If you know me you know that i do not like to complain.  

For the last year we have been getting a taste of the system that we face for Lucas as he transitions into adulthood.  We have spent hours in meetings identifying his needs and how the system can help us.   Lucas will be finishing high school in 4 months. The greatest freedom Kelly and i have gotten in the last 10 years is when Keenan came here to Colorado a couple of years ago.  

Keenan had 10 years of a very unstable life.  It was hard for our family .   But he adores and has always adored his brother Lucas and he is now present and stable.  

In the last year or so, Kelly and I have had more getaways then we have in the 20 years that Lucas has been alive.  We got to spend our 30th anniversary in Italy because Keenan stayed with him for two weeks.   We have been able to go to Mexico for a week.  We have taken countless weekends to the front range to see friends, or to the mountains or to Utah or various other places where we could just kick back .  We come home to Lucas well cared for, happy and our cups full

Keenan has a history.   His has a background.  But he is the best brother Lucas will ever have. Keenan has given us a freedom that is invaluable.   We want him to get paid.  yes , we could pay him but the state has money set aside for Lucas.  For the last year or so we have tried to access that money.    It takes meetings, many unanswered emails and voicemails.  Staff turns over and so you have to start over.  He has funding but there is noone to provide the service.  We have had people signed up who don't show up and come to find out they called that day and quit their job.  

 So we decided to have Keenan apply so that he can get paid when he is covering for "us" as it should be.  He is working so he is not looking to be Lucas's caretaker but we hoped he could get reimbursed when he covers when Kelly and I go away. Respite, right?  

He has spent the last three months trying to apply.  No phone calls returned.  Finally a foot in the door.  He started the training process and come to find out that there is something on his background check that makes him incapable of being hired.   He is our number one choice to care for his brother but the agency can not hire him.  It is truly a broken system.  And so the funds that the state designates for Lucas will go to someone who really does not care for him the way his brother would.  I think as Lucas's parents we should be able to decide whether we trust Keenan to do the work .  

The system is just broken in my mind.  I am tired of trying to play it.   It brings me back to my alternative ideas.  Time to think outside the box.  Again it brings me to my idea of moving to Mexico.  

Feeling frustrated but in the long run,  Lucas is happiest at home with us and we will make it work one way or the other

Longing for the perfect world... I am sure i will be longing for a while but i do believe that there is a better way than this.    

And to keep it all in perspective.  I feel sorrow and am praying for the people in Houston.  I am also reminded of the amazingness of the human community spirit in stories that I hear and see.  

My heart goes out especially strongly to my dear friend Randi Patel and her family ... xoxoxo  .  I hope you are comfortable and that your needs are met.  

I love to come and i love to go .   Yes it is true.  I cannot wait to leave my home and to go on an adventure that takes me away from my everyday life.   As i have said before, I am really and truly a gypsy.  

I love my home.  The fact that I love to leave does not take away from how much i love it.   This weekend we went to Crested Butte Colorado for the wedding of our dear friends Jessica and Charlie.   It was sooooo amazing.  I mean first it is in Crested Butte which if you don't know it is is stunning!
   
There is something about 7000-9000 feet Colorado in the summer and fall that is crazy amazing. Combine that with good people who love life and love each other and you have an amazing time.  Meeting their family was so fun.   They came from Oklahoma and Connecticut.  Wild fun and totally crazy bunch of family loving people.  

It has been 5 years since I completed breast cancer treatment .

 For me hitting the five mark has been a big goal.  I am there and i feel amazing.   When i was starting treatment, one of my dearest friends, Kim Curless told me about a national organization called Casting For Recovery.   It is a program that you have to know about.   Breast cancer survivors of all stages get to go to amazingly beautiful places in this country to fly fish with people who are divine.  It is fun.  It is healing.  If you have a loved one with breast cancer please tell them.  

After Kim told me about it I decided to go.  I went on a trip  here in Colorado.  I met amazing women.   women who had something in common with me.   There was a woman named Julie.  She was very young.  Like 30.  She had young children and we completely connected.  I am sorry to say that today Julie has passed.  She left a trail of amazingness . I met Peggy who now is the national leader of this organization for 18 states and got to totally get down with her last night at the wedding.  yes!

Jessica was a fly fishing guide and she was also a medical student.  We met the first night and hit it off!   The next day I found out that she picked me !  She was going to be my own personal guide.  She is a crazy lady fly fisherwoman!  Not to mention she is so smart, compassionate, loving and funny and adventurous.    We took off in the morning.  She taught me to fish.  She cheered me on about how natural i was as a fisherman, haha!  She celebrated with me,  cried with me,  shared with me her personal challenges.  She went on to graduate from medical school and is now an intern.   She helped me to heal from breast cancer and I supported her journey to be a doctor.   She is going to be totally amazing at it.  She will be a lifelong friend of mine.  I adore her

This weekend in Crested Butte we celebrated life, love , fly fishing memories and the gorgeousness that is Crested Butte.  I met her family and I saw the love that is palpable between Charlie and Jessica.  It was a joy to be at her wedding.   

Kelly and I now both have ebikes and we Love them!  we were able to ride all over the place in crested butte!

Today as we headed home my cup is full.  As i unpack my bags and replenish my bathroom supplies, do my laundry, cook dinner, and make homemade tollhouse cookies with Keenan for Hannah who's birthday is just around the corner, I realize ... I love to leave. and i love to come home.    Life is good.  It is despite it all

I am going to take a moment to discuss something that you might perceive as "political".

A dear friend posted something about how the media is full of double standards.   I am certain that is true.   I of course took a deep breathe because we tend to think differently.  The truth is that i don't think we think that differently but I think we listen to different media/perspectives.    It has certainly created a crevice in our friendship but not one that would break our love for each other.  This post led into a conversation of what seemed like babble.    comments that were bold but very general and you could not make sense out of what the person was really talking about. 

Several years ago , during the time leading up to the election, there was an acquaintance of mine that is very knowledgeable but felt very opinionated and somewhat inflexible.  I ended up deciding to unfollow her.  It just felt icky.  Well today she joined the conversation on my friends post.   My assumption was immediately here we go.  But I recognized her educated and somewhat objective, non partisan opinion.  

I decided instead of continuing this line of facebook input that i would reach out to her privately.  She had made a comment that said this...

" I don't think religion should be imposed on citizens. But I also don't think policies should be imposed on religious citizens when they are able to demonstrate a history of devout belief and practice.".

 I thought to myself,     i agree with you but could you be more specific?  

this is how she responded...



  Her:  What comes to mind as an example is the small mom and pop businesses who have come under fire for not making wedding cake for gay weddings based on religious convictions or small apartment building owners who choose not to rent to openly gay couples based on religious convictions.

While I am pro gay, I think that there needs to be some understanding and respect for small business owners to make decisions based on their religious beliefs and I think they should be required to be able to substantiate said belief in some way
there is an argument to be made that when you enter the marketplace on a larger scale, that you surrender that ability to apply your religious convictions


Me:  Oh yes . I've heard about that and agree they should not be forced . Who the hell cares about that?  . It's so stupid !! Why would you want someone to make your wedding cake when they don't support you
Agreed



Me:  It helps me to have specific examples so I understand . Thank you

Her: so while the law may not specifically disallow small business owners from this practice, it also does not protects them from costly lawsuits
thanks for asking


Me: And I am positive that of  all the gays the vast majority would never sue . The small minority have to ruin it for everyone so often . It is through real conversation we realize we agree on much more than we disagree  I hope you and your family are well

Her:  I agree. I think that if we could just get to a place of dialogue, there is much that the majority agrees with or could be comfortable with if we would just stop surrendering our power to special interest groups on both sides

I hope you guys are doing well too! Cannot get over art work.
Just phenomenal!


Tonight i had a conversation with someone I ASSUMED thought very differently from me.  There were tidbits that were left out in the interest of keeping this short enough.  But i felt connected with my friend who "thinks differently".   does she?  do we know or do we assume what people are thinking.  I feel it is so important to speak specifically about what we believe.  General vague comments ( would you call that a platitude Mom?)  do not work.   We all need to be critical thinkers,  We need to listen to both sides.  

The extremists on both sides ruin it for us all whether it be american, muslim, mormon, christian, black, jew. white...  We can not allow these extremists to divide us as americans.   


WE CANNOT GENERALIZE  and i feel we all need to really listen and we need conversation.   

I pray and hope we can begin to heal this huge divide and realize that most of this does not represent us whether we are republican or democrat, left or right.  We have extremists in the world that want to disrupt our peace and i hope that we can work to heal the divides that exist. no matter what our party line is.  

In love.  

​Stacia




 

)I am in the process of transitioning my medical practice.   I gave a four month notice in my current practice when I accepted a position at Appleton Clinic here in GJ.  This practice is a different model called direct primary care.   Patients pay $79 a month for a membership and in return can be seen when and as needed with no copays, no charges.  They get free labs once a year and free x rays and other very attractable benefits.  Is this better?    That will remain to be seen but I love the transparency of cost that exists.   You know what your health care will cost you and the creator behind this venture, Craig is constantly negotiating the best rates with hospitals, providers and other vendors for the best price for our patients.  

I will miss my practice and have spent the last couple of months saying goodbyes to those that will not be following me.  I have treasured the fact that I have had 4 months as when I left my practice in Maine it was very fast and abrupt.  I left to come to Colorado as I received an offer that I could not refuse.  One that would pay off my $150,000 in student loans for a three year commitment.  I could not turn it down.  It was a good decision but I had to leave quickly and left many patients, staff and friends without proper goodbyes and conversation.  As I look back, I wish that had been different. 

For the last several weeks, I have had treasured conversations with my patients who have shared stories about how I have changed their lives or how I have helped them.  I am reminded of the gift of my ability to listen without judgement which I have heard over and over again.   Such gratitude for that. I am touched by the human connection that I am blessed to have .    I also feel a deep connection with the staff that has supported me to provide great medical care for my patients.  They have cared for me, worked hard for me and have become my friends.   I will miss them but we will remain friends. 

 With the uncertainty in our national medical condition, I feel this is a good decision for me.   I hope that in the coming years we will join the other modern nations of the world in working towards a universal health care system where healthcare is provided to all Americans as a right and a need.  That will remain to be seen. I will remain involved as best I can to speak my truth about this. 

Earlier this month, I was able to go to Maine!   It was amazing.   I framed my trip around a painting workshop in Rockland Maine with Steven Aimone.  It was fabulous.  We ( women from Asheville, Brooklyn, Charlotte, Montreal, Toronto, Kingston, Michigan, Connecticut,  Boston, Atlanta, New Orleans, Mexico City and Me)  gathered to paint, learn, share and be inspired by the Art whisperer.  It was AMAZING!  

I was also able to bathe in the friendships, the beauty, the food , the sights and the saltiness that I miss about my home.   There were many friends that I did not have the time to connect with but ... I hope next time. .   The schooner trip with Hannah off Bailey Island was definitely the icing on the cake.   wow

So I return feeling ready to paint my feelings, my gratitude, my regrets , my fears and my celebrations.  For i feel that is all i can do.  As I head to my studio, i thank you all for the support you have given me whether you have just liked, loved, commented or bought my artwork.   I have averaged a painting a month in sales for the year of 2017 and I am thrilled about that as my husband packages my painting to go live in a cottage on Lake Michigan.   Knowing that my creation travels across the country to those that appreciate my work fills my cup more that you could ever imagine.  

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It is about Peonies.  

It has been a minute since I released a blog post.  I always have to wait until the inspiration arrives.   

I live in the high desert of Western Colorado.   I always saw myself spending some time ( i thought 3 years) in the desert southwest.   I have now been here for 5 1/2 years.   It is a gorgeous place.    like crazy gorgeous and wild and dry and everything that i did not have in Maine.  Now being from Ohio, and feeling very loyal towards the fact that I am a buckeye, and having loved ones there that I would love to rendezvous with , it is my root.

Upstate NY also holds a special place in the corner of my heart.   Cannot even begin to explain why, special place, special people.  fond memories.  


Where is my heart?  right now Maine.  lived there for 20 years and raised by babies.  i am seriously homesick about right now and cannot wait for my visit July 1!  There is something about Maine that is wet and soft.  That I miss.

Where is my soul?  right now Colorado.  I love it's majesty.    I love the unexpected rains!  more than anything,   I love the skies, the horizons, the openness of the people and the wide thoughts.  

Mexico is calling my name too.   I would love to live there at some point.   

The constant is that I am  a gypsy .  My dear friend Jody calls me " willow". 

Life is a journey.  I would  have never imagined that I .... would become a painter.  It is without a doubt one of my biggest passions.  Gratitude for that and for all of you that support me and appreciate my work.  Without having had breast cancer I would have likely never picked up a paintbrush.   Think hard about that.  What a gift.  Seriously.

OK now about the peonies.  When i moved to the desert, I thought " there is no possible way I could grow peonies or hydrangeas".    Last year we put in drip irrigation.   A targeted water system.  how efficient and amazing.  i thought that my peonies died over the winter but they are thriving and they are amazing to watch .  they are about burst .  they are still expanding buds.  I cannot wait to see their flowers any day now.  I think about targeting my thoughts and my energy like this drip irrigation system.   Can you imagine if you could just place your thoughts where you want them?  Direct them like a target.  No waste, no worry.  It is about the peonies. 

As some of you may know, we just returned from a week in Mexico.   I ADORE Mexico in fact I want to live there now but unfortunately I still need to work.   And don't get me wrong, I love my life.  I just really really have a serious adventure bug that does not mellow with time.  I need to travel while I can so... this is my current love of a place and transitioning back to life and work is not always easy.   I have been feeling very overwhelmed despite the arrival of spring and warm temperatures and open windows and buds on the trees.   The time change i believe plays a role as the time did not change when we were in Mexico.  

Jumping back into long days is just hard.   I love my work but I cannot seem to find time to fit in exercise, yoga, and painting. This morning I got up long before the sun so I could fit in a walk with Morgan and Paddington.  As i began walking out of my bedroom with bleary eyes i banged in to the half open door right on the eyebrow.   I was soooo upset and by the end of the day the black eye developed.  

I got home and made dinner and shared it with my family.   Then caught up on some news for an hour at which time i was feeling tired.   My sense of loss was that I have not made it to my studio.  I decided to go there tonight if even for 30 minutes and in that hour my soul was fulfilled.  I realized that this is an essential practice for me as is my yoga.   

As the world seems to get crazier and crazier I feel the need to be grounded and creative.   I am feeling the need to be more mindful about me .  I had an amazing hour in my studio and I feel happiness and satisfaction.  

As I end the evening as lay my head down to sleep , I pray that tomorrow we will move a step  closer towards healthcare for all.  It in my opinion is a need and a right.  As I painted tonight I really painted about equality.  Equality for all.  Which is what i am titling this painting.    

Eating Thorns.   

In order to create their beautiful plumage peacocks sometimes eat thorns.   Hard pointed razor like objects are processed in their abdomens and then contribute to feathers with colors and shapes unmatched throughout nature for their extraordinary beauty.  So it is with us,  that which is the hardest to digest , to process , to integrate into our life experiences is what ultimately transforms us in a positive way.  We become who we are meant to be. 

Marianne Williamson.    Tears to triumph

This post is a bit political but it is really about how I feel about taking care of my patients, my family and my country. 

Inherently, I am a believer that we, in America should have a universal health care system.  If you have not been following my blog for very long, and you are  interested in learning more about why, refer to my blog from 11/2014.  It was a blog about  a book called the Healing of America by T.R. Reid.  You can see a summary of the research findings in that blog post.  

Since I moved from Maine to Colorado, my practice has been working our buts off on a quality project called CPCI. 

Led by the CMS Centers for Medicare and Medicaid Innovation (CMMI), the Comprehensive Primary Care initiative (CPC initiative) is a four-year, multi-payer initiative designed to test practice redesign models and a supportive multi-payer payment model.  The program grew beyond 4 years and we have just been chosen to complete the next chapter of that project.  It has been ALOT of work for all of my staff.  I am so grateful for the effort they were all willing to put in.  

My practice is a rural practice comprised of large numbers of medicare and medicaid patients.  With the affordable healthcare act, I have seen patients who have not had access to care for years .  Their only means was to seek care when they were in crisis which meant emergency room visits with a potential for needing expensive hospital care.  With the CPCI project, we have been able to study our population and to identify those who are in need of extensive management.  We have worked hard to see these patients frequently,  to educate them as to how to best manage their diseases.  We have taught them how to eat well, how to increase exercise, be more compliant with medications,  address the barriers that they have like poverty,  lack of support or transportation.   We have addressed their physical, emotional, mental and economic issues.  We have become a certified medical home and our patients are healthier.  We have significantly reduced emergency room visits, hospitalizations, readmissions to the hospital and unnecessary referrals to specialists.   We have also worked very hard to improve communication between the primary care physician and the specialists as patients transition between the two.  



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In early 2015, CMS released the first evaluation report(innovation.cms.gov)of the CPC initiative that reported favorable findings from the first program year (2013). CMS is pleased with the first year findings, but anticipates it will take 18 months to three years for practices to truly transform and to see efforts on cost, service use, and quality. Here’s what the first report has found:

• The CPC initiative reduced total monthly Medicare expenditures without care management fees during the first program year by $14 per beneficiary, or two percent.
• Impacts were large enough to offset most of CPC initiative’s monthly care management fees, which average $20 per patient per month among participating CPC practices. This implies that the CPC initiative as a whole was close to cost neutral during the first year.  An update to the evaluation report indicates the same reductions in cost through March 2014.
• More specifically, results show a reduction in high cost areas such as hospitalizations, emergency department visits, and specialist visits (all per 1,000 beneficiaries):
  • Annual Hospitalizations decreased by two percent.
  • Annual emergency department visits fell by three percent.
  • Annual specialist visits declined by two percent. 
  • Annual primary care visits in all settings fell by two percent.
  • There was a four percent CPC-wide decline (not quite statistically significant) in unplanned 30-day readmissions

We have just begun to understand from a primary care perspective, which is our foundation, how to reduce healthcare costs.  This was made possible under the affordable healthcare act.  It has not been perfect,  in a country such as ours it will take many years for the creation of a viable, sustainable health care system.  I do not believe the answer is in going back. I believe it is in continuing to build from what we currently have in place.  Having less people insured will only cost us money. I believe we all need to be insured.  

I worry about the repeal of the affordable healthcare for my own personal reasons as well.  Being a breast cancer survivor it could become very difficult for me to obtain health insurance.  Being the mother of a disabled son, I worry that he will lose the medicaid coverage that he has and his social security.  Being the mother of a son who has struggled with addiction, I worry that he will lose the mental health support  that he has gotten that has helped him to stabilize his addiction.  He now has a skill that makes him employable.  He is no longer in homeless shelters and he helps us to care for Lucas, my disabled son. Ignoring these kinds of issues does not make us a stronger country.   It does not save our healthcare system any money. 

I understand that I am powerless to really effect the outcome of what may pass with the coming week which would be in my opinion be sliding backwards to create an even sicker and more expensive health care issue, but i wanted to share the perspective of one passionate American family doctor and citizen.  There is no question in my mind that my patients are healthier today ( if they want to be) than they were when they were uninsured.  It greatly concerns me that the many of the people who bash Obama's healthcare plan really do not at all understand it.  They say things to me like " oh well i don't have Obamacare".  I say to them "Yes you do".    There really is a serious gap in understanding and I thought i would just share a little of my own perspective on this issue.

To end, on Martin Luther King Day

Our lives begin to end on the day that we become silent about things that matter..... Martin Luther King Jr

I am not really a new years resolution kind of person but i definitely like to reflect on the past and on what i may have room to improve on as i set my intention for the coming year.  I came across this quote that i wanted to share as i look at the things that I am hoping to change.  I am thinking alot about willpower and determination and how important these things are as we look at the things about ourselves or our lives that we want to change.  




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​"When your determination changes, everything else will begin to move in the direction you desire. The moment you resolve to be victorious, every nerve and fiber in your being will immediately orient itself toward your success. On the other hand, if you think "This is never going to work out," then at that instant every cell in your being will be deflated and give up the fight, and then everything really will move in the direction of failure."
-Daisaku Ikeda

Today I added a new tab to my gallery.  One for 2017 .  As I look at all that I painted from 2015-2016, I stand amazed.  I can also see the improvement in my technique as I compare to the 2014-2015 tab.  You kind people have motivated me by commenting , loving, sharing and buying my art.  thank you!!!