmacy losing the script and requests a transfer. The pharmacists exchange the prescription information, the receiving pharmacist reducing the information to writing, and upon completion of the transfer of information, treats the record as a new prescription (retaining the original written date, as well as maintaining (hopefully) the accuracy of the number of remaining refills, and other pertinent information) and fills it. When dispensed, Ms. A receives a gift card of somewhere between $4 and $50 (some may only go as high as the value of the medication dispensed) and goes on her merry way, at minimum getting her drugs basically for free.
So, you may say to yourself – what’s wrong with that? Lasix is not an abused drug (so the DEA style restriction doesn’t apply), and isn’t this benefiting the patient (financially at least)? Aren’t medications already overpriced? Why shouldn’t people be able to leverage the system to get what amounts to a discount as the free market of pharmacy tries to gain share?
According to the Ohio State Board of Pharmacy, the manual transfer of that prescription information is where the concern lies. Pharmacists are human, after all, and because of thinning profit margins (it happens everywhere, by the way – not just in pharmacy, though this is a favorite complaint of pharmacists and pharmacy owners – both chains and independents) the volume of prescriptions that must be filled by the same staff is increasing (just to maintain a steady net profit). So, pharmacists are busier and busier, and the error rate in this situation is likely NOT to go down. Apparently in an effort to reduce the potential for errors, the Board has determined that you can only transfer once, and then you’re done.
EXCEPT – if the prescription is “maintained within a real-time online pharmacy system.” It would appear that the Board was swayed to believe that a real-time online pharmacy system (where pharmacies are connected electronically and can potentially transfer the prescription between stores electronically without requiring a manual, verbal transfer of information between pharmacists) removes the potential for error in the transfer of the information, and should not be limited by this rule.
Objectively, it actually make sense – you take the human factor out (at least out of the transfer of the information) and you’ve reduced the risk.
Some in Ohio (specifically independent pharmacies) are arguing that this unfairly advantages chain pharmacies, and disadvantages independents, as chains already maintain these systems, and can easily do so since they are centrally owned. Independently owned pharmacies are extremely unlikely to use such a system.
So, in today’s world (2010) Ms. A can transfer her Lasix to the chain/mass/grocery pharmacy, get her gift card and then transfer it back to her original pharmacy next month. In tomorrow’s world (2011) Ms. A can transfer the prescription to the chain/mass/grocery pharmacy, get her gift card, and then has to continue to fill the prescription at that pharmacy (or one of their other locations if they use a real-time online pharmacy system) until refills run out, or she has her prescriber write a new prescription, which she can take anywhere she wants.
Does this advantage chains? A little, though chains already maintain many advantages in the marketplace, from purchasing power to convenience. Does this add to it? Yes, a little. Is it unfair? That’s the question. Some would like to say that the Board is bowing to the wishes of the large pharmacy chains, but I would argue that the Board is bowing to reason. If you’re attacking errors (which the Board should) then you have no good argument against the “real-time online pharmacy system” allowance. If you’re attacking the competitive advantage of chain pharmacies, then you have a beef – but that’s not the role of the Board of Pharmacy.
Some independent pharmacy owners may think the Board of Pharmacy should be on “their side.” But, the Board of Pharmacy should be impartial, and should be concerned with the safety and welfare of the public as it relates to the practice of pharmacy – not the competitiveness of pharmacy marketplace.
Independents cannot stop the commoditizing of the dispensing service, its happening (or you could argue already happened). What they can do is offer services chains won’t, or offer the same services at a higher level (which the chains can’t or don’t care to). Medication Therapy Management, for example (see part of my previous post on pharmacy reimbursements).
The Board in Ohio may, in other cases, have unfairly given advantages to chains (not sure and certainly not debating here), but in this case, I think they allowed a reasonable exception, because of the goal they were working to accomplish.
Effective Jan 1, 2011, a new rule, promulgated by the Ohio State Board of Pharmacy, will restrict patients to a single transfer of a prescription. The DEA already restricts the transfer of controlled substance prescriptions (those substances that fall under the Controlled Substance Act) to a single transfer, but this will expand the reach of that particular restriction to all prescriptions that are filled within the State of Ohio.
The DEA restricts the transfers of controlled substances in order to help control or prevent potential diversion and/or abuse. The State Board in Ohio is apparently concerned with patient safety (as they should be), as there is an increased risk of errors when a prescription is transferred.
Here is the scenario –
Ms. A goes to her local (potentially independent) pharmacy, and has her prescription for Lasix (actually furosemide) filled (using an example product that is rarely “abused”, except by thoroughbred racehorses, but that’s a different story). She happily pays her $4 (very inexpensive generic drug, and this price likely includes a 300+% margin), is dispensed her medication, and departs. 25 days later, Ms A is reading the Sunday paper, and planning her week, which includes a refill of her medication (which her pharmacist instructed her to take in the AM, to avoid troublesome interruptions to her sleep visiting the toilet), when she spies a coupon in an advertising circular (could be a traditional drug store chain, a mass merchandiser, or a grocery chain, all of whom use this technique). The coupon offers her a “gift card” (of varying value, depending on the competitiveness of the geography in which she resides) in exchange for transferring a prescription to their pharmacy. “Hmmm” she says to herself. “My prescription is only $4, which is less than the gift card. I could make money on this deal!”
So, throwing caution and loyalty to the wind, she takes her almost empty pill bottle into said chain store, and asks to have the prescription transferred. Depending on the store, she could be told anywhere from a 15 minute to a 2 day wait. But, in any event, at some point, the pharmacist from the recipient store calls the pharmacist at the pharmacy losing the script and requests a transfer. The pharmacists exchange the prescription information, the receiving pharmacist reducing the information to writing, and upon completion of the transfer of information, treats the record as a new prescription (retaining the original written date, as well as maintaining (hopefully) the accuracy of the number of remaining refills, and other pertinent information) and fills it. When dispensed, Ms. A receives a gift card of somewhere between $4 and $50 (some may only go as high as the value of the medication dispensed) and goes on her merry way, at minimum getting her drugs basically for free.
So, you may say to yourself – what’s wrong with that? Lasix is not an abused drug (so the DEA style restriction doesn’t apply), and isn’t this benefiting the patient (financially at least)? Aren’t medications already overpriced? Why shouldn’t people be able to leverage the system to get what amounts to a discount as the free market of pharmacy tries to gain share?
According to the Ohio State Board of Pharmacy, the manual transfer of that prescription information is where the concern lies. Pharmacists are human, after all, and because of thinning profit margins (it happens everywhere, by the way – not just in pharmacy, though this is a favorite complaint of pharmacists and pharmacy owners – both chains and independents) the volume of prescriptions that must be filled by the same staff is increasing (just to maintain a steady net profit). So, pharmacists are busier and busier, and the error rate in this situation is likely NOT to go down. Apparently in an effort to reduce the potential for errors, the Board has determined that you can only transfer once, and then you’re done.
EXCEPT – if the prescription is “maintained within a real-time online pharmacy system.” It would appear that the Board was swayed to believe that a real-time online pharmacy system (where pharmacies are connected electronically and can potentially transfer the prescription between stores electronically without requiring a manual, verbal transfer of information between pharmacists) removes the potential for error in the transfer of the information, and should not be limited by this rule.
Objectively, it actually make sense – you take the human factor out (at least out of the transfer of the information) and you’ve reduced the risk.
Some in Ohio (specifically independent pharmacies) are arguing that this unfairly advantages chain pharmacies, and disadvantages independents, as chains already maintain these systems, and can easily do so since they are centrally owned. Independently owned pharmacies are extremely unlikely to use such a system.
So, in today’s world (2010) Ms. A can transfer her Lasix to the chain/mass/grocery pharmacy, get her gift card and then transfer it back to her original pharmacy next month. In tomorrow’s world (2011) Ms. A can transfer the prescription to the chain/mass/grocery pharmacy, get her gift card, and then has to continue to fill the prescription at that pharmacy (or one of their other locations if they use a real-time online pharmacy system) until refills run out, or she has her prescriber write a new prescription, which she can take anywhere she wants.
Does this advantage chains? A little, though chains already maintain many advantages in the marketplace, from purchasing power to convenience. Does this add to it? Yes, a little. Is it unfair? That’s the question. Some would like to say that the Board is bowing to the wishes of the large pharmacy chains, but I would argue that the Board is bowing to reason. If you’re attacking errors (which the Board should) then you have no good argument against the “real-time online pharmacy system” allowance. If you’re attacking the competitive advantage of chain pharmacies, then you have a beef – but that’s not the role of the Board of Pharmacy.
Some independent pharmacy owners may think the Board of Pharmacy should be on “their side.” But, the Board of Pharmacy should be impartial, and should be concerned with the safety and welfare of the public as it relates to the practice of pharmacy – not the competitiveness of pharmacy marketplace.
Independents cannot stop the commoditizing of the dispensing service, its happening (or you could argue already happened). What they can do is offer services chains won’t, or offer the same services at a higher level (which the chains can’t or don’t care to). Medication Therapy Management, for example (see part of my previous post on pharmacy reimbursements).
The Board in Ohio may, in other cases, have unfairly given advantages to chains (not sure and certainly not debating here), but in this case, I think they allowed a reasonable exception, because of the goal they were working to accomplish.
Monday, December 13, 2010
Obamatrition
Nutrition is important. Few would argue that point. Obesity is a foe America is battling - and for the most part, obesity is winning. So, any weapon against this enemy is worth using, right?
Today, President Obama signed the Healthy, Hunger-Free Kids Act of 2010 into law. He joked, prior to signing it, that he would have had to sleep on the couch if he didn't sign it. Unless you've been under a rock, you already know that childhood obesity is a major focus for the First Lady. Childhood obesity is to Michelle Obama as recreational drug use (Just Say No) was to Nancy Regan.
Along with getting enough exercise, making healthy food selections is a main tactic for obesity avoidance - and teaching healthy eating at a young age is arguably (and I agree) critical for life-long health.
On top of that, it's also pretty easy to see that - in order to grow - kids gotta eat. I see it daily at the table at my house - and boy do they eat... Without access to food, it certainly does make it hard for kids to "grow up healthy and strong." Not a tough sell.
And so, the Healthy, Hunger-Free Kids Act of 2010 is hard to argue against. It's got all the important ingredients for a can't fail bill - Health and Kids - and it combines them for a winning combination.
But the bill does a couple things we should probably consider - 1) increases access to school lunch programs and 2) expands the control the United States Department of Argiculture (USDA) will have over the selection of food available in school cafeterias, vending machines, and a'la carte menus. And not just the food paid for by the federal government through the school lunch program - it means all food sold in a school.
I'm all for school lunch fundings - I don't want to see kids go hungry. At the same time, more than half of the children at our elementary school get reduced price or free lunches. I'm sure there are those who need access to the program, and have a hard time getting it - somewhere... But apparently not at our local school. Perhaps making it easier is not the best answer, but making sure those who really need it get it. Making the application process easier or just increasing the pool of people eligible, in the name of making sure no-one who might need it gets it, seems a little bit like watering the ocean to make sure no fish are thirsty.
As for expanding the USDA authority to control food selections in schools, I'm not sure I'm really on board. In the end, nutrition starts in the home - and a group of homes make up a community, and a community should determine the best things for their children. I'm having a hard time with government agents determining the menu at local schools. Maybe it's just me.
In the end, I think it's just really sad that Washington, DC has to legislate school lunch menus. The fact that we, as parents, apparently can't shape the diets of our children is truly sad. Or, perhaps we can (and are)... But I'm sure a beaurocrat can do it better.
Today, President Obama signed the Healthy, Hunger-Free Kids Act of 2010 into law. He joked, prior to signing it, that he would have had to sleep on the couch if he didn't sign it. Unless you've been under a rock, you already know that childhood obesity is a major focus for the First Lady. Childhood obesity is to Michelle Obama as recreational drug use (Just Say No) was to Nancy Regan.
Along with getting enough exercise, making healthy food selections is a main tactic for obesity avoidance - and teaching healthy eating at a young age is arguably (and I agree) critical for life-long health.
On top of that, it's also pretty easy to see that - in order to grow - kids gotta eat. I see it daily at the table at my house - and boy do they eat... Without access to food, it certainly does make it hard for kids to "grow up healthy and strong." Not a tough sell.
And so, the Healthy, Hunger-Free Kids Act of 2010 is hard to argue against. It's got all the important ingredients for a can't fail bill - Health and Kids - and it combines them for a winning combination.
But the bill does a couple things we should probably consider - 1) increases access to school lunch programs and 2) expands the control the United States Department of Argiculture (USDA) will have over the selection of food available in school cafeterias, vending machines, and a'la carte menus. And not just the food paid for by the federal government through the school lunch program - it means all food sold in a school.
I'm all for school lunch fundings - I don't want to see kids go hungry. At the same time, more than half of the children at our elementary school get reduced price or free lunches. I'm sure there are those who need access to the program, and have a hard time getting it - somewhere... But apparently not at our local school. Perhaps making it easier is not the best answer, but making sure those who really need it get it. Making the application process easier or just increasing the pool of people eligible, in the name of making sure no-one who might need it gets it, seems a little bit like watering the ocean to make sure no fish are thirsty.
As for expanding the USDA authority to control food selections in schools, I'm not sure I'm really on board. In the end, nutrition starts in the home - and a group of homes make up a community, and a community should determine the best things for their children. I'm having a hard time with government agents determining the menu at local schools. Maybe it's just me.
In the end, I think it's just really sad that Washington, DC has to legislate school lunch menus. The fact that we, as parents, apparently can't shape the diets of our children is truly sad. Or, perhaps we can (and are)... But I'm sure a beaurocrat can do it better.
Saturday, December 11, 2010
Short Cycle Dispensing - A Prediction - Will Fail to Deliver Net Cost Savings
Last night I posted an "opinion" on an age old complaint in the pharmacy industry about dispensing fees being too low to truly pay for the costs associated with dispensing (inlcuding some clinical-type interventions). In light of the impending Part D changes in the long-term-care (LTC) pharmacy industry, I thought I would expand upon my thoughts about short cycle dispensing (see a previous post explaining the short cycle dispensing proposed rule) and talk a little about what could happen with LTC dispensing fees with the short cycle dispensing changes.
A base assumption of the short cycle dispensing initiative (which some, like LTCPA, have argued is greatly flawed) is that reduced waste of unused medications will overcome increased cost of dispensing fees. The commentary that accompanied the proposed CMS rule reinforced the fact that CMS cannot get involved in the negotiations between pharmacies and Part D plan sponsors that determine ingredient costs and dispensing fees - these are trading partner discussions. CMS did, however, stir the pot a bit, and make comments about their understanding that current dispensing fee arrangements would need to be altered to account for increased work pharmacies would need to undertake to remain compliant with the short cycle requirements.
On the surface, one could argue that changing from 30-day dispensing to 7-day dispensing will increase the cost to dispense approximately four fold. This is both (somewhat) true and misleading. Some costs associate with dispensing will go up close to four fold. Packaging costs (assuming blister-cards and no cost savings from reducing from 30-day pack sizes to 7-day pack sizes) will likely increase dramatically. If you assume no new technology leveraging by a pharmacy, and manual processes are used, labor costs to put the medications in the packaging would also increase (though likely not in direct proportion to volume). A pharmacy servicing LTC facilities are likely already delivering to most facilities on a daily basis already, so delivery costs will likely not be impacted much, if at all. So, some costs increase, and others are the same (or inflate more normally over time). The biggest expense (beyond ingredient cost, which I am excluding from this discussion) is labor, so this is likely the most impactful change that would need to be accounted for.
The specific impacts to labor costs are dependent upon what technology is being used by the pharmacy. The more technology being deployed, likely the less the labor impact. So, pharmacies have to make a decision on if they want to put $$ into labor, or into technology. The options for pharmacies are numerous, and it is likely that technology suppliers will expand their offerrings in light of this new mandate.
Another dynamic here is the endorsement, by CMS, of some very specific technology options for dispensing in the LTC space, as the most efficient options. "Automated Remote Dispensing" is a technology that has appeared in recent years, which allows commonly used medications to be housed on-site in the LTC facility, with ultimate control on dispensing still residing with a pharmacy via a remote connection between the pharmacy's dispensing system and the software that runs the machine in the facility. This setup lets the pharmacy "dispense" the medication to the patient (via a nurse using the machine, requesting the meds) dose by dose. In this way, there is nearly no lost medications due to changes in therapy or change in status of the patient, because the medications don't become the patient's until the time of administration.
This technology is likely the most expensive to implement, and has additional challenges like facility design (and available space). On top of that, you're talking about investing in a machine for each facility serviced (if nor more than one per facility) by a pharmacy. The costs could be enormous.
And so we come back to CMS, and their colorful commentary. In the proposed rule, CMS went as far as to state that they believe it appropriate for dispensing fees to include $$ to help pay for technology investment... In fact they propose to change the definition of dispensing fee to include the costs associated with acquisition and maintenance of technology to maintain reasonable costs...
And this is why I say CMS has basically endorsed automated remote dispensing. In combining a recognition that remote dispensing is the most efficient methodology (with least waste) and giving the negotiating parties direction to consider technology costs in the negotiations that determine the dispensing fee, they have set the stage for variable dispensing fees, with higher fees to be paid for certain technologies - specifically automated remote dispensing technologies.
The ballpark estimation for the CMS-expected adjustment to dispensing fees is an increase between 50 and 100%, with remote dispensing coming in near the 100% increase, and other less technology based methodologies coming in on the lower end. This range of dispensing fee increase would likely eat up at least half of the expected ingredient cost savings. The higher the actuals come in, the less $ saved...
Realistically, with some costs associated with dispensing using current methodologies increasing up to 4 fold, and others increasing dramatically, even if not 4 fold, I truly can't see pharmacies agreeing to dispensing fee increases of only 50%. This will be a problem for Part D sponsors, as sponsors need LTC pharmacies in their network to provide access to medications for LTC residents who are their members... and it should be completely expected that pharmacies will terminate their participation within a payer's network if the dispensing fee discussion does not yield agreement at a level that covers their costs. The fight will be on.
So, the dispensing fee discussion is going to get ugly. And if the net impact to dispensing fees come in closer to 200-300% increase in fees, the savings booked in the health reform legislation will never come to pass (shocker there, BTW).
And in the end, much blood, sweat and tears will be shed, an industry will be shaken by a monumental change, and costs savings will be minimal (if not turning to an increase in cost). Put me down... That's my bet. Anyone want to bet the other way?
A base assumption of the short cycle dispensing initiative (which some, like LTCPA, have argued is greatly flawed) is that reduced waste of unused medications will overcome increased cost of dispensing fees. The commentary that accompanied the proposed CMS rule reinforced the fact that CMS cannot get involved in the negotiations between pharmacies and Part D plan sponsors that determine ingredient costs and dispensing fees - these are trading partner discussions. CMS did, however, stir the pot a bit, and make comments about their understanding that current dispensing fee arrangements would need to be altered to account for increased work pharmacies would need to undertake to remain compliant with the short cycle requirements.
On the surface, one could argue that changing from 30-day dispensing to 7-day dispensing will increase the cost to dispense approximately four fold. This is both (somewhat) true and misleading. Some costs associate with dispensing will go up close to four fold. Packaging costs (assuming blister-cards and no cost savings from reducing from 30-day pack sizes to 7-day pack sizes) will likely increase dramatically. If you assume no new technology leveraging by a pharmacy, and manual processes are used, labor costs to put the medications in the packaging would also increase (though likely not in direct proportion to volume). A pharmacy servicing LTC facilities are likely already delivering to most facilities on a daily basis already, so delivery costs will likely not be impacted much, if at all. So, some costs increase, and others are the same (or inflate more normally over time). The biggest expense (beyond ingredient cost, which I am excluding from this discussion) is labor, so this is likely the most impactful change that would need to be accounted for.
The specific impacts to labor costs are dependent upon what technology is being used by the pharmacy. The more technology being deployed, likely the less the labor impact. So, pharmacies have to make a decision on if they want to put $$ into labor, or into technology. The options for pharmacies are numerous, and it is likely that technology suppliers will expand their offerrings in light of this new mandate.
Another dynamic here is the endorsement, by CMS, of some very specific technology options for dispensing in the LTC space, as the most efficient options. "Automated Remote Dispensing" is a technology that has appeared in recent years, which allows commonly used medications to be housed on-site in the LTC facility, with ultimate control on dispensing still residing with a pharmacy via a remote connection between the pharmacy's dispensing system and the software that runs the machine in the facility. This setup lets the pharmacy "dispense" the medication to the patient (via a nurse using the machine, requesting the meds) dose by dose. In this way, there is nearly no lost medications due to changes in therapy or change in status of the patient, because the medications don't become the patient's until the time of administration.
This technology is likely the most expensive to implement, and has additional challenges like facility design (and available space). On top of that, you're talking about investing in a machine for each facility serviced (if nor more than one per facility) by a pharmacy. The costs could be enormous.
And so we come back to CMS, and their colorful commentary. In the proposed rule, CMS went as far as to state that they believe it appropriate for dispensing fees to include $$ to help pay for technology investment... In fact they propose to change the definition of dispensing fee to include the costs associated with acquisition and maintenance of technology to maintain reasonable costs...
And this is why I say CMS has basically endorsed automated remote dispensing. In combining a recognition that remote dispensing is the most efficient methodology (with least waste) and giving the negotiating parties direction to consider technology costs in the negotiations that determine the dispensing fee, they have set the stage for variable dispensing fees, with higher fees to be paid for certain technologies - specifically automated remote dispensing technologies.
The ballpark estimation for the CMS-expected adjustment to dispensing fees is an increase between 50 and 100%, with remote dispensing coming in near the 100% increase, and other less technology based methodologies coming in on the lower end. This range of dispensing fee increase would likely eat up at least half of the expected ingredient cost savings. The higher the actuals come in, the less $ saved...
Realistically, with some costs associated with dispensing using current methodologies increasing up to 4 fold, and others increasing dramatically, even if not 4 fold, I truly can't see pharmacies agreeing to dispensing fee increases of only 50%. This will be a problem for Part D sponsors, as sponsors need LTC pharmacies in their network to provide access to medications for LTC residents who are their members... and it should be completely expected that pharmacies will terminate their participation within a payer's network if the dispensing fee discussion does not yield agreement at a level that covers their costs. The fight will be on.
So, the dispensing fee discussion is going to get ugly. And if the net impact to dispensing fees come in closer to 200-300% increase in fees, the savings booked in the health reform legislation will never come to pass (shocker there, BTW).
And in the end, much blood, sweat and tears will be shed, an industry will be shaken by a monumental change, and costs savings will be minimal (if not turning to an increase in cost). Put me down... That's my bet. Anyone want to bet the other way?
Friday, December 10, 2010
Pharmacy Reimbursement - A Common Argument
If you have been involved in the retail pharmacy industry for more than a fees seconds, you've heard the argument that goes something like this...
"Dispensing fees are a joke. They are too low to cover the cost to dispense medications and provide all the wonderful clinical service and interventions pharmacists do every day. The act of dispensing and clinical services should be separated and pharmacists paid for their work."
I admit that I used to subscribe to such a theory. However, over time and through my own professional experiences I've come to a different thought process.
First, the current level of dispensing fees were not designed to cover the cost to dispense. Most who know the going industry level of retail dispensing fees might agree that it may cover the cost of the vial and label, and perhaps a technician's time to count the drug, but little else. The fact is that historically speaking most other costs were accounted for in the "ingredient cost." Let me illustrate with this formula:
Payment = Benchmark Price +/- % + Dispensing Fee
The total payment a pharmacy receives when dispensing a medication is based upon a markup or markdown of a "benchmark" price for the drug being dispensed plus a set fee. The secret (not well kept actually) in all this is that the benchmark price is actually bogus... And all of the pharmacy's margin is hidden in there. If you want to learn more on the fallacy of AWP (as an example benchmark that is very commonly used) just google it, or perhaps I can write another post to explain more.
Suffice it to say that the cost to dispense is not covered by the dispensing fee, and never has been. So, no, dispensing fees are not sufficient, but that's because the ingredient cost reimbursement has been inflated. It varies by product, but it can be extremely high on things like recently introduced generics, and is generally pretty steady on higher-cost brands, because there is less variance on those products between their true acquisition cost and their benchmark prices. Sure there has been cost pressure on drug prices, and payers have negotiated deeper discounts on ingredient costs, but that's because there was room to negotiate for the pharmacies - because there was margin being made...
But let's not ignore another little part of the above common argument about pharmacy payments... The cost of clinical services and interventions. Now, I was a retail pharmacist, and I know that pharmacists do some wonderful and sometimes life-saving things... Just not on every prescription. Whether you knew it or not, pharmacists are supposed to do a Drug Utilization Review every time you fill a prescription. Reality is, the computer does it, and pushes "alerts" to the pharmacy staff, which can easily be overridden. These automated systems are often very inflexible in their sensitivity, and often generate so many false positives that it can lead to all warnings sounding like noise - and I'm sure some valid warnings get missed. But, the point is that unless you happen to have a pharmacist who is truly conducting these reviews on a regular basis, and is invoking their clinical knowledge and judgement, there is truly little "costly" investment of time that would dictate a big fee for the service. Realistically, the biggest thing a retail pharmacist does (besides provide the license to allow the pharmacy to be open) is validate the right drug is in the bottle. (which is important, don't get me wrong)
So, why do pharmacists go to school for so long? Why would a pharmacist need all that training and knowledge? Well, it truly CAN be used for betterment of patients. And guess what... Interventions and reviews of medication therapy have been theorized (and even shown in some cases) to improve outcomes and lower costs. And so was born Medication Therapy Management (MTM). MTM is a Medicare service that pharmacists can participate in that allows payment of fees for time spent working with Medicare Part D patients on their medications. Part D payers are required to offer such programs, though not all do it through pharmacists.
However, those that DO offer these revenue streams to pharmacists have seen disappointing results, given the universal level of interest in such payment for services. Statistics related to actual consults conducted compared to those offered or available are not considered public, but the ones I've been privy to are nowhere near a level that would indicate pharmacists are truly taking advantage of the opportunity. The offer of $ for services has been made, but the $ are largely still on the table untouched.
So, sure, if you're doing work, and someone is benefiting (especially if they benefit financially), the person doing the work should likely be compensated. That extends to pharmacy and pharmacists. But, I say don't complain about low dispensing fees, unless you're willing to get reimbursed true drug acquisition cost. (you pass on true cost without built-in margin, and your costs SHOULD be covered, plus a little profit, through a dispensing fee) Also, I believe in the value of pharmacist activity in the health care space, but don't complain about not being paid for services you're not really doing (most of the time) and when you're being offered $ to do similar (though more in-depth) work, and you're not taking advantage.
"Dispensing fees are a joke. They are too low to cover the cost to dispense medications and provide all the wonderful clinical service and interventions pharmacists do every day. The act of dispensing and clinical services should be separated and pharmacists paid for their work."
I admit that I used to subscribe to such a theory. However, over time and through my own professional experiences I've come to a different thought process.
First, the current level of dispensing fees were not designed to cover the cost to dispense. Most who know the going industry level of retail dispensing fees might agree that it may cover the cost of the vial and label, and perhaps a technician's time to count the drug, but little else. The fact is that historically speaking most other costs were accounted for in the "ingredient cost." Let me illustrate with this formula:
Payment = Benchmark Price +/- % + Dispensing Fee
The total payment a pharmacy receives when dispensing a medication is based upon a markup or markdown of a "benchmark" price for the drug being dispensed plus a set fee. The secret (not well kept actually) in all this is that the benchmark price is actually bogus... And all of the pharmacy's margin is hidden in there. If you want to learn more on the fallacy of AWP (as an example benchmark that is very commonly used) just google it, or perhaps I can write another post to explain more.
Suffice it to say that the cost to dispense is not covered by the dispensing fee, and never has been. So, no, dispensing fees are not sufficient, but that's because the ingredient cost reimbursement has been inflated. It varies by product, but it can be extremely high on things like recently introduced generics, and is generally pretty steady on higher-cost brands, because there is less variance on those products between their true acquisition cost and their benchmark prices. Sure there has been cost pressure on drug prices, and payers have negotiated deeper discounts on ingredient costs, but that's because there was room to negotiate for the pharmacies - because there was margin being made...
But let's not ignore another little part of the above common argument about pharmacy payments... The cost of clinical services and interventions. Now, I was a retail pharmacist, and I know that pharmacists do some wonderful and sometimes life-saving things... Just not on every prescription. Whether you knew it or not, pharmacists are supposed to do a Drug Utilization Review every time you fill a prescription. Reality is, the computer does it, and pushes "alerts" to the pharmacy staff, which can easily be overridden. These automated systems are often very inflexible in their sensitivity, and often generate so many false positives that it can lead to all warnings sounding like noise - and I'm sure some valid warnings get missed. But, the point is that unless you happen to have a pharmacist who is truly conducting these reviews on a regular basis, and is invoking their clinical knowledge and judgement, there is truly little "costly" investment of time that would dictate a big fee for the service. Realistically, the biggest thing a retail pharmacist does (besides provide the license to allow the pharmacy to be open) is validate the right drug is in the bottle. (which is important, don't get me wrong)
So, why do pharmacists go to school for so long? Why would a pharmacist need all that training and knowledge? Well, it truly CAN be used for betterment of patients. And guess what... Interventions and reviews of medication therapy have been theorized (and even shown in some cases) to improve outcomes and lower costs. And so was born Medication Therapy Management (MTM). MTM is a Medicare service that pharmacists can participate in that allows payment of fees for time spent working with Medicare Part D patients on their medications. Part D payers are required to offer such programs, though not all do it through pharmacists.
However, those that DO offer these revenue streams to pharmacists have seen disappointing results, given the universal level of interest in such payment for services. Statistics related to actual consults conducted compared to those offered or available are not considered public, but the ones I've been privy to are nowhere near a level that would indicate pharmacists are truly taking advantage of the opportunity. The offer of $ for services has been made, but the $ are largely still on the table untouched.
So, sure, if you're doing work, and someone is benefiting (especially if they benefit financially), the person doing the work should likely be compensated. That extends to pharmacy and pharmacists. But, I say don't complain about low dispensing fees, unless you're willing to get reimbursed true drug acquisition cost. (you pass on true cost without built-in margin, and your costs SHOULD be covered, plus a little profit, through a dispensing fee) Also, I believe in the value of pharmacist activity in the health care space, but don't complain about not being paid for services you're not really doing (most of the time) and when you're being offered $ to do similar (though more in-depth) work, and you're not taking advantage.
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