It’s Hickory Season Again!

If you’ve been hanging out with me for a while, then you may remember that I wrote about foraging for wild hickory nuts way back in 2018. If you’re a more recent follower, odds are that the hickory nut post is what brought you here! It’s the most popular post on the site, and I get it. They’re delicious!

A word on hickory nuts, though – if you shell more than you’re going to use right then and there, keep the shelled nuts in the freezer. They keep basically forever when frozen, but they’ll go moldy pretty quickly at room temp or in the fridge because they have a high moisture content (ask me how I know). In the shell, they’re good for quite a while, so if you’re short on freezer space then don’t crack them open until you want to use them. You could also dry or roast them, but hickory nuts have a much higher moisture content than most other nuts, and I find that it’s easier to just freeze them.

So if you’re like me and you think found food is the best food, then I’ve got a recipe for you to try. While hickory nuts (a buttery-tasting relative of the pecan) are delicious in a variety of applications ranging from cakes to muffins to ice cream, my very favorite way to use them is in a shortbread cookie. It’s kind of like a pecan sandie, but better (in my opinion). Give them a try!

Tasty!

Hickory Nut Shortbread Cookies

Serving Size:
30-36 cookies
Time:
30 min active, chilled overnight
Difficulty:
easy

Ingredients

  • 1 c butter, softened
  • 1/4 tsp fresh orange zest (optional, but delightful)
  • ½ tsp salt
  • ½ tsp vanilla extract
  • 2 c flour
  • ¾ c powdered sugar
  • ½ c hickory nuts

Directions

  1. Cream together butter, zest, salt, and vanilla. In a separate bowl, whisk together flour and powdered sugar. Add the flour/sugar mixture to the butter mixture, and mix until just combined. It’s going to look very crumbly. Finally, stir in the hickory nuts.
  2. Dump out the cookie dough (it’ll probably seem too dry) onto a large piece of plastic wrap, and use the plastic to form into a log approximately 2 inches thick (you can also use parchment paper if you’re opposed to plastic). Make sure it’s nice and compact, with no air bubbles. Refrigerate overnight, or 2 hours minimum if you’re in a hurry.
  3. When ready to bake, preheat the oven to 350o and cut cookies into 1/4 – 1/2″ slices. Place on a cookie sheet lined with parchment paper or a silicone mat, leaving about 1″ between cookies (they don’t spread much). Bake for 10-12 minutes, or until done to your liking. I like to cook mine until the edges start to turn golden brown but the main part of the cookie is still white.

That’s it! How easy is that?! I like to keep my uncooked “roll” of cookie dough in the fridge, and slice off a few cookies at a time to bake here and there when I’m feeling snacky. If I made them all at once, then I’d have to eat them all at once (well, I guess I wouldn’t have to eat them all, but I probably would anyway).

Happy baking!

It probably won’t last forever

It’s been a busy summer! We moved about a month ago (maybe 2 months? Time is flying by), and we’ve been working hard to get unpacked and settled in. I only have one room left to finish unpacking (my craft room), and we’re still waiting on a new couch and kitchen table to be delivered.

We’ve learned a few lessons since we moved, and things are going much smoother now.

  1. If you can’t find Madeline, she’s probably at the neighbor’s house (her name is Cathy, and she’s Madeline’s new BFF. She’s also probably in her 70s, but Madeline doesn’t care).
  2. The best way to stop Madeline from waking Cathy up at 5:30 in the morning is to get some better locks. I recommend a lock with a combination keypad. Put it on backward so that you need to enter the code to exit the house.
  3. Put a lock on the garage door, too. She’s crafty like a fox.
  4. Ban all outdoor time unless under the direct supervision of a parent or teacher for the remainder of the summer.

In other news, while searching for furnishings for our new digs, we found a comically large roll of toilet paper. Of course we bought it, and I have to share it with you. You know those really big rolls that you need to buy an extension for so that it fits on the wall dispenser? This one comes with a stand-alone holder, because it’s that big. We’re talking the size of 11 or 12 “normal” rolls. It’s massive.

Just look at it. It’s ridiculous.

I seem to be the only person in this house who knows how to put toilet paper ON the wall roll holder, so this is just *muah*

It’s like those big rolls they use in retail store bathrooms, but this is regular, 2-ply, so soft toilet paper.

We didn’t put it in a bathroom the kids use (even I’m tempted to put the end of the roll in the toilet and flush to see what happens), but I’m just psyched that it exists and that I have it in my house. If you’re wondering, it’s called the Charmin Forever Roll. I have my doubts about the “forever” part, but it certainly looks possible. They’re not paying me, but if any Charmin execs are reading this I’ll gladly continue to sing your praises.

Oh, also I got 10 chickens. That’s something people do, right?

The prescription pricing system I’m not allowed to talk about.

It’s been a while since I’ve written about anything that matters, but this is something that’s incredibly important. There’s been a lot of talk about the rising cost of drugs in America, and we’re so eager to place the blame at the feet of pharmaceutical companies that we’re completely ignoring the role that PBMs play in all of this. Pharmacists like me have been shouting “Why isn’t anyone talking about the PBMs?!” But it’s hard for non-pharmacy people to talk about something they’ve never heard of. PBMs operate in the shadows, and that’s just the way they like it.

Today we’re going to get down in the weeds and talk way too much about the real reason your drugs cost so much. I’m going to provide you with as much information as I can without risking any repercussions from my employer (I do, in fact, need to keep my day job). Graphs and other visuals in this post are not my own, but I have independently verified their accuracy – references are at the bottom. I realize that this will be way more than most people care to know, but knowledge is power and we need all of it we can get to change our broken healthcare system.

PBMs, or Pharmacy Benefit Managers, are what we typically think of as “prescription insurance.” They’re not really “insurance” on their own, but they like to pretend that they are. They use the same words as health insurance – copay, deductible, prior authorization, etc. But what a PBM actually does is act as a middleman. Your health insurance includes coverage for prescription drugs, but they don’t actually deal with pharmacies directly. A PBM takes money from your insurance company and handles the negotiations and payments on their behalf.

Most people understand how health insurance works, at least in a general sense. Your insurance company enters into a contract with either you as an individual, or with your employer. If you pay a certain amount each month, the insurance company will negotiate with healthcare providers on your behalf, pay a portion of your medical expenses (if you’ve met your deductible), and you will only need to pay a small portion of your medical bills out of pocket. If you look at your bill, you’ll clearly see how much the doctor or hospital charged, what the insurance company paid, the lower price they negotiated on your behalf, and what you’re expected to pay. We might not understand why a hospital charges $12 for a single ibuprofen tablet, but we at least understand how it’s being paid for when we see our bill. PBMs are different. A lot different.

PBMs began to pop up in the ’70s, and really started to take off in the late ’80s and early ’90s. Before that time, prescription drugs were relatively inexpensive, and there weren’t very many medications on the market (at least not like we have now). As time went on, insurance companies found it more and more difficult and costly to keep up with the pharmaceutical boom, and someone had the bright idea to approach an insurance company and offer to deal with the pharmacies and drug companies on their behalf. How kind of them.

I don’t want to underplay it too much – drugs are definitely expensive, and PBMs do a lot of work that should help lower the cost of medications. They develop and maintain a formulary, contract with pharmacies, negotiate discounts and get rebates from drug manufacturers, and process and pay for prescription drug claims on behalf of insurance companies. That’s no small feat, and they should absolutely be compensated for the work that they do. The idea is that a PBM will have better luck negotiating lower drug costs than the insurance companies themselves can do, and that savings is supposed to be passed back to the insurance company, which should then pass that savings on to the consumer in the form of lower copays/deductibles/premiums. Isn’t that just the funniest thing you ever heard? Yeah. It doesn’t work.

Insurance plans are relatively transparent about where the money goes. You can see it right on your bill, and they’ll explain it to you in detail if you call them. However, PBMs (the middlemen) are not open and transparent about how your medications are paid for. In fact, when a pharmacy contracts with a PBM, part of that contract says that pharmacy employees are prohibited from telling patients any details about pricing and/or payments received from the insurance company. That’s right, folks. I know how much the wholesaler charges the pharmacy, I know how much the pharmacy bills the PBM, and I know how much the PBM pays the pharmacy. I’m not allowed to tell you any of the details. I’m. Not. Allowed.

So please explain to me how people are supposed to be financially smart about their healthcare decisions. You can’t “shop around” for the best price on a medication when the entire pricing system is a secret. There’s no competition in the market when nobody knows what anyone else is charging or paying.

Let me give you a specific example, without giving you more information than I’m allowed. I’m going to make it clear what details I’m not legally allowed to share just to point out the ridiculousness of the whole thing. One of my medications (I can’t say which) costs $452 without insurance. I haven’t met my deductible yet, meaning I’m paying out of pocket, so my kind and generous PBM (I can’t tell you which one) has negotiated a lower price for me and I only paid $89 today. Thank you, PBM! I feel #blessed to have insurance.

But this medication cost my pharmacy (I can’t say which one) $5.61 to purchase from our wholesaler (I can’t tell you which one). I’m paying $90 for $5 worth of medication. Cool. But get this – the random dollar amount that has been set as the “recommended list price” (also called AWP, or “average wholesale price” – it’s a made-up number without any basis in reality) for this medication is $566. What?

While it seems like the pharmacy is ripping me off here, I also filled someone’s prescription the other day that cost us $3.04 to purchase from our wholesaler, the patient had a $5 copay, and the insurance paid us $-4.85. Yes, you read that right, they didn’t give us any money, WE had to pay THEM as.. what?.. an offering to the PBM gods? Oh, and the AWP for this drug was $474, with a “cash pay” price of $305, because that makes sense. Losing money isn’t super common (pharmacies are for-profit businesses), but it does happen. Our contracts with PBMs say that we can’t turn people away if we’re losing money on a prescription, even if we’re losing a lot. The whole system is effed.

Obviously, every company has overhead expenses, employees to pay, and needs to make a profit. This is America, after all. If we’re not profiting off someone’s misery, we’re doing it wrong. But PBMs have actually created the drug pricing system we have today, and I would argue that they are a major reason why drugs are so expensive.

When you buy something like a TV, it’s made by a manufacturer, sold to a wholesaler, sold to a store, and sold to the customer. The price goes up a bit with every transaction. That makes sense, right? Drugs are also products that go through this same process, so the price should also increase a bit with each transaction, right? Wrong. Or, rather, it would be right if not for PBMs. Let’s follow the money.

Americans spend a lot on prescription drugs, and costs have risen exponentially over the past 20 years. I couldn’t find any graphs with the current numbers, but I still like the visuals. I’ll let you know the current numbers (for the year 2020) as we go.

The Real Price of Medications | U.S. PIRG
Wowzers, what the heck happened?

In 2020, Americans spent $393 billion on prescription medications. Most sources will give the “average amount spent on prescriptions” (by insurance, the government, patients, and charities) of $1200/person, with out-of-pocket costs averaging $168/person. It’s doable for most people when spread out over a whole year. But, given that only 40% of Americans actually take prescriptions, this number doesn’t give you a good picture of what’s really going on. The ACTUAL amount spent yearly by people who take prescription medications is $3004, with an average out-of-pocket cost of $420 per year. Not sure how that stacks up? Americans spend more than twice as much on prescriptions as people in other countries. And most other countries don’t have any out-of-pocket costs. It’s not because we’re taking better drugs – they’re literally the same medications. We just pay more.

The numbers have gone up a bit since 2017 (see above), but the percentages of who’s paying have stayed roughly the same.

You’ll notice that the fine print in the above chart says that these numbers are taking rebates into account. This is important to note, because nobody knows how much money is saved by rebates. Why? Because PBMs don’t want you to know. We’re all in the dark on how much money is actually spent on prescriptions in America, but we think these numbers might be a close estimate. Maybe.

So that’s a bummer and all, but that’s just the way it is, right? Prescriptions are expensive, we pay for them to stay alive, end of story. But it didn’t use to be like this. Because of inflation, we expect prices to go up a bit every year. That’s expected, we get it, it’s how things work. But the cost of prescription drugs has risen so much more than inflation that it’s getting seriously out of hand. And there’s no reason for it! Well, except for PBMs (I’m imagining a PBM as a type of mustache-twirling Snidely Whiplash character). And we just let it happen, because what can we do? This is America, and prices can go up up up as high as people are willing to pay.

Branded drug pricing has well outpaced general inflation in every year over the past decade.
The orange line shows the inflation increase from year to year, the blue bars show the inflation of prescription drug prices. Trust me – it’s only gotten worse since 2015.

Okay, so we can all agree that prices have gone up, and it’s becoming unsustainable. But how do PBMs actually play into this? Don’t manufacturers, insurance companies and pharmacies share a lot of the blame here? Absolutely. But I’d argue that the different components of the pharmaceutical industry don’t exist in isolation. What one company does affects all the others. PBMs are the first domino to fall, and their actions directly affect how every other business in the industry operates, to our detriment. Let’s see why.

First off, let’s establish something important. Medication doesn’t have a set cost. It’s a bit like gasoline. The prices change from one day to another, from this gas station to the one across the street, and from region to region. But, unlike gasoline, nobody knows what anyone else is paying for prescription drugs. Makes competition in a supposedly capitalist market impossible, right? Yup.

On top of that, prices are affected by rebates and discounts given by manufacturers to wholesalers, pharmacies and PBMs. And these rebates aren’t insignificant. In 2015, more than 1/3 of a brand medication’s “list price” was discounted in some way. It’s like how Hobby Lobby says “Furniture is always 30% off the advertised price!” Like, okay, but then why don’t you just put the actual price on the sticker? If something is always on sale, then just change the price to that. Except that rebates are a secret. A manufacturer might give a 20% rebate to my insurance company, a 50% rebate to your insurance company, and might make another company pay full price. And nobody knows who’s getting what discount, or if other companies are getting them at all. Remember how I said earlier that Americans spend $393 billion each year on prescriptions? It’s estimated that rebates and discounts on prescription drugs (remember, we’re just guessing here) exceeded $100 billion last year. That’s crazy.

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For real, though. This is just for brand name drugs. The spread between the “list price” and the actual price is substantially bigger for generic medications.

You can see in the above chart that while drug prices are certainly rising, rebates and discounts are rising faster. What does that mean? It means that PBMs are receiving more rebates and discounts every year, and they’re clearly not passing that savings on to their customers.

So where does the money go? Drugs travel how you’d expect: manufacturer –> wholesaler –> pharmacy –> patient. The money should flow the opposite way, right? The patient pays the pharmacy, the pharmacy pays the wholesaler, the wholesaler pays the manufacturer. Nope. Here’s what actually happens:

Not following? There are too many “dollar flow” arrows here, right? This is where it gets interesting. (and there should actually be a green arrow going from “patient” to “health plan,” but that’s okay)

First, a patient (or their employer) chooses an insurance company. The insurance company hires a PBM, and pays them to negotiate lower drug prices on their behalf. The PBM then acts as a “funnel” to transmit payments from the insurance company to the pharmacy. With me so far? Everything is working how it should. But here’s where the PBMs work their magic. Somehow, all the “payment” arrows wind up pointing to them.

The health plan pays the PBM. The pharmacy pays the PBM for the “privilege” of getting paid (I know it doesn’t make sense, but we do actually pay a set fee for every claim we bill, even if that claim is later reversed and the patient doesn’t get their prescription). Discounts and rebates that the PBM negotiates don’t get passed on to the patient, they get secretly refunded directly to the PBM. The PBM is supposed to report back what discounts and rebates they’ve received and pass it on to the insurance company (minus a small fee for their trouble), but they don’t – at least not as much as they’re supposed to. When health plans DO receive their share of the rebate or discount, they’re supposed to use it to lower premiums, copays and deductibles for their members. They don’t (at least not as much as they should). Get the picture? Why is anyone surprised that when a for-profit business is allowed to operate in complete secrecy, they do what’s in THEIR best interest rather than that of their customers? I’m serious about that – secrecy is in their contracts. They don’t have to tell anyone anything, and the companies they work with aren’t allowed to tell anything to anybody either.

So that all makes sense, and it’s upsetting but not surprising. But here’s another issue. Remember how I mentioned “AWP” (average wholesale price) in passing? Originally, the “average wholesale price” was exactly what its name suggests. It was the average amount that a drug would cost to purchase from a wholesaler. Nobody knows when it changed, but it’s well known in the pharmacy business that AWP is a meaningless number. Supposedly it would be accurate if rebates and discounts didn’t exist and everything were left to the free market and manufacturers could charge what they wanted and what patients were willing to pay, but that’s not the world we live in. As a result, you might find that the AWP for a certain drug is $100, but the actual price from the wholesaler is $1. Or the AWP is $100, they charge the pharmacy $90, and then they give the PBM a $60 rebate. So why does that matter? Who cares what the AWP is when it’s not the actual price of the drug? Deductibles. Deductibles are why this grossly inflated number is important. Because until you meet your deductible (and again once you hit the “donut hole” if you’re on Medicare Part D), the cost that you pay is based on the AWP. It doesn’t matter that the drug actually cost the pharmacy $1, or if the manufacturer gave a $60 rebate. What matters is that the AWP is $100, and the insurance company is going to graciously negotiate a reduced copay for you of $95. How nice of them!

PBMs also have the power to create a formulary, which is a list of the drugs they will cover without requiring a special explanation from your doctor about why that exact medicine is required (also called a “prior authorization”). Some PBMs also have “tiers,” which means that drugs in one tier are preferred and have a lower copay for the patient, and drugs in a different tier are still covered, but at a higher copay. The point of this (the reason they give, anyway) is to encourage you to take less expensive medication whenever that’s an option. If a lower cost drug does the same thing as a higher cost drug, it makes sense that the insurance company would try to steer you toward the less expensive option. Sounds great. If everybody takes less expensive medications, then healthcare in general is less expensive for everyone.

Exceeeept…. lots of manufacturers want their drugs to be on a PBM’s formulary. They can (and do) buy their way onto a formulary. They buy their way into a better tier. They literally pay a PBM to make patients more likely to take a more expensive medication. And the PBM doesn’t care one way or the other, because they’re just funneling that money from the insurance company to the pharmacy, so if they get a nice kickback from a drug company then they’re going to take it. 100%. And they don’t have to pass any of it along to the health plan or the patient because it’s a secret. As long as nobody finds out how much they’re pocketing, they’re in the clear. This is not hypothetical, it’s fact.

I’ll add a disclaimer that PBMs report retaining an average of only 10% to 15% of the rebates they negotiate, and they pass the rest of the savings off to health plans. This, obviously, is all self-reported and unverifiable due to the complex arrangements and secrecy agreements. But maybe they’re right. How much of that rebate is being retained by the health plan? A good chunk. How much is actually saving you money? Pennies on the dollar.

Oh, and have you ever gotten a letter in the mail from your PBM saying something like “Drug XYZ is changing to a different tier next month! Call your doctor now and switch to drug ABC to continue paying a lower copay!” Yeah. Manufacturers offer additional rebates to PBMs when the number of prescriptions sold for a given drug exceeds a predetermined threshold. Tell me again how that’s supposed to save Americans money rather than lining the pockets of PBMs? Mm-hmm.

Oh, and get this – a standard clause in a PBM/manufacturer contract requires the manufacturer to pay an additional “processing fee” when they send a rebate. Raking in all that dough is hard work. It’s like if your employer payed you to drive to the bank to deposit your paycheck. Sounds nice.

I know I’m making it out to sound like PBMs are solely responsible for our effed up prescription system, but they’re just the catalyst that lead to the mess we have now. Because manufacturers have to pay off PBMs to be included on their formularies, they jack up the prices of their drugs. Because they jack up the prices, wholesalers don’t want to buy the drugs (wholesalers have a pretty low profit margin in the big scheme of things). To make purchasing their drugs more appealing, manufacturers actually pay wholesalers to buy their medications. Please, explain to me how on god’s green earth that makes any sense!? It’s called a “distribution service fee,” and it’s what the wholesaler charges the manufacturer for the “service” of buying their drugs (including the cost of inventory storage and distribution to pharmacies). What?

Pharmacies make secret (obviously) contracts with wholesalers to keep their pharmacies stocked with drugs, and they get some sort of undisclosed discount from what the wholesaler is charging everyone else. But.. do they? Who knows, because it’s all secret.

You’d think it wouldn’t be too hard to find out where all the money is going, right? Most PBMs are publicly traded companies, they file taxes, and all that jazz. But with the growing number and scale of “administrative fees” and “service fees,” it’s increasingly complex (nigh on impossible) for medical plans, patients, the government, or your average Joe Schmoe to assess whether the fees/rebates/discounts are being passed through to reduce overall medical costs, or if they’re contributing to increasing costs. What I can say is that The National Pharmaceutical Council recently conducted a study of employers’ perceptions of the value that PBMs provide. Over 65% said that PBMs lack transparency in how they make money, and around 50% felt that rebates contribute to misaligned incentives that put PBMs’ business interests before those of their patients. Another way of putting it: 2/3 of employers think their PBM is doing something fishy, and 1/2 think that PBMs are ripping them off.

I found a couple of excellent examples of where, exactly, the money goes when you buy a prescription. Keep in mind that both of these scenarios assume that the system works exactly as intended, the PBM is being 100% transparent and honest with the health plan, and all rebates and discounts (minus the agreed upon administration fees) are being passed back to the health plan so that premiums and copays can decrease. This is assuming the PBMs are NOT skimming off the top, or requiring that patients purchase a more expensive medication because it gives the PBM a better rebate.

This is the ideal situation for a patient who has met their deductible and is purchasing a $100 medication that has an AWP (made-up nonsense price) of $120. This is what happens when the system is working as intended. The insurance company is losing money, and the PBM is making money.
This is the ideal situation for a patient who has NOT reached their deductible yet, and is buying a $400 prescription with an AWP of $480. This is how it’s really supposed to work, without any deception or secrecy (at least between the health plan and PBM – this would never work if the patient knew what was going on).

That second example just makes me mad. And I guarantee you that this is an accurate example. The PBM will tell you that they’ve negotiated a lower copay for you. See? The AWP (the “retail price”) of the medication is $480, and they’ve negotiated a lower copay for you so that you only need to pay $408. Because you’re still working toward your deductible, the insurance company isn’t going to help you pay for your drugs. Thankfully, they’re still negotiating on your behalf to bring down the cost a bit. But did you notice that the insurance and PBM combined are MAKING $292.75 OFF OF YOUR PURCHASE?? If the manufacturer is willing to settle for $88, the wholesaler only wants $2, and the pharmacy is fine with making $25.25, then WHY ARE YOU PAYING $408??? If PBMs had a face I would punch it.

As prices increase because of this ridiculous system we’ve developed, insurance companies have raised deductibles, premiums and copays. I know mine has. Did you notice that the insurance company and PBM make WAY more money before you reach your deductible? Yeah. That’s intentional. So tell me again how manufacturers and/or pharmacies are responsible for outrageous prices and copays? Mm-hmm.

And now PBMs are merging like crazy to decrease competition. There are only 3 PBMs (Express Scripts, Optum, Caremark) that handle over 75% of prescription claims. Express Scripts merged with two other major PBMs in recent years, taking out some major competitors (Medco and Cigna). Optum is owned by the insurance company UnitedHealthcare, and is gradually acquiring a slew of physician groups and clinics throughout the country. Caremark is owned by the pharmacy chain CVS, and has recently acquired Aetna (another major PBM). All of these mergers and acquisitions have majorly reduced the competition, and it’s giving these companies an opportunity to double-dip. People talk a lot about “big pharma,” but in 2017 (the most recent reliable data I could find), the largest PBMs had a higher revenue than the largest pharmaceutical companies. For example, Express Scripts reported revenue of $100 billion, while the pharmaceutical giant Pfizer had a revenue of $52 billion.

In an ideal world, with full transparency and healthy competition, PBMs would be performing a valuable service. Using their larger purchasing power to negotiate lower costs for prescription drugs is a good thing. But as it exists today, the system isn’t designed to prioritize savings for patients. A big reason for this is that PBMs aren’t incentivized to negotiate for lower prices, but for higher rebates. Manufacturers have two options in our current system: lower the cost of their medication across the board, or raise the price of their drugs while increasing the rebate they provide to PBMs. Either way they make the same profit per prescription, but the latter option ensures that they get good positions on a formulary and more people take their medication. Guess which one they’re going to pick.

An excellent study from 2018 (link at the bottom) tracked AWP prices against net prices for insulin (the “cash price” they base your deductible on, versus how much the manufacturer actually makes). From 2002 to 2013, the cash price for insulin nearly tripled. If you take insulin, you probably felt it hard. However, the money the drug companies actually made on insulin during this same time period either increased modestly, or actually went down. So if you’re paying more, and the manufacturer isn’t getting more, where is that money going? Ding ding ding! PBMs.

The people are starting to get wise to PBMs, but it’s not enough. In March, my state (Wisconsin) established a law intended to hold PBMs accountable for rising prescription drug prices (Act 9). It sounds great, but I’ve read the bill and it’s not going to change anything. The bill claims to “protect patients from the powerful middlemen in the prescription supply chain by shining the bright light of transparency on their actions.” That was in the Governor’s press release – sounds great, but no. The only thing I saw in the bill that looked helpful was restricting a PBM’s claw back ability. Previously, a PBM could, at any time, zoink money back from a pharmacy for a claim they’ve already paid for. Claw backs were a major problem, because the PBM didn’t even need to give a good reason. They could just change their mind about something they paid for without needing to prove why they think a claim was paid incorrectly. Now, they at least have to give notice and give the pharmacy a chance to appeal first.

Manufacturer rebates are also (supposedly) going to become transparent, but not really. Starting in June, all PBMs will need to submit reports showing the aggregate rebate amount that they’ve received and retained from all pharmaceutical manufacturers for prescriptions sold in Wisconsin. Sounds great, except that they’re reporting this information annually to the Office of the Commissioner of Insurance (the government) rather than the actual patients who were affected, and they don’t have to break it down by drug or anything. So, yes, we’ll know how much they’re stealing from us every year, but you’ll have no idea if YOUR drug prices were affected.

This new law also prohibits PBM gag clauses on pharmacists! Yay! But, no, because I read the verbiage used in the law and it specifically says that a PBM can’t stop me from telling you what drug would be cheaper. That was never part of our gag order to begin with. So, yes, they’re doing something, but not anything that needed to be done.

It also limits how much a PBM can charge a patient for their medications! Yay! But, no, because it actually says that the PBM can’t charge a copay that’s greater than what the pharmacy would charge a patient who didn’t have insurance. They’re “fixing” a problem that doesn’t exist. So, there’s that.

I just want the bullshit to end, but it’s never going to so long as healthcare is a for-profit business. We can’t rely on PBMs to do what’s right, so we need to do everything we can to educate the public about what the problems are in our current system so that we can, some day, make it right. Are you with me?

References:
http://phrma-docs.phrma.org/files/dmfile/Follow-the-Dollar-Report.pdf https://www.statnews.com/2018/08/27/pharmacy-benefit-managers-good-or-bad/ https://jamanetwork.com/journals/jama/article-abstract/2678286 https://time.com/5564547/drug-prices-medicine/ https://www.congress.gov/115/plaws/publ263/PLAW-115publ263.pdf https://www.kff.org/medicare/issue-brief/how-does-prescription-drug-spending-and-use-compare-across-large-employer-plans-medicare-part-d-and-medicaid/ https://www.rand.org/pubs/research_reports/RR2956.html https://care.diabetesjournals.org/content/early/2018/05/03/dci18-0019

Getting Back Into the Swing of Things

I don’t know about you, but the past year has been HARD. Quarantine hasn’t affected my social life or anything (I didn’t have one before COVID, so no great loss there), but daaaaamn, these kids need to get out of my house. They love each other, I love them, obviously, but this “together 24/7” thing isn’t doing anyone any favors.

These Hilarious Cartoons Showcase the Reality of Distance Learning at Home  | Parents
Seriously? Every time. Every. Time.

In my area, school has been completely virtual since last March. They went back to in-person starting March 1st (4 days in person, 1 day virtual), but that only lasted 2 weeks. This past week was spring break, and next week is all virtual because they’re expecting people to do something stupid over spring break and get everyone sick (they’re not wrong). That 2 weeks of being child-free was just enough for me to remember what I’ve been missing. I got so much done! I wasn’t constantly bombarded with “mom mom mom” and got to actually finish tasks without (Hey mom, look at me!) having to (Hey, MOM! He hit me!) stop every 5 (Can I read you this story? Except that I don’t know how to read, but I really do, but I don’t want to read this) seconds to deal with (I’m so hungry, I need a snack nooowwww) their nonsense. It was fabulous.

30+ Mom Memes For All The Tired Moms Out There – theCHIVE :
Seriously, though.

I’ve been doing a lot of freelance writing lately, which is weird to think about. Like, people are actually giving me money to write stuff? What? I love it, but it’s so weird. I’ve been primarily ghost writing blog articles for a law firm in Philadelphia. They’ve finally realized I have a medical background, so now I get to write about things like premature births, anticoagulants, and radiology malpractice. It’s way more interesting than the property and product liability stuff they had me writing about in the beginning (yawn). I literally don’t even know how I got that job, but it’s steady work and I’m enjoying it.

I also did quite a bit of writing last month for a parenting app that has yet to be released. That was interesting. It’s apparently going to be an app that gives you ideas for developmentally appropriate activities to do with your baby or toddler. But, and this is my favorite part, they’re making it for parents like me. They gave me ideas as they’re typically presented to parents, and I got to write it in a way that would appeal to someone like me.

A typical parenting blog/app/guilt trip might read: “Offer your toddler 3 meals and at least 2 healthy snacks every day. Ensure that all food groups are offered, and encourage them to try at least one bite of each food you place before them. To help pique your child’s interest, use a variety of colorful foods to create a fun work of art on their plate!” Instead of that malarkey, I got to write things like: “There will be days when your kid turns up their nose at the food you’ve made in favor of the stale crushed crackers they find between the couch cushions. That’s okay, it happens. Offer healthy food whenever you’re able, and don’t sweat it if they turn it down and decide to go hungry. They won’t starve themselves.”

Think you're a bad mom? | Bad mom, Mommy humor, Mom humor
As long as you’re not throwing your child at predators, you’re probably good.

In unrelated news, I spent the last year memorizing the entire soundtrack from Hamilton (not, like, intentionally, it’s just been the only thing I want to listen to since it came out on Disney+). The only downside is that now Madeline will occasionally burst out into song. Why’s that a downside? Because you never know if she’s going to sing a random line from “Say No to This” in public (if you’ve seen it, you know why that’s less than ideal). But then sometimes she just belts out a “I’m young scrappy and hungry, and I’m not throwing away my shot!” and it’s all good again.

It’s been a hell of a year.

It’s been… a while since my last post, and for that I apologize. It’s been a busy couple of months! We’re going to recap the events of the past 2 months at warp speed, because that’s how fast it’s seemed to go by.

Halloween! To me, it’s always been a holiday for little kids. I like to make the kids’ costumes, but sometimes I don’t have time and we just buy one. Of course, the purchased costumes are expensive and fall apart after a couple of wears, so making one is usually my preference when I can. This year, COVID threw quite the wrench into things. Trick-or-treating was cancelled, and I wasn’t about to make them a costume to wear at home. So they just wore one from a previous year and we decided to have a party at home.

Scratch that, Madeline decided we’d have a party at home. An all day party. With a scavenger hunt. And all the decorations. And Halloween food. With Halloween cookies, and candy, and prizes. She made up her mind, and that was that. It’s hard to argue with a kid who’s been stuck inside since March.

I don’t really do parties, or decorations, or holidays that aren’t Christmas. Just not my thing. But it’s been such a dumpster fire of a year that I figured they needed something to lift their spirits. So we had a Halloween party. And it. was. epic.

I know that word gets thrown around a lot for non-epic events, but this was truly stupendous. Monumental, even. I made the best cookies I’ve ever made. I arranged party games, Halloween-themed meals and snacks, and stayed up way too late the night before filling goody bags with candy and decorating the kitchen and living room so they’d be surprised when they woke up. And we had an all day scavenger hunt. That was one of the most exhausting thing I’ve ever done. I’d give them clues to find a craft hidden somewhere in the house, they’d do the craft, and when they finished I’d give them a clue to find a gift bag filled with candy or a prize. It doesn’t sound like much, but we did this for hours. Literally hours. They loved it, and I never want to do it again. It might not have been so bad, but they’re terrible at clues so I didn’t want to hide everything beforehand or else they’d find everything right away. So I was running around the house during each activity trying to hide things in different places for the next round of clues. And Emmett can’t really do crafts on his own, so I was helping with that. And I still had to make the food. I’m not complaining – it was an amazing day – but, jeeze, never again.

Next was Emmett’s birthday! He’s 8 years old now. It’s crazy. He said he wanted a “beautiful chocolate cake,” so I decided to plan something amazing. Nothing could beat the cake I made for him last year, but I knew it would still be awesome.

Last year’s cake. It was a masterpiece of chocolate cake and delicious, homemade marshmallow fondant. I peaked too soon.

I was planning on some Great British Bake-Off level chocolate work. Ribbons, curls, straws, multiple colors, maybe some homemade chocolate candies, all tempered to give it a glossy shine. I was ready to make it amazing. Of course, Emmett’s birthday came just a few days before Thanksgiving this year, so I had that on my mind, too. I had more big plans for Thanksgiving – lots of cooking, baking, beautiful cookies…. but then we got COVID.

Let me start by saying that we wear masks everywhere. The kids are on board with masks, too. They think it sucks, which it does, but we wear them and silently judge anyone not wearing one in public. We don’t go out much – I work 2 days per week, I get groceries a little more often than every other week (ordinarily I go every other day), and we rarely venture out to go shopping. Even with all that, we got COVID. I blame my work, because it’s been spreading through employees like the plague.

You hear a lot about how most people are either asymptomatic or have symptoms like you would with the flu. Everybody with half a brain knows that the severe cases are a hell of a lot more severe than the flu, but mild cases are supposed to be manageable. Let me tell you, I’ve had the flu, and this was not it. We’re talking a fever, complete with terrible sweating and teeth-chattering chills for a full week, sleeping 18-20 hours per day, body aches and muscle spasms that made me cry, coughing to the point where you have trouble breathing any time you try to move for more than a couple of minutes, and feeling like I was going to pass out and/or throw up any time I tried to stand. I also lost my sense of smell, which was actually a blessing, because I couldn’t physically get myself into the shower.

Aaron also got it, and had basically the same symptoms as me except that his breathing was worse. We contemplated going to the hospital, but we weren’t sure who would drive. His oxygen level kept dipping, but it always came back up after a couple of minutes, so we stayed home and hoped for the best.

But then it was Emmett’s birthday. I was in some sort of fever-dream state, feeling like I would keel over at any minute, and Aaron kept saying, “I bet everything we own that you won’t be able to make a cake.” Because I have the same level of stubbornness and determination as the people who die climbing Everest, I informed him in no uncertain terms that there WOULD be a cake, and it would be BEAUTIFUL. I don’t actually remember making most of it, but it turned out alright. None of that boxed cake mix and jarred frosting for me. It was beautiful and delicious. Not quite my vision, but it served its purpose. Just imagine what it could have looked like if I was mentally present. Also, I managed to wrap his presents somehow, because despite what Aaron said I was NOT about to give my child his birthday presents in a plastic bag. And no, I did not have the ability to make dinner. My stubbornness did not extend that far. We had cake for dinner.

He was happy about it, and that’s all that really matters.

The kids mostly had to fend for themselves. We traded off who slept on the couch and who slept in the bed in case they required the presence of an adult, and we left the snack cabinet open so they could eat whatever they wanted. So it was mostly chips, granola bars and fruit snacks for about a week. We sometimes ordered food to be delivered, but then one of us had to get up to open the door. It was only sometimes worth the effort.

Thanksgiving didn’t really happen. We were starting to improve, but still not really capable of much. Thankfully, a good friend brought us an entire Thanksgiving dinner the following day that kept us going for several days.

Now it’s almost Christmas, and things are starting to look up. We got a tree (it’s a bit of a Charlie Brown tree, lots of open spaces, but that’s alright), we have a few decorations up, and our elf on the shelf has been hiding throughout the house, spying on the children. I’ve decided that we’re going big for Christmas. It’s not like we have anything else going on, and we need something to be happy about.

Oh, and the rabbit, Nibbles, is VERY excited that we brought in a giant stick for him to chew on. It even has the green bits! His favorite! I put up a fence around the tree, but he can still reach some of the branches if he stretches, and he takes every opportunity to do what he does best (nibble).

He thinks he’s so sneaky. I see you, rabbit.

Since my recovery, I’ve been working on a lot of projects. I’m still doing some freelance writing, still teaching online, and my business is still going (though that’s fallen a bit to the wayside with everything else going on). Virtual school for the kids is a perpetual challenge, but we fix problems as they come up (and then new ones come up – it’s this fun game they play of “who can frustrate Mom the most today”). But honestly, it’s not so bad. It sounds like Emmett may get to go back in-person in January at some point, so here’s hoping that doesn’t change.

And finally, for now, here’s the best picture I’ve taken in a long time. It snowed a few days ago (though “snowed” is giving it too much credit – it was more of a dusting that stuck), and Madeline somehow made this amazing snowman. It’s perfect, and 100% Madeline.

Just LOOK at its face. It’s everything that’s right with this world.

So now this is me, signing off for now, wishing you all a very happy Chrismasolsticehanukwanzakah.

Same old, same old

I haven’t done much posting lately, for which I apologize, but I’ve been in a bit of an emotional funk. And, because mental health needs to be normalized, I’m going to tell you all about it! What fun!

My doctor had me take a hiatus from my antidepressants several months ago to try out another medication for a (probably?) unrelated issue, but it turns out that was a poor decision. I’ve just been feeling… absent, I guess? It’s not like I’m crying myself to sleep or anything, but I can’t seem to get really engaged in much of anything. Simple things have been difficult to do, and difficult things have seemed almost insurmountable (virtual school, anyone?).

I haven’t done any crafting or sewing in months, I’ve virtually stopped baking, work is the worst, and my side businesses/jobs have fallen by the wayside as I try to sort out why I feel like a shell of a person. Oh, and we’re on month 8 of social distancing/quarantine, and it feels like there’s no end in sight. My county has somehow become the epicenter of the entire nation’s pandemic, but bars and restaurants are packed every night because a large swath of our populace believes that if they ignore it then it’ll just go away. Yeah, that’s definitely how diseases work. “Science” isn’t really a thing here, apparently. I’m just gonna be over here, wearing a mask and staying home with the rest of the “sheeple” who are “living in fear” *insert heavy eyeroll.*

Depression (even when mild, like mine) can really creep up on a person. I was doing great, keeping it together, doing the things I loved, and I don’t know when or how that changed. It’s like you’re going about your life, and then someone puts a very light blanket on your back. You hardly know it’s there. Except they keep adding thin blankets, one at a time, until you’re buried under 100 pounds of fabric and you can’t remember how or when it all became too much to bear, and now all you want to do is collapse, face down, and never move again. But the kids have school, people need to eat, I have to go to work, and clothes need to be washed. Sometimes it feels like there’s not much of me left to pretend that everything is fine for the people around me.

Speaking of family, they know I’m not quite myself right now, but there’s not much they can do to help. I know it’s frustrating for my husband, but he gets it and has been very supportive. Internal problems are hard to fix from the outside.

But it’s not all bad. I started taking medication again (it’s not working yet, but that’s okay), and I’m telling you all about it, so we’re going to call that therapy. I never found actual therapy to be particularly helpful, but I’m not really a verbal sharer anyway.

Also, I’ve done what I always do when things get rough, and I’ve found yet another job to keep me occupied – freelance writing. I’ve only been paid for one article so far, but they liked it so now they’ve hired me to write three more articles by the 26th. It gives me something to work on whenever I’m feeling particularly useless. So if you have any questions about liability lawsuits in the state of Pennsylvania, I’m your gal.

To wrap things up on this “since we last spoke” special, I’ve been working on finally fixing my chronic pain issue. After much searching, I found a specialist who’s actually trying to help me fix what’s wrong rather than just giving meds to mask the pain (not that those ever really worked before anyway). It’s going to take a while, but it feels like I’m on the right track. But physical therapy exercises are difficult to remember to do when you’re just trying to make it through the day. I’ll keep trying.

In other news, it sounds like some sort of WWE Tournament of Champions is happening upstairs, so I’m going to go check on that before someone brings out a folding chair.

Adventures in Rabbitry

Two months ago, Madeline presented a PowerPoint (which I helped put together – lest we forget, she’s only 5) to explain why bunnies make good pets. Aaron conceded, and the search for a rabbit began. Surprisingly, it’s rather hard to find a “normal” rabbit. I could only find a couple of breeders in the area, and I wasn’t interested in a Flemish Giant or Angora.

Seriously – if it’s dog sized, is it even still a rabbit?
www.thesprucepets.com/thmb/RLILRcg4EXtpVySL9aXI...
While the fiber spinning potential is appealing, I’m not about to spend more time every day grooming a rabbit than I do myself. Also, just look at that thing. It’s like a giant cotton ball with a mouth.

Luckily, there’s a small animal rescue group (primarily rabbits, but they have some other animals as well) down in Appleton. I was able to set up an appointment for us to meet some rabbits that they thought would be a good fit for our family. Unfortunately, that appointment was 2 weeks in the future. Not knowing what breed we’d wind up with made it a little tricky to find a properly sized cage, but I did my best to prepare for the new arrival.

It’s hard to say exactly what Emmett thought was happening (his language skills, while improving every day, still leave a bit to be desired). He seemed to be under the impression that we were going to try to trap the Easter bunny and keep him for a pet. He was very concerned that the cage wouldn’t be big enough.

When the cage arrived, it all became real for Madeline. After assembly, she just sat in front of it and basked in its glow, struggling to keep her breathing even. A day or two later, she was practicing a dance in front of the cage “because the bunny will be so excited to see how well I dance for him.”

It was a very energetic dance.

We decided to move the cage to the laundry room so he’d have a quiet place to get away from Madeline (it was quickly apparent this would be necessary). Madeline did not (and still doesn’t) like that the cage would be located in a room she can’t get into. She began a countdown to the rabbit coming home:

“9 days?! I can’t wait that long!”
At 6am – “MOM! IT’S ONLY 8 DAYS NOW”

The brainstorming of potential rabbit names began before we even found one:

Emmett was adamant that “Bunny” was the only name he’d be okay with.
Madeline wanted something along the lines of “Sweetie Pie,” “Hoppy” or “Oreo.” Terrible.
Aaron was rooting for “Crash Bundi-coot.”
No one liked the names that anyone else came up with.

There were concerns that naming this animal would cause a rift in the family.

We found our little man, and brought him home. It took a while before we actually settled on a name, but we’re all (mostly) happy with it. Emmett still thinks his name should be Bunny.

Nibbles (named after Nibbles the Book Monster, and because it’s kind of what he does) is settling in well. He has full run of the ground floor of the house, but he’s afraid of the tile floor because his only method of movement is hopping, which is tricky when your back legs slide out from under you. He’s litter box trained (so glad I didn’t have to do that), and he goes where he wants. He mostly wants to sleep under the couch.

My very favorite thing is when we catch him at the end of the night (I don’t want him roaming unsupervised) and he THUMPS the floor. It’s the only sound he makes. He’s warning any neighboring rabbits that danger’s afoot. I love it.

I laughed until I cried

The ancient Greeks believed in a concept known as the “wandering womb.” It sounds like the title of a horror B-movie, but it’s actually the (disturbing?) notion that a woman’s uterus could travel throughout the body, and depending on where it decided to hang out, it could cause all sorts of different “female” issues. Because of this, women were prone to bouts of “hysteria,” which is kind of a catch-all phrase for any mental or emotional problem that the medical community declared to be “uterus-induced.” Fun fact, the Greek word for “uterus” is “hystera.”

Also, I’m just going to throw this in for kicks, this is an actual passage from a document written by a 2nd-century Greek physician named Aretaeus:

“In the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or the spleen, and it likewise is subject to prolapsus downwards, and in a word, it is altogether erratic. It delights also in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.”

Now I’m not going to say that physicians have believed in the “wandering womb” concept in recent times (because that’s insane), but the concept of “hysteria” as a legitimate medical diagnosis existed until 1980. That’s crazy to me.

So why am I bringing this up? Oh, boy. Pull up a chair, and I’ll tell you the story.

When I was pregnant with my first child, Emmett, I had several bouts of what I’ve self-diagnosed as “hysteria.” The first time was truly terrifying, and after that moment I lived in fear that it would happen again at work, or in front of someone who wasn’t my husband. So what happened? I laughed until I cried. Except not like that. I laughed until I CRIED. But not like that. Like, I CRIED while laughing. But that’s not it either.

There’s no good way to explain it without seeing it, but just imagine a sobbing woman. Her dog just died and she’s heartbroken, holding his limp body. She’s devastated. Except her dog didn’t die, she’s actually laughing. But no, she’s sobbing. Clearly someone died to justify this level of emotional anguish. But she’s insisting that she’s actually laughing. But she can’t stop. A pool of tears are soaking through her shirt, and the tissues aren’t helping. She’s laughing? No, she can’t be…. but she’s insisting that she can’t stop laughing… but… the heartbreaking sobs are making everyone uncomfortable… it’s not stopping.

What could cause this level of emotional outburst? Aaron showed me a video on YouTube of a pony that was picking its feet up a little higher than normal when it walked. It was the kind of video that a normal person sees and says “Hehe, that’s cute.” Not this pregnant lady. I started to laugh, and then I felt something happen… like an emotional dam broke… and I started… crying? I didn’t know what was happening, I think Aaron thought I had gone insane, and I just kept repeating “No, I’m laughing, I don’t know why I’m crying,” but I literally couldn’t stop. I think it honestly went on for a good 10 minutes before I was able to turn off the faucets of insanity (aka my eyes) and stop laugh-crying. It was intense. It was frightening. It was, I assumed, pregnancy-induced momentary madness. It was hysteria.

There were a few other times it happened when I was pregnant with Emmett. Once time, Aaron was filling his cup from the freezer door ice-dispenser, and an ice cube fell on the floor. It was an “oops” moment. Maybe worthy of an under-your-breath brief chuckle. It became a 15 minute melt down of hysterical crying that I insisted was actual laughing that I couldn’t stop. The fact that I couldn’t stop actually made it more funny to me. And the fact that it was so funny that I couldn’t stop made the sobbing sound even more insane.

It got to the point where I could actually feel the moment a laugh “snapped” inside me, and I would just cry “OH NO” as I dissolved in a fit of sobbing (I swear I was laughing). My worst nightmare came true when it happened in front of my family. We were playing some sort of game. Catch Phrase, I think. And one of my brothers said something silly about one of the former presidents having a brother with a weird name (it wasn’t funny, I swear – Like, Jimmy Carter and his brother, James Carter), and I giggled and then cried “OH NO! AARON, PLEASE TELL THEM WHAT’S HAPPENING!!” because I knew I was no longer in control of my body. Of course, he didn’t say anything for a while, because he thinks it’s funny (it is), but my poor family probably thought I had finally snapped (I had).

The worst instance happened when I was in the hospital. I was still pregnant with Emmett, in my 7th month, and it had been determined that Emmett wasn’t growing anymore. It wasn’t dangerous for him YET, but blood-flow in the umbilical cord was sporadic at best. It was a terrifying 2 weeks as I worried that my baby could die at any moment while my husband was slowly dying next to me (it was a bad year, but all 3 of us thankfully pulled through). So I was hooked up to 2 fetal monitors, along with machines measuring my own pulse, oxygen, heart rate, and all that good stuff, for a solid 2 weeks while on hospitalized bed rest. And then something was said (I don’t remember what), and I had “an episode” and the nurses lost their shit. My heart rate was insane, my oxygen dipped, the baby’s monitors got weird… but I couldn’t stop! I finally calmed down, baby was fine, but it was scary for all parties involved.

After Emmett was born, I didn’t have any more episodes. I was so thankful that nothing ever happened at work. I told coworkers about it, just in case it ever happened and they thought they needed to call 911 or something, but thankfully nothing came of it.

When I got pregnant with Madeline, I thought “Maybe it was a one time thing,” but I was wrong. It happened again! And again! I can’t actually remember any of the reasons, but it was really something. After she was born, I thought I was good. There was no longer reason to fear public places. Everything was fine. The uterine curse was over.

Except… it’s not. It still happens. Not as much as it did, but it still happens. I can still feel the moment a normal laugh is about to turn into an episode, and Aaron quietly says “YES!!” whenever I laugh and cry “OH NO!” and let the insanity take me. Thankfully it’s still rare, but it always makes me ask “Am I pregnant?!” I’m not, this is just my life now. It’s okay to laugh about it. I am.

So why am I telling you all this? Apart from the fact that I don’t want to be ashamed of my momentary lapses in sanity, it happened again recently. This time was the first time it happened in front of the children, and it was… tense.

We were eating dinner, and I bit my cheek. Like, really bit it. I could feel the “crunch,” and I was worried that I actually bit a part of my mouth off (it’s fine, it healed up quickly). But as I was telling Aaron why I had suddenly frozen and had a weird look on my face, a tear formed in my eye. It hurt, okay! And Madeline, angel that she is, said “Mom? Why is there water coming out of your eye?” and I laughed and felt myself spiraling and cried “OH NO!” and Madeline’s face made it so much worse – she was looking at me with a combination of horror, confusion, and despair. She was witnessing her mom’s decent into madness, and I couldn’t stop laughing. I wailed “GET HER OUT OF HERE! PLEASE!!!” because Aaron was just laughing at me and looking at her face, and it was too hilarious for me to be a part of. No child should witness that. As he ushered her away from the table to let mommy have some “crazy time,” I heard Madeline ask why I was crying, and Aaron tried to explain that mommy’s not crying, she’s laughing, but sometimes she goes a little crazy. And that was so, so funny to me. The sobbing intensified. And then he said something like “You’ve never seen mom cry, have you?” because she was so terrified of what was happening, and she said “Yes, I have, she cried on Emmett’s birthday.” This didn’t make sense to Aaron, but … …

You guys, I did cry on Emmett’s birthday. Back in November. They found his presents, and opened all of them before I even woke up that morning. I came downstairs to wrapping paper and ripped up packaging everywhere. They were so happy, but I felt a small piece of me shrivel up and die because I missed the look on his face when he opened his birthday presents. It seems silly, but I don’t care. I didn’t say anything. I just sat down on the living room floor and let the tears fall down my face as they stared at me, not understanding why I was so sad. I’m crying now just thinking about it.

But, you guys, it’s July now. I don’t think I actually told Aaron I cried about it back in November, because it seemed like a silly thing to be so sad about, but now I had to explain, while sob-laughing, what she was talking about. And reliving that moment somehow made me laugh and cry even harder. The sadness of the memory, combined with the horrified look on my daughter’s face was somehow so hilarious to me in that moment that I had a moment of hysteria like none I had experienced before. It didn’t want to stop. And as I finally started to calm down and remembered how to breathe, Emmett (who stayed at the table this whole time) whispered, “Mom, are you okay?” and that started it right back up again, because no, mommy is not okay, this isn’t normal, but I can’t stop laughing about it. And I swear to you, baby boy, that this is truly laughter, despite all sights and sounds to the contrary.

So that’s my secret. My name is Casey, and I’m a walking time-bomb of emotion. Thank you for letting me share with the group.

Juneteenth

Today is Juneteenth, which is a day I never learned about in school. It celebrates the day that Union soldiers marched into Texas to announce that the slaves were free. Or, rather, that they had been free for the past 2.5 years. Because apparently we thought we could just say “slaves are free” and the southern slave owners would pass that information along on their own. It’s like when my daughter says “yes, my room’s clean… but don’t look at it!”

In honor of Juneteenth, I want to share some stories of the last slaves in America. We know slavery to be “a bad thing that happened a long time ago, and then it stopped. The end.” People (white people) want to be able to say that slavery was so long ago, why are we still talking about it? Racism is a thing of the past, what are all these whiny snowflakes going on about? You can’t blame your problems on something that happened to your great, great, great, great grandparents.

But here’s the thing – it wasn’t actually that long ago. Slave ships, which kidnapped and/or captured mostly children and teens (you could fit more kids than adults on a boat) from Africa and brought them to America, were outlawed in 1808. Obviously, that didn’t stop the ships from coming. One of the last known slave ship survivors died in 1937. Her name was Redoshi, and her owners renamed her Sally Smith. Her father was killed in a tribal war in West Africa, and she was kidnapped, sold to slavers, and brought to Alabama when she was 12 years old. On the auction block, she was paired with an adult man from another tribe who spoke another language than her, and they were sold as a husband and wife “set.” They had a child while they were still slaves, and stayed together for the rest of their lives. Emancipation came when she was 17, but she stayed working the fields of her former owner’s plantation until she died. She knew where she came from, and likely still had family members living in her village, but she had no way to go back home. We know so much about Redoshi because she was interviewed for a book, a newspaper, and was featured in a short film about the benefits of sharecropping (basically a propaganda piece to keep Black people working on their plantations and stop them from moving north).

It was discovered just this year that another woman, Matilda McCrear, was the final slave ship survivor. She was brought here as an infant, and died in 1940. She was on the same slave ship as Redoshi.

I want to pause here. There are people living today who knew someone who was brought here on a slave ship. Think about that for a second. Really think about it. People are alive today who KNEW someone who was brought here on a slave ship. How royally messed up is that?

One of the last confirmed Americans born into slavery, Eliza Moore, was born in 1843, and died in 1948. Emancipation came when she was 22, and she became a sharecropper with her husband. She spent 22 years as a slave, and she lived to see the invention of the microwave oven.

A man named Alfred “Teen” Blackburn, who was born into slavery in 1842, remembered having the best job on the plantation. He got to stay inside and shoo flies from the table, serve guests at fancy parties, and take care of the children. He was given this special job because of the light skin he got from his owner-father. He is recorded as fighting in the Civil War, where he was listed as the “body servant” of his owner-father, and he served at the First Battle of Bull Run. He did not use a gun, but was given a knife to protect himself. He died in 1951.

The last American slave (though it can’t be confirmed – birth certificates weren’t given to slaves, and records were lost after the Civil War), claimed to have been born in 1841. His name was Sylvester Magee, and he served on both sides of the Civil War. He never learned to read or write, but historians who spoke to him said he could describe events from the war as only a person who had fought there would be able to do. He had four wives, three of whom he outlived. He fathered 7 children, the last at the age of 107 (no thank you). He claimed that he never drank alcohol in his life, but he smoked cigarettes for 108 years. He died in 1971.

Slavery is not some long-forgotten institution. People still live who knew the survivors. We’re hearing every day from Black people who say that the system is working against them, and the system keeps trying to argue that each individual is completely responsible for what the system does to them. You can’t tell me that we have moved past the repercussions of slavery when the people who were directly affected are still in society’s living memory. This wrong will not be righted any time soon without a decisive and purposeful decision to make changes for the better.

Basically, what I’m trying to say here is that Black lives, and their stories, matter.

Yogurt – when milk goes bad, it’s good!

Yogurt is a strange food if you really think about it. It’s milk that sat somewhere much too warm for much too long and got … funky. Personally, I’m not into it. I don’t like the flavor, the consistency, or the smell. It’s a real bummer, because I love making it! And I’m going to show you how to make it, too. It’s easier than you probably think.

Ingredients and Supplies:

  • Milk
  • Yogurt
  • Thermometer
  • Pot with lid
  • Whisk
  • Towel
  • Incubation station

Yes, I recognize that it’s weird that you need yogurt to make yogurt, but the bacteria have to come from somewhere! If your grocery store carries yogurt starters (AKA powdered yogurt bacteria), go for it. Mine does, but I still always go for the single-size plain yogurt. It’s cheap, it’s easy, and I’m all about that.

The ratio of milk to yogurt isn’t SUPER important. I usually do 4-5 cups of milk with one container of Chobani, but feel free to go with a larger or smaller batch and adjust the yogurt amount accordingly. It doesn’t matter what brand you use so long as it’s got LIVE bacteria (check the label) and it doesn’t contain any “extras” (fruit, flavors, etc). Plain is best, but vanilla will do in a pinch.

What kind of milk? I prefer whole milk, because it makes a thicker yogurt. Other kinds of milk work too, but they’re going to be thinner. If you’re cool with that, then go for it. (You can add a couple of spoonfuls of powdered milk to your milk before you start this process to thicken up the end product if that’s something you keep in your pantry – and if you don’t, you should).

What’s an incubation station? It’s a warm place. Ideally, you want a location that can keep your milk around 100℉ for the entire duration of your incubation. Wrap your yogurt container (I keep mine in the pot I cooked it in, but you can also pour it into jars or something) in a towel to keep it safe from sudden accidental temperature changes. I use my oven with the light on (it stays at a perfect 100℉ until you turn off the light), but you can also use a warm room or a cooler. Before I discovered the oven trick, I used a big cooler with a tea kettle of really hot water on one side, yogurt on the other side, and towels wrapped around both for added insulation.

Directions:

  • Heat milk to 180℉
  • Cool milk to 115℉
  • Whisk in yogurt
  • Hold at 100℉ for 6-12 hours

That’s it! Couldn’t be any easier.

We heat milk until it’s really hot (but not boiling) to make sure that all the bad bacteria (from your milk, your whisk or your pot) are definitely dead. We’re going to be growing bacteria, but we want to make sure it’s just the good kind. I’ve heard that heating the milk also does something to the proteins in the milk, which makes them better for the yogurt’s final consistency, but there’s conflicting information on that. Also, make sure you STIR your milk during this process to stop it from burning on the bottom of the pan. That would be no bueno.

Make sure your milk is sufficiently cooled after the heating process so that it doesn’t kill your yogurt bacteria. Anywhere from 110-120℉ is good. We want to make sure it’s warm enough that adding the yogurt won’t drop it below 100℉.

Make sure your yogurt is at room temperature before you add it to your warm milk. Remember – we want to keep it at 100℉, and adding cold yogurt will drop the milk’s temperature too much.

How do you know how long to incubate your yogurt? I don’t have a good answer for you. I always let mine go overnight (except this last time – I set it up in the morning, and took it out and popped it in the fridge before bed). The longer it sits, the thicker and tangier it will be. It’s not really something you can check on during the process, though – each time you open it up, you drop the temperature. Stirring it disrupts the bacteria and makes them stop working for a bit, so doing that will majorly affect your incubation time. So basically, you just go until you feel good about it, and if it’s not to your liking then you do it differently next time. I usually aim for 8-9 hours. Also good to note, after it’s done incubating it’ll seem really thick – when you stir it, it thins out a lot.

Stir, stir, stir! Don’t let your milk burn, and keep an eye on your thermometer!
Incubation station! Check out that perfect temp! Please ignore my dirty oven. It’s fine.

Like Greek yogurt? Easy peasy. Snag a bowl, a colander, and a couple of coffee filters (or a few layers of cheesecloth). Line the colander with the coffee filters or cheesecloth (I like to use 2 coffee filters just in case one rips when I’m transferring the yogurt at the end), add the yogurt, and let it sit over a bowl in the fridge. If you made a lot of yogurt, you might not be able to fit it all in the colander at once – I did mine in batches. Check it every couple of hours until it’s the consistency you like. It can take anywhere from 4-12 hours depending on your preference. I like mine around the 6-8 hour mark, so I let it go overnight. Don’t worry if it goes too long and is more cream cheese than yogurt (fun fact – when it strains for a long time – 24-48 hours – it’s called yogurt cheese and is a lot like cream cheese). You can always add some of the liquid back in to thin it out if you need to. Make sure that your bowl is big enough. From my most recent batch, I used 5 cups of milk and a container of yogurt, and I strained out almost 2 cups of liquid.

The liquid strained out of the yogurt is called whey, and you should keep that if you like making stuff from other stuff (or toss it – your loss). It looks kind of like lemonade, but it’s got a slightly thicker, almost syrupy consistency. It’s full of protein, vitamins, and other good stuff, so I recommend keeping it. More about how to use whey in a future post!

And finally, unless you like eating plain yogurt (what’s wrong with you?!) you’re going to want to flavor it. I wouldn’t add regular sugar (it stays grainy and weird), but honey, ultrafine sugar (also called bakers sugar), and jam work really well. So get out there and give it a shot! You can do this!