My Suggested Reading List For Adults

I was asked to provide a list of books I would recommend to a friend. Now, this task is not something I take lightly. People ask me for book recommendations occasionally, but not as much as I’d expect since I read constantly and have for 24 years. Perhaps they know I’ll scoff at modern romance novels and fake vomit when they say their favorite author is Nora Roberts. Call me a book snob. I don’t care. There are much more diverse and amazing books out there to stretch your mind. When someone asks me for a book suggestion, I start to panic. What if YOU don’t like a book that I loved?! Will our friendship survive? Probably not.

If I suggest a book specifically FOR YOU, keep in mind that I try to take into account your personality, your likes and dislikes, and what I think you could use a little more of in your life. But this list is different. They are books that I either loved or learned immensely from. So here, in no particular order, is a small list of the books I think are worth a read:

-Ender’s Quartet by Orson Scott Card– the entire series is about ethics and morals and religion and science. The ideas in this science fiction quartet are actually the basis for my religious beliefs (no, I’m not a scientologist; read the books and then we can discuss). The Ender Universe has sixteen novels and thirteen short stories so strap in!

·         Ender’s Game

·         Speaker for the Dead

·         Xenocide

·         Children of the Mind

-Tao of Pooh by Benjamin Hoff– religious educational fiction that teaches the elements of Taoism by using Winnie the Pooh characters

-Boys Adrift : The Five Factors Driving the Growing Epidemic of Unmotivated Boys and Underachieving Young Men by Leonard Sax– non-fiction, self-explanatory; a little scary but maybe I’m a tad over-reactive as a mother of a boy

-Still Life With Woodpecker by Tom Robbins– fiction; kooky, witty, and so interesting; He is such a strange author, but solid story-telling. Hope you have an imagination.

-Stranger in a Strange Land by Robert Heinlein– science-fiction; transformed MY life and it was the first adult science fiction I read at 17; made me realize that there are other ways to think about relationships and love that society will never accept

-Shantaram by Gregory David Roberts– LOVED this one, partially because I found it on my own; Author claims it is non-fiction but people who are characters in the book disagree; story of an escaped Australian convict who goes to Bombay and experiences life; it is a long book> worth it. There are few books that give me a relationship with the characters. I didn’t want this book to end. He wrote a sequel called Mountain’s Shadow which is actually downloaded onto my phone but I can’t seem to get into it.

-Art of Racing in the Rain– the only new-age fiction that I like; story of a man and his dog; 10/10 will cry

-Of Mice and Men by John Steinbeck– short and heartbreaking; a classic; it brings up an interesting view of where society draws its lines

-Devil In The White City by Erik Larson– Non-fictional story of the serial killer at the Chicago World’s Fair in 1893; super creepy, super cool

-The Stranger by Albert Camus (pronounced Ca-moo, don’t make the same mistake I did and call him Cam-us and get laughed out of the room)- a fictional and philosophical story of a man who experiences life; a foray into existentialism; look for the many hidden meanings; you may have to read multiple times

-Bernice Bobs Her Hair by F. Scott Fitzgerald– cute and pithy short story that made me laugh. I identify with Bernice…

-Breaking “Innocence” by me– non-fictional account of a female Marine who went to war young and made a lot of bad decisions (selfish plug)

-Unbroken by Laura Hillenbrand– non-fictional account of an Olympian and Japanese prisoner of war during World War II. It is amazing what humans are capable of enduring. I cried, a lot, but this story is simply amazing. Sometimes justice isn’t done.

Jane Eyre by Charlotte Bronte- a fictional classic about a woman who doesn’t abandon her morals and suffers heartache through the actions of others. This book is pretty awesome.

This list is constantly growing, and if I know you, I might suggest completely different works.

The picture at the top of the blog is from Bluestocking Books located in Hillcrest, San Diego, California. It is a cute local bookstore. Check it out!

Protecting Your Children From Molestation And Other Sexual Abuse

Molestation is a very sensitive topic for most decent human beings. This might be because molestation is associated with inappropriate sexual behavior towards minors, our children. As a parent who cares immensely about this subject, I want to share some suggestions to other parents, guardians, and other caretakers of children that I believe curb the ease with which predators target children.

It is never a child’s fault for being molested. Sexual predators aim for a particular type of child to “groom”, and all we can do is try and educate our children, and ourselves, to be aware of things that make them “easy prey”. Here are the suggestions:

1) Teach your child the proper names for their genitals.

It is not a “special spot”, a hoohah, a vajayjay, or any other ridiculous name. It is a vagina or a vulva. It is not a turtle, a johnson, or your stick. It is a penis. Stop using euphemisms for teaching body parts to your children. Using “pet names” for a sexual organ on a child makes diagnosis and identification of sexual abuse harder, which is difficult already with a small child. A future predator might be put off by your child using a medical term for their genitals instead of encouraging the use of a pet name.

2) Empower your child to wash their own privates.

Once your child is old enough to hold a loofah or washcloth and mimic scrubbing, have them wash their own genitals. You supervise to ensure they are cleaning themselves thoroughly, but intervene less and less as they get older and have more control over their ability to scrub.

3) Be aware of everyone, both sexes, all ages, and their interactions with your child.

Molestation doesn’t just happen by the creepy man down the street. It happens by family friends, family members, older siblings, and other children on the playground. Neither sex is free of suspicion. Try not to leave your child alone with anyone until your child is vocal enough to tell you what happens when you’re not around. Employ babysitters and daycares with complete camera coverage. Some daycares allow you to log in at any time to view your child. That is a great peace of mind for parents who work and trust others with their children.

4) Discuss consent, personal space, and privacy.

No one should touch your child without their permission. Don’t force your child to hug or kiss anyone that they don’t want to hug or kiss. I can’t stress this enough, especially for family members who think they are entitled to affection from your child. Forcing your child to kiss and hug a relative to prevent harming the relative’s feelings teaches your child that their consent is not necessary for intimate interactions. This is NOT okay. This allows predators to make a child feel like the predator is owed affection. This kind of twisted thinking is exactly what predators use to manipulate and coerce a child to do what they want. Family is not exempt from consent, parents included.

Teach your child about appropriate personal space and privacy. If someone wishes to be left alone while they undress, that should be allowed. Don’t barge in on your child while they are getting dressed or undressed. While nudity is not shameful, some children do not wish for the world to see them naked. That should be respected.

5) Foster positive communication with your child.

Don’t let your child be afraid of your reactions to what they may tell you. This goes beyond molestation and extends into drug use, alcohol, bullying, etc. Be the parent and expect respect from your child, but also give it. Listen to them when they speak and encourage them to tell you things without immediate judgment or fear of punishment while they are still in danger. Get your child to safety and then teach them with intellect and the maturity that your years hold. This kind of communication begins in very early childhood. Be someone your child trusts and they are going to be more willing to talk to you about things that may signal a possible predator.

6) Trust your gut.

No matter what, listen to your gut and remove your child from a bad situation. The worst that can happen is that your child will be safe. That isn’t so bad at all.

If you think molestation has already happened to your child, remove your child from all questionable situations and see a doctor immediately. Call the police along the way to the doctor. If you don’t report sexual abuse to the police, you may be responsible for further child abuse to someone you can’t protect. Don’t blame your child or cover it up because of who may be in trouble when the molestation is investigated. Believe. Your. Child.

The Soul Collector- A Female Marine Boot Camp Story

Imagine that you are hit repeatedly in vulnerable places on your body to conduct “body hardening”, which damages your nerve receptors to prevent flinching from the pain when you are struck. Imagine being thrown, flipped, punched, verbally degraded, choked and thrown up against the wall, slapped, spat on, stepped on, sleep-deprived, and starved.

Then imagine being taught how to defend yourself. Imagine being taught how to kill with your bare hands in less than eight seconds. You know how to go with less food, you know how to keep hiking for over ten miles on less than three hours of sleep. You know how to ignore the pain of the broken bones in your body as you keep. going. You are trained to do more with less. You are taught how to kill. And your body wants it. Your body is heightened by your own physical pain that you are ignoring and you want to kill.

The Marine Corps taps into a person’s primal desire to survive. It tears a person down to their barest minimum to break them before training them to be killers. The MC takes people from around the world (yes, the world), from all different backgrounds, and breaks their spirits together over the course of twelve weeks. Some people break faster than others. Some people need to be taken to the tree line and given a little more attention to get to the Marine Corps’ desired state of broken.

For me, I took extra attention. What was used to break the softer recruits didn’t work on me. I grew up with a dad who screamed and yelled, who verbally and emotionally abused me and my sister and my mom, and who shot firearms INSIDE of the house while we were cowering upstairs. I was used to being yelled at and hit. So the Marine Corps drill instructors’ psycho actions were just a regular Tuesday for me. It worked in my favor for a long time. I didn’t flinch, I didn’t care about being forced to do push-ups until my arms gave out, and I just ran faster to get away from the weaker crowd and the drill instructors intent on making the weak strong.

The drill instructors saw me though. It is hard to hide in a platoon of 35 women and five drill instructors, especially when you are the guide, or the leader of the recruits. As the guide, it was my responsibility to lead the rest of the recruits and to be the prime example of order, discipline, and perfection. I was seventeen, and couldn’t lead a cat out of a wet paper bag. The drill instructors punished me with every single other recruit who was punished to teach me leadership. If Sanchez was a little slow, I had to run sprints with her. If Bullock lost her canteen cup, I was taken to the pit with her. Everyone else’s mistakes were my own, which is the epitome of leadership. If your subordinates mess up, it is your fault. The Marines taught that lesson through physical pain. But it still didn’t break my spirit. Physical pain can be borne indefinitely, or so I thought.

During range week, when we hiked through the swamps of South Carolina to reach the range and “learn how to shoot”, I broke my ankle. It was during an early morning hike of probably six miles. We had our rifles and our packs, and we were walking through dark and wooded paths in the swamp. As guide, I also had to carry the guidon, or the troop identification flag. It had to be carried a specific way when marching, with your right hand holding the flag pole closer to the bottom, positioned with your thumb pad directly on the thumbtack, while your left hand clasped closer to the flag. You held that thing perfectly while you marched, next to the company commander, and you didn’t look down.

The company commander was speed walking. She didn’t have a pack or a rifle or a guidon. She was going for a stroll and wanted the recruits to move quickly. So we moved. And we sang cadence. And we didn’t look down. Blindly marching, I led the company with Speedy Gonzalez, and stepped straight into a hole. The snap was audible, and my yelp wasn’t muffled enough to not gain the attention of one of my five drill instructors. Still marching, my voice quivered to the cadence and tears welled in my eyes. The DI offered to fire me, in less than tactful terms. I picked up my pace and kept going.

Range week was horrible. My combat boot kept my right ankle together as much as possible. I would tie it tighter each day, imagining it was a removable cast. I had to get my bunkmate to pull my boot off at the end of the day because my ankle had tripled in size. The known distance (KD) range is broken into three different yard lines to shoot and qualify from. The 200 yard line required shooting standing up, kneeling down, and sitting. 300 was kneeling and sitting rapid fire, and 500 was the prone position, belly down and legs splayed. Standing was fine, sitting was fine, and prone was fine. The kneeling was the most excruciating pain I had felt up to that point in my life, including the body hardening exercises where we beat the living shit out of each other. I was forced to fire dozens of rounds in the kneeling, with my weight on my broken ankle as I kneeled upon it. I couldn’t move to any other position because it just wasn’t allowed. After a time, I crouched to where I wasn’t putting any weight on my ankle. It was less steady and my aim suffered immensely, but my ankle wasn’t screaming at me.

On the fifth day, qualification day, I was doing fine…until the kneeling position. The same DI who heard me on the hike from Monday stood behind me, and when she noticed that I was protecting my ankle by hovering, she shoved me down onto it by slamming my shoulders down in full force. As my eyes watered in pure pain from broken bones moving around damaged tissue, she smiled at me. I began to anticipate each shot as I pulled the trigger, aware that the kickbacks would cause further pain on my ankle.

Anticipation is probably the number one reason people miss when they fire a weapon.

I failed the range by two points. I unq’ed (pronounced “unk”). I was unqualified. When “every Marine is a rifleman”, this was unacceptable. I knew they were coming for me. I was publicly fired as guide before the hike back to the squad bay. Public humiliation was really no big deal since I was eight and had accidentally farted on the cute boy behind me while performing a fish dance rendition of some classical piece. So I still wasn’t mentally broken, although I was scared shitless that I would be dropped from the platoon.

That night, I was awoken to covers being snatched from my body and a disembodied voice that told me to get the fuck into the head (bathroom, for you civilian types). Scrambling, I sprinted while the DI who had shoved me onto my broken bones on the range hissed threats into my ear. She pushed me against the wall and kicked my ankle a few times, asking if it hurt. Refusing to give in, I kept saying “no, ma’am.” If I was smarter, I would have acted like my spirit had been broken by my disqualification on the range. Instead, I kept up my spirit, which gave her the desire to break me for good. She had all night. I couldn’t scream for help, that would have shown weakness and surrender. I was already supposed to be broken. This was Week Eight of training. Most girls broke by Week Three.

We stayed in that bathroom for what felt like an hour. I ran the length of the bathroom, bones crunching away. I did pushups. I did jumping jacks (practically one-legged). I whisper-screamed my responses to her. Everything out of her mouth was said to mess with my head. I tuned it out until she found the one thing that hurt. “You failed today. No one is surprised. That’s all you are and that’s all you’ll ever be: a failure.” She didn’t notice at first that she had found the chink in my armor. She didn’t notice until she started saying other stuff like I was a piece of shit, which just reminded me of everything my dad had called me growing up. All it takes is one comment to chisel away at the crack in someone’s facade. She had called me a piece of shit before, but this time it was well-placed after identifying my biggest fear, and showing me that I was, indeed, a failure. I had nothing to prove her wrong. I was unqualified on the range and I was fired as the best recruit after holding the title for over a month. I lost the meritorious promotion that would have gone with graduating as the guide as well. I was a failure, and I got into my own head.

Supposedly verbally and emotionally abused children have a tape that plays in their head on repeat with the shitty stuff they have been told. My psychologist taught me that when I was 16. He worked hard with me for one year to try and break the tape that was on repeat of the things my family and classmates and church mates had said to me. First he made me tell him everything that I had been told or called or blamed for. Then he made me promise that I would catch myself with every self-deprecating internal comment and try to logic out why it wasn’t true and to remind myself and repeat back that I wasn’t everything I had been called:

Lazy, selfish, crazy, tissue in the wind that blows away when there’s work to be done, Lolita, fickle, unwanted child, the reason my parents fought, cheater, weirdo, waste of space, Femme fatale, vivacious, narcissist, slut, too young, five-head, cunt, liar, bitch, impossible to please, draining, rude…a failure.

So the DI had tapped into my self-deprecating tape and turned up the mental volume without knowing it. My face must have changed because she stopped short and laughed before taking her right hand and grasping me by the throat. She shoved me into the wall and then slid me up it, by my throat, with one hand. My feet dangled an inch off the floor and I began to struggle to breathe. As one tear leaked from my right eye, she reached up and wiped it away with a finger on her left hand.

“I have your soul.”

She placed my soul into her pocket.

In retrospect, as a demented veteran, this is hilarious. Props to her for breaking me. I understand it’s necessary to provide mentally and physically hardened Marines for the fleet and drill instructors are amazing for this aspect of training. They are ruthless because our lives depend on it, in combat and in life. They break us down, make us tap into our primal desire to survive, and then teach us how to kill. With them, and further training, Marines become the best war fighters on the planet.

When she gathered my soul and delicately put it into her pocket, that drill instructor made me primed and ready to learn how to kill.

Thanks, Soul Collector. You fucking suck.

Side note- it took two years for my ankle to “heal”. Yes, I receive disability for that ankle because I’ll be damned if it doesn’t just give out on me once a week and cause me to fall face first without warning.

Side side note: I qualified on the range as expert the very next week (although Parris Island only allows you to be named a lowly marksman until you qualify in the fleet when you unq in boot camp) and for the rest of my career. Shout out to my husband for teaching me how to shoot when I got to the fleet, even on my shitty ankle. Third award expert. Yes, this is matters to me.

You Know What Really Grinds My Gears? Or My List of First World Problems

-When two people stand on opposite sides of the hallway and carry on a conversation that I have to walk through. If I walk through your conversation more than once, saying “excuse me” each time, how about you get it together and convene somewhere else? Or at least stand on the same side of the hallway.

-When people misuse the following words/phrases:

  • Error on the side of caution = Err on the side of caution
  • It would behoove of you = It would behoove you
  • Irregardless = not a word
  • Due to = due should be only used in matters of finance; use “because of”
  • In regards to = in regard to; regards are only given
  • Intensive purposes = intents and purposes

-When I receive an email that tells me I have successfully unsubscribed from emails

-When people “apologize” by saying “I’m sorry you feel that way.” No, be sorry for what you did.

-When my kid dumps his shoes full of sand onto my freshly vacuumed carpet. *shakes fist at sky*

-Littering. It’s just lazy.

-People who smoke. Just because you do it outside doesn’t mean you don’t reek of it. I can appreciate a good drag maybe once every few years when I’m blitzed, but smokers are notorious for taking more breaks at work than non-smokers.

-How terrible American chocolate tastes. Hershey’s tastes like wax.

-How many passwords I have to remember. I wrote them all down once; I have over sixty-five, not including social media. Yup.

-That I can never remember how to spell:

  • lieutenant
  • rendezvous
  • guarantee

-That the Pun of the Day app stopped being compatible with Apple software

-Acronyms that don’t make sense. This includes acronyms within acronyms. Stop trying to acronymize a thesis statement, United States Navy!

-That I wasn’t allowed to own a car in Japan, but my husband was. This is because he was the sponsor for the Status of Armed Forces that allows Americans to own cars in Japan. I understand why, but that really ground my gears.

-When people make lists of what grinds their gears.

-Embedded links on people’s pages that give them money if you click on them. Ads on people’s pages. That certain websites won’t let you access them if you have on ad blocker (which I know you can solve by disabling JavaScript but should I REALLY have to do this?!). Pop-ups. LITERALLY ANYTHING THAT IS TRYING TO MAKE MONEY FROM MY VIEWING. Don’t try to show me what you think I want to see based upon my cookies. If I need something, I’ll find it. I will never put ads on my blog. Jesus, this really irritates me. I don’t even care if you are upfront about your affiliate links. You look like a douchebag (“Hey guys, I’ll get paid if you click on certain links in my blog!” Fantastic. I’ll just Google the item instead of clicking on your link. Yes, I’m that petty. You made me read your life story when I just wanted a brownie recipe.). Give me the old-school subliminal messaging to change my purchasing habits.

-That algorithms give people what they think they want to hear and see, which ends up allows like-minded people to congregate. This develops pockets of like-minded people who dutch rudder each other with their points of view instead of exposing them to different points of views that might allow them to grow in their understanding and compassion of others. I would vent on this one awhile too.

-When songs or commercials or TV shows aren’t the same volume as the other things I’m watching/listening to. Stop making me mess with my volume. It isn’t that hard to change the decibels on a recording (first hand knowledge here; stay tuned for my sex tape).

Alright. I think I’m done for now.

Some Administrative Stuff

I’m sure you’re wondering what happened to me writing The Breaking of the “Innocent”. As it turns out, publishers don’t take too kindly to “previously published” works, even if the publishing occurred on a personal blog. Therefore, I have locked down all chapters and haven’t published any others that I have written.

I found an editor, who is actually pretty awesome, and possibly have a lead in for a huge agent. Let’s cross our fingers, shall we? I have completely edited the entire manuscript, and I have about ten percent left to write before an introduction to two international publishers. If you wish to stay up to date on the book, which is now called Breaking “Innocence”, please follow me on my Facebook page, Bamboo and Bananas.

Thanks for following!

Financial Advice From Someone Who Has No Official Education On The Subject But Seems To Be Doing Okay

No, there are no affiliate links. I just want to help people.

Let’s talk finances. For some reason, speaking of money makes people uncomfortable. Perhaps it is the idea that a person’s value is based upon their net worth and everyone is afraid to look like “less of a person” when they aren’t the richest in the room. However, it is only through discussion that we learn and grow! Don’t be selfish with your money knowledge! Let’s talk about some of the ways I have found to save money/grow money. No, it is not all inclusive but it is a start. Not all of these may be applicable to you, but check it out anyway:


-Check to see if you are owed any money by companies by searching your name in every state you have ever lived for “unclaimed property”. Companies have to report funds that they owe their customers to the state comptroller and when it isn’t claimed, the money goes…? No idea, but this is legit and safe. Check for your family members (even deceased!). Quite a few people I know received a windfall from this tip. Personally, I was owed $60 and I am expecting the check within the week. Some work may be required to claim your money, like proving who you are, but duh…this is money that is literally yours. Go get it. And check once a year for newer accounts. Companies are shady. Don’t let them not pay you.

-Ask for lower APRs on your credit cards once a year. This will save you money if you do have debt that you are paying off.

-Ask your credit card company to increase your credit limit once a year. This helps your credit score. This doesn’t mean use that extra credit; just lower your credit to debt ratio by increasing how much money you COULD spend.

-Link all of your accounts together to be viewed in one place. USAA does this easily. I have 23 accounts that I manage; I separate them into “Banking”, “Debt”, “Savings”, “Investments”, and “Insurance”. This allows me to see everything at the same time with no guessing about accounts at other banks. Link everything: loans, savings, credit cards, checking, TSP, 401k, IRAs, etc.!

– Look at the statements of every account religiously. Challenge anything that looks out of place. Make sure you cancel any automatic charges that you see that you aren’t using anymore. When I walked one friend through this step of financial welfare, he found that he had been paying Sirius XM for a car he had sold over a year ago. WHAT?!

-Automate all of your bills. It’s 2018. Come on. Besides saving money on stamps and saving the trees, this prevents any bills from being paid late.

-Because accidents happen, set up backup accounts for every account that pays your bills. This prevents overdraft fees because your bank will automatically dip into your backup overdraft account when your original account can’t keep up with your expensive coffee habit. Some banks (like Navy Federal Credit Union) actually allow you to open a small line of credit as an overdraft account. Other banks may ask you to use your savings account. Either way, you have a good buffer in case some asshole company accidentally charges you twice and sends you into overdraft fee area. (Beware, that line of credit will cost you interest if you don’t pay it off immediately, but that won’t happen to you, right? You know to check your accounts religiously.)

-This bullet is going to be huge. Everyone says to write out a budget. Oh yeah, that’s a great idea. Of course it is. Pull up Microsoft Excel and write out a line item list of your budget. Identify every source of income and every expense. I suggest making each tab at the bottom of the spreadsheet its own month. Here is what mine looks like:


There are a few equations I’ve built into the spreadsheet to calculate totals. When a source of income comes in, I mark it green; when a bill is paid, I mark it green. I have identified every due date (automatic payments, my friend) as comments on the bills. “Other Deductions” and some of the investments are automatically withdrawn from paychecks so I don’t give them a color.

Separating into 1-15 and 16-31 columns allows me to see how evenly my bills hit my accounts. You can call up companies to move your bills to another date within the month to spread the pain over the month a bit.

The BIGGEST game changer for me was creating a new line in the budget for “Yearly Expenses.” I don’t know about you but every huge annual bill seemed to hit at the exact same time for us (probably because we tend to make huge life decisions at the same time every year when the military moves us.) During this month, I would see savings accounts drain to cover bills like vehicle registration, ball tickets, insurance, and Amazon Prime. So I took every yearly fee and listed it on a separate tab. I identified its due date and how much it costed yearly. I added up every yearly charge, and then divided it by 12 (for months in the year, doofus). This was my new line item in the budget. As time went on, I expanded this line item to include $2000 a year in vehicle maintenance (think oil changes, paying for parking, and new windshield wipers). So when I needed new tires, I didn’t even flinch. It was already covered in this “Yearly Expenses” account.

I also identified every outstanding issue for finances (don’t we all have those?) to keep an eye on. For example, I have been fighting the VA for a ton of money since 2016. That is on my list and will be until they GIVE ME BACK MY MONEY. Other things on the list include known financial variables such as guaranteed raises and when they will happen, getting multiple vehicle discounts on your insurance when the vehicles are insured in the same state, etc. Think of that tab as a financial forecast for you to know what is coming (good and bad).

Let me know if you want me to send you a copy of my full budget spreadsheet. I have been doing this for five years and it has given me serious peace of mind.

-There are free National Parks Days. Use them!

-Everyone should aim for these financial milestones:

-Three to six months’ worth of savings that will cover EVERY bill in case something goes wrong.

– No debt

– 15% of your income into retirement. Some companies match up to 5%, which is FREE MONEY!

– Everyone should also have the following:

-Life insurance

-Medical insurance

-Dental insurance

-A will

-Possibly a power of attorney if you think you can handle someone else making financial decisions when you are in a coma. Haha!

-Other good tips:

-Housing shouldn’t cost more than 28% of your income.

-If you lend money to friends and family, don’t expect it back. I’m not saying not to give it to them, but understand that once it leaves you, it is gone. If they surprise you and give it back, hey, it’s a nice windfall.


-Sign up for active duty checking through Navy Federal Credit Union. You can get this while you are active duty and continue to receive the benefits, such as $20 back a month in ATM fees from any ATM in the world, for the rest of the time your account is open, even if you are no longer active duty. When ATMs charge you ridiculous fees to access your own money, I see this as a win.

-Sign up for the Navy General Library Program and download Overdrive onto your phone. With your military email account, you can access millions of audiobooks and e-books FOR FREE. Don’t pay for Audible; if the Navy Library doesn’t have the book, you can request it. This is an amazing resource.

-Realize that you get free access to National Parks and Monuments for free while you are active duty.

-Notary services are free at all legal offices.


-Get rated by Veteran’s Affairs (VA), EVEN IF YOU HAVE NO INJURIES. California allows any child of a United States veteran to attend any state college or university TUITION FREE with a disability rating of 0%. Do you realize how huge this is??! That alone is worth my entire enlistment.

-Veterans with a verified disability can receive a pass for free access to all National Parks and Monuments. America is beautiful, guys. Go see it for free.

Let me know if you have any questions or want that spreadsheet:

Rare Chronic Illness in the Electronic Healthcare World

In 2016, I wrote this research paper for my graduate program at Virginia Tech. The professor asked me to publish it but that never came to fruition. The topic may be dry (there are even references and appendices!), but I poured a lot of my heart into the research because it was for someone I used to love. I want to share it so maybe some people will learn about an unusual chronic illness and so I don’t lose it in a late night attempt to remove this man from every aspect of electronic existence. It took a lot of work, and even dry work can be appreciated by some of us.

Executive Summary

            The patient is a middle-aged male with thyroid cancer, hypoparathyroidism, and a heart condition. This research paper discusses the experiences with the electronic health record (EHR) system of Scripps Medical Center in San Diego, California and the subsequent trials and tribulations of the currently used system as a patient with a chronic health issue. The good and bad experiences of this patient as detailed by this report are a glimpse at the impact electronic health record systems have on patients with long-term illnesses. Finding a way to increase the quality of health for patients through the proper development and implementation of Healthcare Information Technology can ease the strain of chronic illnesses on the family, friends, and first most, the patients. This report will discuss the results of my interview with the patient regarding his healthcare experience through the years. The report identifies the difficulties of this patient’s experiences with his personal health record management and healthcare management through his eight year journey. Suggestions will be made to increase patient autonomy, patient-doctor interactions, and overall healthcare experience through biometric patient identification, integrating patient monitoring systems into a patient’s EHR, patient reminders for appointments and prescription renewal, improved EHR system design, a proposed patient monitoring system, and digital support from others with the same chronic conditions.


In 2015, a man stumbles into the hospital’s emergency room. He is incoherent, and leans heavily against the receptionist’s desk while tapping his right arm with his left fingers. The receptionist asks for his name and ailment. She repeats herself as he struggles to breathe, seemingly suffering from severe body cramps. A nurse sees his actions from across the room and rushes towards him. Just before she reaches him, he collapses.

The nurse takes the man’s vitals and rushes him into the back room, working to rule out conditions such as stroke or heart failure. While the nurse works, another nurse searches the man’s pockets for identification or any paperwork that would help them understand his ailment. Without identification of the patient, the process of determining what is physically wrong with him can take a long time- long enough to possibly damage his body further. As the two nurses work, another one walks by and recognizes the patient. She identifies him, and then pulls up his medical chart in the hospital’s Electronic Health Record System. With his health history readily available, the diagnosis is quickly made by the attending physician: hypoparathyroidism. He is immediately treated with the proper dosage of calcium and begins to regain control of his muscles.

In 2012, this man was my immediate supervisor. We had worked closely together for two years, spending sixteen hours a day trying to ensure our jobs stayed intact. Along the way, we morphed into friends as well as supervisor and subordinate. One day, he mentioned he needed to go to the doctor to get a lump in his throat checked out. He brushed aside my concerns and did not mention it again. Because I knew his personality and his extreme disregard for logistical events such as scheduling appointments and actually going to the doctor, I doubted he would be seen by a doctor. When he mentioned that the lump was discovered in 2008 and he had ignored it thus far, it became evident how insignificant he believed this lump to be. He would get around to getting it looked at by a doctor when it was convenient for him.

This paper discusses the implications of the patient’s diagnosis and the difficulties he has had with managing his health as an individual with thyroid cancer, hypoparathyroidism, and a heart condition. Because I am his friend, I know an improved EHR system in addition to an at-home patient monitoring kit for calcium levels would encourage more patient interaction, patient-centered care, and better healthcare management with a person as stubborn and unorganized as he.

Other Research

Chronic Disease Management

In the United States, 70% of deaths are caused by a chronic condition such as heart disease, cancer, and stroke (Zamosky, 2013). With such a high number of patients experiencing these kinds of health problems, doctors, from primary care physicians to specialists, are determining ways to best help patients manage their healthcare through the use of electronic health records that show a patient’s complete health history. If primary care providers and specialists alike share access to the same EHR for a patient, or if the facilities which the patient uses have interoperable EHR systems, then a patient’s electronic health record will have a complete picture of who is treating the patient and how they are approaching the management of a patient’s chronic disease. With Americans such as the patient in this report, there is not just one chronic condition to have a complete understanding of when treating a patient. One in four Americans under the age of 65 have more than one chronic condition, and that number increases to three in four Americans after the age of 65 (Multiple Chronic Conditions, 2016). As more Americans age and develop chronic conditions, it is extremely important for EHR systems to be interoperable so a doctor can view a patient’s EHR and be assured that the information is complete and accurate.

Currently, a lack in EHR system interoperability is challenging patients and doctors as patients try to get their records updated as they move between healthcare systems and as doctors try to fully understand a patient’s past health with incomplete records. Although incentive programs driven by Medicare and Medicaid and endorsed by the Office of the National Coordinator for Health Information Technology are in place to drive interoperability and meaningful use of EHR systems within hospitals, barriers such as timeliness and vendor replacements are causing interoperability to be lacking in most EHR systems (Achieving Interoperability that Supports Care Transformation: A Report of the American Hospital Association Interoperability Advisory Group, 2015). When EHR systems are not interoperable, patients become overwhelmed with additional paperwork and vender requirements to get their EHR records consolidated and complete.

Patient Monitoring Services

There have been multiple types of patient monitoring services that track a patient’s health data and upload it to an area of the internet for review. This type of monitoring can be for the patient’s personal knowledge of their working body, such as through a heartrate and activity tracker like the externally worn FitBit (See Appendix A). The data collected from personal monitoring devices such as an iPhone Health Kit is not uploaded to the patient’s EHR and thus is inaccessible to the doctor to produce a better picture of the patient’s health and level of activity. With personal monitoring devices like glucose testing meters, the information is displayed immediately to the patient and the patient makes personal medical decisions based upon the numbers produced. However, the numbers are also rarely uploaded to an EHR for the doctor to review them and to track the health of the patient over time. Some monitoring devices can be used for diagnostics, to catch an event that happens when the patient is sleeping or otherwise away from the doctor’s office, like the externally worn Holter device (See Appendix B). This information is available to the doctor’s office, alerts the doctor of any immediate issues, but the device information is not always uploaded to the patient’s EHR.

EHR systems are changing the way patients can view their health records and how doctors can track and treat diseases. If EHR systems have fully integrated patient monitoring systems like the FitBit, the Holter device, or blood serum chemistry monitor results that update into a patient’s record, doctors could more easily see trends with particular patients. Over time, the collected data of EHR systems and related patient monitoring systems could allow clinical decision support systems (CDSS) to provide evidence-based proof of why patient care should be handled a certain way. Some home monitoring systems have begun to integrate the data collected into the patient’s EHR record, but this capability is not available with every monitoring system or with every EHR system so many patients are not awarded the benefits of integrating their data and having their health history on file (ECG and Glucose Data: Collect them directly to Your EHR, 2014).

Data collection/data analysis/method of analysis/methodologies

An email was sent to the patient on July 9th, 2016 with a list of questions so I might better understand the journey his health had taken and how he felt his EHR record management was handled by the hospital and outpatient facilities during his ongoing eight year journey (See Appendix C). Our discussions of his health over the years have been in person, through Google chat, through email, and over the phone and Skype. I have listened to his medical concerns, his successes, and his failures. I will try to consolidate his medical journey from the past eight years below.

Lump Identified

This patient’s medical journey began in 2008 with a routine medical visit to his primary care doctor. The patient discovered a lump in his neck and went to a local imaging clinic to have the lump identified. During the computed tomography (CT) scan, a salivary stone was identified. Once the doctor identified the stone, he mentioned that there was another lump “worth getting checked out.” The patient ignored the lump until 2012, when he switched primary care doctors and went to a doctor within the Scripps Medical Center who determined the lump must be looked at immediately. He met with an endocrinologist to get a fine needle aspiration (FNA) biopsy (see Appendix D). However, the FNA biopsy has an inadequate specimen rate of 10-20% and the patient underwent two unsuccessful biopsies with three to five aspirations each before getting placed under anesthesia within a Scripps laboratory to ensure the aspirations provided an adequate specimen (Kim, 2008). The endocrinologist performed over 20 aspirations on the patient at this time. The specimens taken at this time were still inadequate so the endocrinologist decided to have half of the patient’s thyroid removed.

Thyroid Surgery and Hypoparathyroidism Review

The first thyroid surgery went well. Half of the patient’s thyroid was removed by an otolaryngologist (a surgeon of the ear, nose and throat) through a partial thyroidectomy and sent to be biopsied. One of the serious complications of thyroid surgery is the rare chronic illness, surgical hypoparathyroidism, which means the parathyroid glands, located near the thyroid, are damaged and can no longer regulate the calcium needed for the body to function by the release of the parathyroid hormone (PTH) (See Appendix E) (Hypoparathyroidism – National Organization for Rare Disorders, 2014). When the calcium levels in a person’s body drop, the parathyroids create more PTH, which causes the body to create more calcium. Inversely, if the calcium levels are too high, the PTH levels are decreased and the body slows the production of calcium. After the removal of any portion of the thyroid, a patient will be closely monitored to ensure his/her calcium and parathyroid hormone levels are within sufficient levels (See Appendix F). These blood tests are conducted during surgical recovery, and are ordered by the otolaryngologist to be conducted in the hospital’s lab once the patient has been released for at-home care. During surgical recovery, patients are orally given calcium and vitamin D to prevent hypocalcemia, or a decrease in calcium in the blood, in the days immediately following surgery (Sanabria, 2011). After the initial tests, it was revealed that the patient’s parathyroid glands were working properly and his body was capable of regulating calcium.

Cancer Diagnosis and Hypoparathyroidism

The biopsy of the patient’s thyroid came back as malignant. He was diagnosed as having a Stage 3 follicular variant of papillary thyroid cancer and would require immediate removal of the rest of his thyroid. The second surgery was performed by the same otolaryngologist. After the conclusion of the second partial thyroidectomy, the patient’s PTH and calcium levels were monitored and he was released. A patient’s calcium and PTH levels can take a few weeks after thyroid surgery to return to acceptable standards. This patient’s PTH levels were tested weekly, and showed that the patient’s parathyroids were unable to produce sufficient levels of PTH. The calcium levels in his blood were not high enough to control muscle function in his body.

Surgical hypoparathyroidism is a permanently disabling chronic condition that requires the patient to consistently take calcium and vitamin D to help their body’s muscles function normally. Vitamin D allows the body to properly absorb the calcium ingested by the patient. Without proper levels of PTH and calcium, the body begins to experience muscular spasms called “tetany”, extreme discomfort and tingling in lips, hands, and feet, difficulty walking or breathing, and a sense of “grogginess” in mental function (Lewis, n.d.). Oral calcium and vitamin D supplements help relieve these symptoms in the short-term, but long-term effects of hypoparathyroidism include kidney failure, basal ganglia calcifications (calcifications in the brain), neuropsychiatric derangements, and infections (Lorente-Poch, 2015).

Patients with hypoparathyroidism experience a decreased quality of life from having to take medicine hourly, from having to attend multiple appointments with endocrinologists and other specialists, and from having blood drawn consistently to track calcium and PTH levels. Keeping PTH and calcium levels consistent in the body require constant discipline in diet, restriction of physical activity, and a desire by the patient to stay healthy. This patient was required to maintain his calcium at a moderate level through oral consumption of calcium supplements, Calcitriol, which is a prescription form of vitamin D to help the body properly absorb calcium properly, and magnesium (Calcitriol: MedlinePlus Drug Information, n.d.).

Heart Failure

Because calcium levels in the blood dictate muscle control and function, experiencing an increase and decrease in levels over time can influence the function of the cardiac muscle (Marks, 2003). In 2014, after the patient’s second thyroid surgery, he began experiencing painful heart palpitations six or seven times per hour. After a referral to the cardiologist, he was placed on a Holter monitor, which is a portable electrocardiogram (EKG) recorder externally placed on the patient’s body for 24-48 hours (See Appendix B). The electrodes read the rhythm of the patient’s heart, record the rhythm for a period of time, and synchronize the recordings to a BlackBerry phone. If a cardiac event is particularly significant in nature, the Holter device will immediately send the EKG results to the doctor’s office and alert the doctor who is on-call of the patient’s current heart condition (Cardiac Event and Holter Monitoring, n.d.). However, this device must be worn by the patient continuously to ensure an accurate monitoring of the cardiac muscle (Holter Monitor, 2015). This patient did not wear his Holter monitor consistently enough for the doctor to make a diagnosis and the patient was ordered to wear the monitor for an additional recording session.

During the next recording session, the Holter monitor revealed a significant event in the patient’s heart called ventricular tachycardia, or V-Tac, that causes palpitations of the cardiac muscle, a slowed heart rate, and weakness (Koplan, 2009). The patient’s doctor’s office called him and insisted he come into the hospital immediately. During the hospital’s evaluation of his condition, he was placed on a calcium and magnesium drip as his calcium levels were decreased as a side effect of his hypoparathyroidism illness. The patient experienced a second V-Tac episode and underwent open heart surgery to address the V-Tac episodes and an additional atrial flutter that had been identified through a cardiac catheter ablation. Catheter ablations attempt to correct heart arrhythmias through the destruction of the heart tissue that seems to be causing the arrhythmia (Ablation for Arrhythmias, 2016).

During the heart surgery of the patient, the cardiologist was able to recreate the atrial flutter and thus fix it with the catheter ablation. However, the cardiologist was unable to recreate the V-Tac episodes. The cardiologist and the anesthesiologist assigned to the surgery woke the patient up and asked if they could drop the patient’s calcium level, which had been brought to the proper levels in preparation of the surgery, because they believed the extremely low levels of calcium the patient experiences had influenced and possibly caused the V-Tac episodes. The patient dissented and the V-TAC issue was not replicated in surgery, therefore the possibility of the patient experiencing another V-Tac episode in the future is possible.

The patient was required to take a beta blocker to restrict his heartrate from exceeding a certain number of beats per minute. A beta blocker slows a patient’s heartrate down by blocking the norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves. This blockage of the beta receptors causes blood vessels to constrict, airways to tighten, and the patient’s heartrate and breathing to slow down, regardless of how much oxygen or blood the body needs to function correctly (Beta Blockers: Drug List, OTC, Brands, and Side Effects, n.d.). The patient stated that the beta blocker was painful, disconcerting, and made him feel very light-headed. As an individual who likes to stay active, the patient was used to getting his heartrate elevated during exercise. The beta blocker restricted his activity level and made his usually active lifestyle very sedentary.

Linq Monitoring Device Implant

While the Holter monitoring device was beneficial for identifying the atrial flutter and V-Tac episodes, the device is bulky and required the use of several electrodes that remain attached to the body. It is cumbersome but acceptable for a few days of observation. In long term monitoring scenarios, cardiologists advise the use of an internal monitor. Medtronic Diagnostics is a third party company that develops the Linq Heart Monitor, a device approximately smaller than the size of a single AAA battery, which is placed between the skin and ribcage on the left side of the patient’s body (See Appendix G) (Reveal LINQ | Insertable Cardiac Monitoring | Medtronic, 2016). The patient had this device placed within his body in 2015 after his second heart surgery via catheter ablation to address the atrial flutter. The lifespan of the Linq device is three years, but the one originally placed within the patient’s body began to show signs of failure within six months of its implantation. The patient underwent another surgery to have the faulty device replaced with a second Linq device in December of 2015. There have been no issues with the patient’s currently installed Linq device.

Reducing Medicinal Dependency

After researching the long term effects of taking calcium supplements, the patient determined he would cut down on the amount of calcium he was taking. Through trial and error, the patient reduced his dependency on Calcitriol, calcium, and magnesium. The patient’s cardiologist determined that the second heart surgery had gone as planned and he was slowly weaned off of the beta blockers. While the patient feels well enough to attend work and conduct strenuous exercise on most days, his calcium levels are still too low to be considered healthy and acceptable and his body is not producing PTH. The patient’s endocrinologist disagreed with the patient cutting down on his calcium but eventually agreed that if he feels well enough, then that is what matters most.

Current Condition

The patient is currently taking 250 milligrams of over-the-counter calcium supplementation twice a day, at 10 in the morning and 8 at night.  The patient is inconsistent with when he takes the calcium and refuses to take his prescription of Calcitriol, which means his body may be receiving the calcium he is giving it twice a day, but the calcium is not getting properly absorbed because the body needs proper amounts of vitamin D. The patient claims to not take his Calcitriol because the timing is inconsistent, his work is distracting, and he forgets. The patient will often wake up “groggy”, or mentally impaired, and occasionally throwing up bile. However, the patient’s consistently decreased calcium levels will affect the patient’s already weakened heart. The patient should focus on increasing his calcium levels within a normal level to preserve his heart in the long-term, regardless of how he feels on a day-to-day basis.

Results and discussion

Electronic Health Record Errors, Faults, and Inconsistencies

The patient rarely accesses his electronic health record via Scripps Health Hospital System’s patient portal, MyScripps, because of the lack of complete and helpful information. When the patient had his original CT imaging completed on his neck to diagnosis the salivary stone in 2008, he went to an imaging clinic outside of the Scripps Health Hospital System. The imagining clinic retains electronic medical records for each patient but they require access to an electronic health record system that is separate from Scripps’ (See Appendix H). For the patient to have the scans from the imagining clinic made available within his MyScripps EHR, he is required to call the imaging clinic and submit multiple types of paperwork to have his 2008 images moved to the Scripps EHR system. This lack of interoperability between EHR systems brings irritation to the patients and a lack of a complete history of a patient’s health if he or she is treated outside of his or her normal EHR supported healthcare system.

In one instance, the patient was required to have the medical records from one of the Scripps Healthcare facilities be transferred to his specialist. He had the option to get the medical records mailed through the United States Postal Service or hand-carry the records himself. The mailing of the records would take seven to ten business days, and the patient had forgotten to request the records be mailed, so he was required to pick up the records at one location and take them with him to his appointment. Relying on a patient to take their own records from doctor to doctor, or having to rely on the patient to submitted a request to have their medical records mailed allows medical records to remain incomplete because patients with chronic conditions  are already overwhelmed with the number of appointments and medications to retain and are likely to forget medical records.

The solution to this particular issue is to ensure hospitals and healthcare facilities implement or update to EHR systems that have interoperability with other EHR systems. When a patient has to complete extra paperwork to get his/her electronic health records merged into one system, it is a time consuming waste when a simple electronic request from one facility to another to have a patient’s records transferred should be sufficient. The consolidation of patient EHRs from each system will help all patients, especially those with chronic conditions which require seeing multiple doctors in multiple systems around the country or world. The meaningful use of EHR systems in the interoperability capacity will support patients with chronic conditions who have a lot to track regarding their medical health.

Biometric Identification Use

Scripps Health Center uses biometric information to identify patients at some of their facilities (Drake, 2013). Instead of fingerprinting, which is impossible with 2% of the population because of damaged fingertip ridges, Scripps Health Center has implemented palm scanning technology called PatientSecure (Wilson, 2003). This type of patient identification scans the patient’s palm and immediately brings up his/her electronic health record, which provides instant and easy identification for every patient if he/she is checked into at a facility which uses the palm scanning devices (See Appendix I). However, the patient stated the palm scanning devices are not always in use, possibly because of system maintenance, and also because the scanning devices are not installed at every Scripps location. During the emergency room visit discussed in the introduction, the palm scanning identification devices were installed but not in use and the patient had extreme difficulty in identifying himself. The muscle tetany, caused by the lack of calcium in the patient’s body, caused a seizing of his muscles and his inability to speak or retrieve his wallet with his identification from his back pocket.

If the palm scanning biometric systems would be in use at all locations at all times, patients would not have to provide a source of identification independent of their own body. If patients are incapacitated, unable to speak or move, the palm scanning biometric system can be used to easily bring up a patient’s electronic health record in the hospital’s system that states allergies, ongoing and chronic health problems, and reduce the number of medical mistakes that are made from a lack of patient identification.

Lack of Emotional Support

Today’s world is linked together through the Internet and many people turn to the Internet when they need medical guidance (Belbey, 2016). When a patient has a rare disease such as hypoparathyroidism, they become a member of a small community that does not have much public awareness. The lack of public knowledge or support can lead to a patient with a rare disease to feel alone in his/her healthcare experience. With the advent of the Internet, social media platforms such as Facebook, Twitter, and personal blogs began to give patients an area to discuss personal healthcare stories, upcoming clinical trials, and connect with professional healthcare providers. It is the responsibility of the patient to seek out these platforms and discuss their health with virtual strangers. This patient, as a middle-aged male, is not classified as an individual who immediately seeks health advice from the Internet. He feels disconnected from other individuals with these chronic conditions, even though he has tried finding people like him on the Internet.

When hospitals have a social media platform that engages patients and doctors, they are cultivating interaction between patients who have similar diseases. This type of support and medical transparency fosters medical knowledge and hope among people with serious chronic conditions. Scripps Health has a Facebook account that it is very active, but it does not encourage patients to discuss medical experiences with each other. Again, patients must seek out support groups individually. The patient portal which he/she uses to view his/her EHR is an ideal place for the healthcare system to place links and information regarding support groups. Through the use of data mining, EHR systems can link approved social media outlets for patient support dependent upon the diagnoses in the patient’s EHR. Hospitals could endorse the social media platforms and patients would not have to search for support groups and reliable information on their own.

Limits of Electronic Health Record Interaction

MyScripps is the portal in which patients within the Scripps Health Hospital System view their electronic health record (See Appendix J). The EHR system gives patients a way to see their laboratory results, email their doctor with concerns, see their complete health record, and make appointments. While the portal is an excellent device for patients to be more involved with their healthcare, the current EHR systems used by Scripps, GE Healthcare’s Centricity Enterprise EHR and Allscripts, is lacking in mobile application support and the doctor/patient email system is flawed (Miliard, 2016). Currently, a patient can look at his/her electronic health record on any mobile device. However, when a patient pulls up his/her laboratory results, the bloodwork is displayed in a desktop setting, which makes reading the bloodwork impossible on a mobile device as the patient must scroll back and forth between small print and unmatched lines of blood chemistry levels. This lack of mobile support is inconvenient for patients who must log into a laptop or desktop machine to properly display the blood test results.

The patient portal that allows patients to view their electronic health record also allows patients to email questions or concerns to their primary care physician and any specialist doctors whose care they might be under for specific illnesses. However, the patient in this research paper has had issues with the allowed length of digital communication with the doctors. He is limited by the system on the number of characters he is allowed to type in his concerns. While his endocrinologist, the doctor with whom he is most in touch with regarding his calcium levels, is prompt with her responses, there is a significant lack of complete communication through this email service. While a patient’s concerns might be lengthy, a well-written email can articulate certain aspects of his/her care that the patient might otherwise forget in a face-to-face doctor’s visit. As appointments with doctors are limited to time slots of 15-30 minutes, allowing a better way for doctors and patients to communicate without character length restrictions through the patient portal would foster more interaction and knowledge of his/her illness by the patient.

The patient prefers to call the hospital system to make appointments instead of using the patient portal. In the early days of his thyroid surgeries and heart issues, the number of appointments the patient had to schedule was numerous. When the patient would call Scripps to make an appointment, appointment reminders were not sent to him by email, text message, or mail. He would have to manually enter appointments into the Microsoft Outlook account managed by his work to keep track of the cardiologist, endocrinologist, and otolaryngologist appointments, as well as all blood test appointments to track his calcium and PTH levels.

Calling the hospital healthcare system to make appointments is time consuming and allows a lack of responsibility when an appointment is scheduled incorrectly. On one occasion, the patient believed he was to attend an appointment in one location because the receptionist phone who scheduled the appointment on the phone told him his appointment would take place in that location. On the day of the appointment, he arrived at the location to learn that the doctor he was meant to see was not scheduled to treat patients at that location on that day. The miscommunication of appointment locations cost the patient a day at work and an additional appointment had to be scheduled. Although the patient could have avoided this scenario by scheduling his own appointment through the patient portal, Scripps Health Center could alleviate situations such as these by sending email appointment reminders or text alerts which notify the patient the day prior and the day of the appointment of the appointment time and location. The patient expressed a great interest in textual alerts getting sent to his phone.

Lack of Monitoring Information Access

Although the patient has access to his EHR through the MyScripps patient portal, the information from his Linq heart monitoring device is not linked to Scripps’ system. If the doctor wishes to discuss something unusual that has occurred with the patient’s heart as identified by the Linq device, the doctor must access Medtronic Diagnostics’ electronic database to pull up the EKG results, and then print the findings out on regular paper to be available for the patient to view during his appointment. The patient has access to his Linq monitoring information, but it is a costly and timely process involving the doctor’s time, the hospital’s paper resources, and the medical assistant who answers the phone to take the request for the information to be pulled for his appointment. The patient is not given access to Medtronic Diagnostics’ portal for their information and their information is not linked to their EHR.

Not having convenient and constant access to his personal health information without the assistance of the doctor’s office is cumbersome and limits a patient’s ability to notice possible correlating events in his healthcare. If the patient was to exercise intensely and it affected his heart’s function, he would not know until his next doctor’s appointment. Urgent heart issues are brought up to the doctor’s office immediately upon occurrence, but less concerning although still important heart activity is earmarked by the monitoring system for later discussion with the doctor. If the patient had access to his heart’s activities through his EHR, he would be more knowledgeable on his heart’s health and stressors from a day-to-day view. Allowing the patient to see immediate results of his heart activity shifts the healthcare experience to be more patient-centered and gives the patient more responsibility for understanding his heart and adjusting his daily activities accordingly.

Patient Monitoring Services

With the many factors that can affect calcium levels in the body, such as exercise, caffeine and food intact, and the levels of magnesium and phosphorus, an individual with hypoparathyroidism finds that keeping their calcium level without excessive calcium supplement use is difficult. The use of a patient monitoring device that allows patients with hypoparathyroidism to check their calcium levels at intervals during the day could give doctors and patients a better idea of what specifically affects his/her calcium levels. The calcium level in a person’s blood is sometimes compared to that of an individual with diabetes’ glucose level in hypoparathyroid support groups. Without glucose, or calcium, in the proper amounts in the body, certain activities such as holding a full time job or completing everyday tasks can be severely affected. Individuals with hypoparathyroidism often find consistent work or exercise causes sudden debilitating cramping and fatigue.

There is an extreme interest by the hypoparathyroid community to have an at-home calcium monitoring system to help monitor which activities will affect an individual’s calcium levels (See Appendix K). This type of patient-centered care can give more control to a person with hypoparathyroidism and allow him/her to safely push their bodies. Currently, a person with hypoparathyroidism has to wait days and sometimes weeks for a doctor to order a blood test within a laboratory to know if their calcium levels are within healthy standards. He/she must continue to take the same amount of calcium, even if it is too much, to prevent themselves from becoming too weak or putting their lives in danger. With a patient monitoring system that allows a patient to check their calcium levels at home, he/she could feel at ease with knowing their calcium is just right or catch it dropping too low before feeling the effects of muscular seizures and having to rush to the hospital.


Contributions of your work & lessons learned

Pursuit of a Patient Monitoring System for Calcium Levels

During the research conducted in this paper, it was determined that the need and desire for an at-home calcium monitoring kit among patients with hypoparathyroidism is high. There are multiple social media groups and forums for people with hypoparathyroidism who are determined to properly manage their calcium levels and improve their quality of life. While most people with hypoparathyroidism struggle to work full-time or have a semblance of a normal life because of the fatigue and discomfort hypoparathyroidism brings, there is a specific group of patients with hypoparathyroidism who run Ironman races, marathons, practice Brazilian jujitsu, and lead an active lifestyle. The Facebook social media group, Athletes Beating Hypopara, is a group with 218 members who are either patients with hypoparathyroidism who attempt to complete physically demanding feats or are friends and family members of those with hypoparathyroidism who wish to help their loved ones have a normal life (See Appendix L). This group discusses ways to mitigate tetany, tingling and numbness, and extreme fatigue during and after exercise. While they do not diagnose or justify changing medication without discussing it with a doctor, they do provide their personal experiences, exchange ideas, offer support, and pass along information regarding on-going studies or advancements in the field of hypoparathyroid research.

After discovering this group and a larger group of people who struggle with daily tasks and life, Hypopara Lodge, the discussion of a development for an at-home calcium level testing kit was brought up by the group. Members are willing to band together and create a plan to have a prototype of the calcium level monitoring kit developed with the help of endocrinologists, pathologists, and members of the National Association of Rare Diseases (NORD). While hypoparathyroidism is considered a rare disease, the invention of an at-home test that determines the exact calcium level that is in the blood at the time of the blood drawn could help other patients with other calcium related diseases.

I have reached out to Dr. Michael Levine, chief of the Division of Endocrinology and medical director of the Center for Bone Health at the Children’s Hospital of Philadelphia, in hopes that he might be willing to work with pathology residents at the University of Michigan’s clinical research program to pursue a valid calcium blood test for direct-to-consumer testing. I am pursuing the development of a patient monitoring device that will be integrated into the patient’s EHR when results are updated. The development of the device will take the collaboration of clinical pathologists, endocrinologists, individuals with hypoparathyroidism and others whose lives will be changed by the development of an at-home calcium test kit.

Past Successes and Failures with Clinical Blood Tests

Research on innovative technology for testing calcium levels in the blood was conducted by the privately-owned research company called Theranos in 2014. Theranos claimed their technology was capable of testing levels of calcium in the blood with one drop (Primack, 2015). The current test for calcium in the blood by an independent laboratory requires at least two full tubes of blood to be properly read (PTH, Intact (ICMA) and Ionized Calcium, n.d.). However, Theranos is under scrutiny by the Food and Drug Administration (FDA) for the technology used by their tests and has cast doubt on the validity of the blood tests results (Primack, 2015). Walgreens Pharmacy had originally provided these blood tests produced by Theranos until the FDA suspended licensing for the tests and the tests were removed from Walgreens Pharmacies (Primack, 2015). While the instability of the tests produced by Theranos speak to the difficulty of preventing molecular breakdown of small amounts of blood during the calcium tests, Theranos stands by their technology and might have made a significant breakthrough in blood tests (Primack, 2015).  

The innovation of using one drop of blood to test calcium levels of a patient would completely change how disease management is conducted by the group of individuals who are diagnosed with hypoparathyroidism. Talks have already begun in these social media groups regarding the validity of past tests created by Theranos. If a test was created that allowed small amounts of blood to be used for calcium and PTH testing, a device could be created similar to a diabetic’s glucose test monitor to allow patients to monitor and regulate their blood calcium levels. A prototype that updates a patient’s EHR would provide complete and accurate blood serum levels for a patient over time. Coupled with a patient’s knowledge of activity levels, diet, and medicinal habits, doctors and patients can work together to treat diseases like hypoparathyroidism more effectively and possibly reduce adverse side-effects of long term care.


The proposed prototype will be ideally bought by the hospital or covered by insurance and given to the patient for daily monitoring of the level of calcium in his/her blood. The patient will be required to obtain lancets (See Appendix M) and test strips, preferably also covered by insurance. The patient will take the device home with them, plug it into the wall jack for power, and test their blood as necessary.

The at-home calcium test kit will be similar to a blood glucose meter. Patients who need to test the level of calcium in their blood should prick their finger with a clean lancet and deposit the blood drawn onto a test strip. Once the strip is saturated with enough blood, the strip can be inserted into the calcium level test reader. After a few seconds, the display screen will indicate the exact level of calcium in the blood at the time of the blood draw. The patient can see if they need to take more calcium immediately to offset their fatigue or tetany. Inversely, a patient who takes over 3000 milligrams of calcium a day can begin to safely decrease their dependency on the calcium by testing the levels of calcium in their blood as they decrease the amount they take without affecting their calcium levels.

With this prototype, the levels recorded by the patient monitoring system will be linked via wireless Internet to the patient’s home network and will contact the hospital’s EHR system through a virtual private network (VPN). The VPN will provide safe connectivity to the hospital’s EHR system and fully encrypt the patient’s healthcare data as it is transferred. The user should not be required or allowed to access the graphical user interface that sets up the VPN with the hospital. The VPN should be set up and managed by the hospital’s information technology staff. The patient’s identification number will be input into the patient monitoring system by the healthcare information technology staff. Through the VPN, the monitoring system will send every blood test that it encounters to the EHR system housed by the hospital. The patient’s identification number will be looked up by the EHR system as it receives notice of an incoming test result, the patient’s electronic file will be updated, and the blood test results should be immediately made available to the patient and doctor through the EHR.

While this prototype is currently meant to stay at the patient’s home and remain connected to the home’s network, it is within reason to expect development of a testing system that is smaller and portable to be connected to a “home base” for updating the patient’s medical information in his/her EHR. Further developments may include a way for blood tests to be conducted through a patient’s personal cell phone and have the results updated within the patient’s EHR immediately.

The results of the blood tests getting uploaded to a patient’s EHR will allow doctors and patients the ability to view chronic conditions in a more complete manner. In the particular instance of this patient, calcium levels and heart arrhythmias can be tracked and linked to certain levels of activities and medication intake. This will provide a more complete picture of the patient’s health as related to everyday activities and care. If the patient’s Lync heart monitor would also be updated within his EHR, a CDSS could begin to drawn relations between heart activity and the patient’s blood calcium levels. Currently, the cardiologist and endocrinologist believe there is a correlation but do not have any evidence to support their hypotheses. The data collected by the Lync heart monitored and the proposed calcium patient monitoring kit would provide long term evidence to support or disprove the doctors’ theories. With clearly obtained evidence of a correlation between calcium levels and the heart condition of this patient, as well as others with these chronic conditions, doctors would be more likely to find a solution to address both issues. Thus, the EHR system could prove as a valuable tool for chronic disease management, research, and development of new technology and drugs in the healthcare field.

Lessons Learned

Patients with chronic diseases are often overwhelmed with information, doctor’s appointments, and medicine he/she is required to take. Healthcare Information Technology systems like Scripps’ EHR system can greatly improve the quality of healthcare a patient receives if the systems are fully integrated, interoperable with other EHR systems, accessible in all hospital locations, and used to help patients attain the best possible healthcare. MyScripps Hospital is currently upgrading their EHR system from the outdated GE Healthcare’s Centricity Enterprise EHR and Allscripts system and implementing the EPIC EHR system throughout all of their hospitals and ambulatory centers (Miliard, 2016).

The Epic EHR system claims to address interoperability issues with EHR systems outside of the Scripps Hospital System (Miliard, 2016). With the interoperability of this EHR system, patients at Scripps will no longer have to worry about having their medical records mailed from one hospital system to another. Patient healthcare information will be immediately transferred in an electronically secure manner and all patient records will be complete. Implementation of this new EHR system should begin in 2017 and bring continuity between every system within Scripps Health as well as begin to eradicate the missing parts of patients’ electronic healthcare records.


Healthcare Information Technology is greatly improving the lives of patients with chronic diseases. However, there are lapses in the technology such as incomplete EHR records, a lack of interoperability between EHR systems, and patient monitoring device information that is collected and not fully put to use by the healthcare field. Addressing these discrepancies can further improve chronic disease management, drive patient-centered healthcare, and bring a new understanding of complete patient health by addressing a patient’s entire bodily health instead of focusing on individual chronic issues. Using EHR systems to their fullest extent can prompt patients to understand their chronic diseases in a more complete light with social media support, knowledge, and experience sharing.

Full and proper use of the EHR systems can drive research and development of the medical field. Correlations between chronic diseases can be noticed and addressed through integration of patient monitoring systems. This data collected by patient monitoring systems can enable doctors to view the patient’s health as a whole, and allows clinical decision support systems to draw possible conclusions regarding the long term health and disease management of patients with chronic illnesses. To ignore the possibilities that can be developed through a well-maintained EHR system is to not fully support the health of the patients.

Ultimately, healthcare information technology is unlimited in how it can support the healthcare community, from patients to doctors and everyone in between. Medical advancements can be more possible through the evidence-based information gathered by EHR and CDSS systems. Identifying the weaknesses in the implantation of EHR systems can bring better designs to EHR systems and more meaningful use to the healthcare field.


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Appendix A:

This image shows an example of the health information gathered by an externally worn FitBit.


Appendix B

This image shows the externally worn Holter monitor with an example of the EKG reading.


Appendix C

The following questions were sent to the patient through e-mail on June 9th, 2016:

-Specific type of cancer?

-Were you referred to Scripps by your general practitioner or was he already within the Scripps system?

-How did they know something was wrong?

-Rough dates of diagnoses:

-Rough dates of surgeries and what they were for:

-What type of specialists have you seen? (I know you have an endocrinologist and a cardiologist)-

-Did you go to the same hospital or hospital system for all surgeries and ER visits? (Because Scripps uses the same Electronic Health Record system for their hospital and 26 outpatient centers, anyone included in that system would be “yes”)

-What special tests did you have to get done? (MRI, CT scan, etc.)

– (This one is almost comical) How did you track your appointments? Do you have a family member or friend assist you? Have you ever mixed up what doctor you were supposed to see?

-Can you access your records? Your blood test results? X-rays or results of other tests or scans?

-If you can, do you like the interface? Are you able to email your doctors within the system?

-How often do you need bloodwork?

-How do you track what medicine you take?

-Are your prescriptions from different doctors? (I’m trying to determine if the system will warn all doctors of possible drug interactions with medicine you were prescribed by other doctors)
– Do you always remember the questions you think to ask your provider? Do you ever write them down?

-Did you ever have to hand carry records between doctors?

-Did you ever have to repeat paperwork (like constantly fill out allergies or medications you’re currently taking) or verbally answer the same questions over and over again (verbal confirmation of information already taken down is not the same thing. I have had issues where they will continue to fill out the same records for me over and over when I go to the doctor)?

-Did you experience any particular areas of irritation regarding your medical information (accessibility, continuity between doctors, etc.)?

-How was insurance taken care of? (I need help understanding this one because I have never used private insurance so I have no idea what the process is) Do you receive bills? Do you have to contact your insurance every time you visit for pre-approval? Did you have to modify your insurance?  Did your premium go up?

-When you had to go to the ER and you were incapacitated, how did they identify you? You mentioned you had a card to give them. Do they recognize you on sight when you go? (I know medical laws require you to identify yourself, so if you can’t, does that card suffice?)

-Have you ever experienced any issues with medical privacy? (Thinking HIPAA impact here) Did you ever feel like your medical privacy was compromised? Since I have no idea what your wife does at the hospital, I’m guessing at this one but has there ever been a crossover in medical and personal life? Like, was she allowed to treat you or see you medically?

-Is there any way you would improve your medical record experience?

Appendix D

This image shows the fine needle aspiration (FNA) conducted to biopsy the lump in the patient’s neck.


Appendix E

This image shows the location of the parathyroid glands in relation to the thyroid gland in the patient’s neck.


Appendix F

This image shows the acceptable levels of calcium in a person’s blood by age (8.5-10.2 mg/dL).  Normal PTH Levels are (10-65 pg/mL or 10-65 ng/L).


Appendix G

This image shows the internally placed Linq Reveal Heart Monitor that synchronizes with the Blackberry assigned to the patient.


Appendix H

This image shows the login screen for the imaging clinic that is not tied to Scripps’ Electronic Health Record system.


Appendix I

This image shows the PatientSecure palm scanning biometric technology currently used by Scripps Health.


Appendix J

This image shows the initial login screen for the MyScripps portal for patient access to their personal health records.


Appendix K

These images are from the Hypopara Lodge Facebook group regarding their desire to see an at-home calcium level test kit.



Appendix L

This image shows the hypoparathyroidism Facebook Group for those who wish to maintain an active lifestyle while living with the disease.


Appendix M

This image is of blood lancets, which are used to pierce the skin and produce a drop of blood for testing.