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I remember watching the Julia Robert’s movie, Erin Brockovich and thinking how is it possible for that insurance guy to be able to go along with that memo/mandate from the powers that be and deny patients their health coverage?  Then, this past year the very same thing happened to my sister.  She suffers a congenital degrading disc thing in her back.  She is a fit, previously healthy 29 year old.  She had a discetomy in her lumber region when she was in high school.  Since then she has lived with continuous back pain.  She has seen specialists all over the Chicagoloand area.  She continues to suffer extreme pain.  Finally, her main specialist suggested a fusion.  This would be a major operation and require pre-authorization.  BCBS-IL denied her because she had not attempted other means of fixing the pain.  Her previous discetomy was too long ago to be considered a viable attempt at fixing a “degenerative” situation.  So, in December she had another discetomy and recovered to only a slight amount of relief.  I now blame BCBS-IL for basically turning my otherwise healthy younger sister into a near Vicodin addict.  She has been popping major pain pills for almost a year now.  And now, NOW, BCBS-IL finally approved the fusion surgery because the various specialists all determined that the discetomy was not a viable treatment option for a condition that will only continue to get worse with time – as the “degenerative” label so obviously suggests.  So, until the fusion surgery she will continue to pop the Vicodin just to grit and bear it.  She has talked to lawyers and sought an outside review of the whole situation, but her situation has been resolved with the scheduled date of the operation.  Now she faces an even more interesting situation since the “spinal” issue will flag her for future insurance plans and thus cost her more.  The method of how BCBS-IL handled her case is just one example that completely frustrated her (and our family).  It coincides with my own.

I was denied for Surgical Treatment for Morbid Obesity.  Let me update this whole thing because I am not HUGE, but I am obese by BMI standards and having R.A. makes working out something that helps to combat joint stiffness, but doesn’t necessary allow me to attack flab with the gusto that I once enjoyed so much.  I looked into this two summers ago and began jumping through all of the BCBS-IL hoops toward approval.  Two years ago I was also a cardiac patient as a congenital heart condition came to light at the same time as my diagnosis with R.A.  Actually it was the chest pain that got the whole health assessment ball rolling.  The cardiologist suggested a follow up appointment with a rheumatologist and the rest is history: LBBB, R.A., and hypothyroidism.  That was a fun year: 2008.  I wasn’t really THAT overweight in 2008, I had previously lost a lot of weight in 2007 due to my obsessive working out that I did to cope with mourning a death.  I just thought that I was sore and my family was worried that my massive weight loss, combined with pain, was something heart related – especially since our family has heart issues on both sides.  Anyway, as 2008 hit me with all the medical woes, the working out scaled back and almost stopped, with the rare exception here and there.

With the slide into unhealthiness and the mental shock of dealing with a diagnosis of R.A. – the same disease that has possessed my mom – I was not the most motivated patient when it came to hitting a treadmill or lifting weights.  If I did what I used to be able to do with such little effort, I would be so sore and so stiff that I could barely function the next day.  I wore magnetic bracelets, sought Eastern therapies, and began to discover what life with R.A. was really like.  I had been heavy, then fit, then fat, then less fat, then really fat, then just mushy….all my life going up and down the scales and clothing sizes.  All my life I had done one thing or another to address my body composition.  Finally, the rheumatologist suggested that I look into Lap Band.  Getting all and any extra body weight off my sore joints was hugely important.  So in 2008 I attended an informational meeting about it.  There seemed to be so many insurance hoops to clear just to get to the point where they could submit to insurance.  I didn’t have the time and I really didn’t have the money.  So I continued to attempt diets.  The bariatric doc from 2008 suggested that I see another doc who prescribed the OptiFast diet.  I’m not sure how many readers can ever, ever say that they sustained a long-lasting success using this p.o.s. plan.  I did the weekly weigh-ins, meetings, and extra vitamin shots (those weren’t free either).  This was all very expensive, but I sucked it up because it was a “non-surgical” treatment.  I starved on that program, had migraines, flare-ups, and all kinds of digestion problems.  So I stopped because I couldn’t continue to feel like crap from doing that.

I had acupuncture.  I had a permanent pin in my ear in order to “curb” my appetite.  By the way, the acupuncture was super helpful, and of course, since it was able to actually relieve my R.A. pain (I mean “relieve”) it was not covered by BCBS-IL, so I became poorer in my paying out of pocket for it and then had to give it up since I just couldn’t do it because of cost.  Nonetheless, I continued to gain weight and hurt.  The vicious spiral or R.A. and weight….it hurts to work out, so you don’t, so you get heavier, you hurt more, you become even more sedentary.  Last January (2010) I finally resolved to see out the bariatric surgery option, really as a last resort.  My surgeon said that I should have no problem getting it covered because of my BMI and the co-morbid condition of R.A.  Well, if only it was that easy.

I began to work with my new PCP who not only was the THIRD doc to explicitly recommend The South Beach Diet as part of my “medically supervised diet” but who also addressed the heart related issues that I needed to have monitored.  BCBS-IL paid for these monthly appointments, the mandated pulmonary and gastric testing, and other appointments with specialists as part of the pre-op process.  There was a sleep study and an upper-GI – these exams are by no means cheap, and BCBS-IL paid them.  Then, as the scheduled date for surgery approached I received a letter to say that my coverage was denied due to two reasons.

The first reason is crazy.  They claim that I have not documented that I am 18 or older.  I’m sorry – every doc’s note shows my birthdate on it…are they kidding????

The second reason states that I have not attempted appropriate non-surgical treatment!!!  What?!  Come on BCBS!  They want to see a medically supervised diet!  Didn’t I just do that?  But they wanted Weight Watchers, NurtiSystem, or Jenny Craig.  That is nuts!  The South Beach Diet was recommended by THREE different doctors.  Am I supposed to be doing a “medically supervised diet” that goes against what a medical practitioner says to do so that I can go to a strip mall store front and check in with a part-time customer service agent?  Give me a break, BCBS-IL!  You are purely playing a numbers game and denying me the procedure because you think that you can.

I’m going to fight!  I pulled together the 54 pages of the previous submittal and re-submitted with a cover letter that outlines the points of their contention.  My PCP wrote a letter stating the “medically supervised” part of the process.  I just heard today that BCBS-IL turned it down again.  The date was set for July 19th, is now pushed back to July 26th.  It looks like it might be pushed back to December now since they want me to do Weight Watchers.  I intend to get this in the calendar year 2010 since I don’t want to have to go through paying my deductible all over again – which is probably a factor that they have considered.  What a nasty numbers game!

So I surfed the web to see what other factors were going on with BCBS and was shocked to see what a large number of consumer complaints there are.  I’ll begin by saying that their pre-authorization procedures for my case (and for my sister) are ridiculous!  I can’t also begin to express my absolute and utter DISGUST at their automated phone system.  Their help line needs help.  They will not pass me along to anyone who can do more than simply restate what was in a letter or what the plan states.  They don’t HEAR you, they don’t LISTEN.  BCBS-IL will find any way it can to keep the BIG MONEY that it gets paid.  It is all about profits.  It is rather sad that people’s hard-earned cash gets funneled into this system that makes it impossible to get the coverage when it logically makes sense to provide it.  Hanging up coverage on a tiny technicality here or there, forcing my sister to have an operation that the specialists knew would not do a thing for her, just because the damn insurance company wanted to see that procedure first, is inhumane.  She suffered pain, loss of time from work and family, and a year of her young life to pain.  Their system, that she, me, you – all of us pretty much have to fund FAILED.

Just to make things all the more disgusting, try this.  Do a web search of BCBS CEO’s salaries.  Their salaries aren’t nearly as shocking as the “bonuses” and “payouts.”  There are fat-cat corporate dudes getting rich because of my monthly paycheck deductions.  Yet, I have to continue to jump through hoops for some company that can fly their execs around on Leer Jets!?  Unbelievable!

I’m going to the Illinois Insurance Reform Group’s site and seeing what my next steps are.  I’m going to ask BCBS-IL to do a peer-to-peer review.  I am also going to have an outside review too.  I’d love any thoughts/ideas/suggestions for how to get some actual answers from someone who can actually do something.

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John Clease played a funny peasant in Monty Python’s Holy Grail.  In a scene where the townspeople want to burn a witch he claims, “she turned me into a newt.”  Then, since he is obviously human he adds with a goofy smirk, “I got better.”  Whenever I do get better from something I hear that character’s voice in my head.  My back is doing better.  I have realized that a lot of the pain was coming from my glutes and hamstrings.  Nevertheless, my back was seriously messed up and until about two days ago I was wondering when it would improve.

Despite the pain and the spasms I continued to work out – at a much, much lighter level.  I stabilized my back and did a lot of upper body stuff and smooth cardio.  The gym has a Cybex elliptical that is so smooth I can’t tell if I’m moving forwards or backwards.  It is awesome!  I also did walk in the therapy pool.  I had to spend a couple of hours sewing up a tear on my new swimsuit.  The last time I used it at the club I put it into that spin-dryer.  Since it is a larger size it got all twisted up on the machine and I had to rip it out of there.  It was a brand-new suit and so I was determined to stitch it back together so that I could get my money’s worth out of it.  My mending job makes it look like some Frankenstein thing.  Anyway, I managed to salvage it and use it!  I also kept up with the ice and heat therapy at home.  I continued to take anti-inflammatory meds – but not the prescription.  I forced myself to keep active after brief periods of resting.  The result is that I’m doing a lot better.

Today I had a one hour swedish massage at a little spa in the downtown area.  The newspaper kids gave me a gift certificate there and I couldn’t imagine a better time to use it!  Wow, this was just what I needed.  The therapist found all of my knots and sore spots.  She spent a lot of time on my back, shoulders, and legs.  When she asked me to flip over I could barely move – that was because I was so relaxed.  The lavender aroma-therapy oil also helped to soothe away my tension.  I could really get used to such luxury, too bad my bank account can’t.  One thing that I wish I could take better advantage of is that foot massage.  Once, when I had visited San Francisco’s Chinatown I found a reflexology place.  I don’t know what they did to my feet, but it took an hour and I never had happier feet!  The massage today included some work on my feet.  That really helped me relax and feel better.  I will research online and see what other places in the vicinity might have reflexology.  I’d like to do that.

I would also like to re-visit accupuncture.  I did a series of treatments a little over a year ago.  It was too expensive to keep up, but it was awesome!  I could feel the chi responding to it; I also became aware of listening/feeling my body.  I am admitedly a needle-phob.  It takes a lot of mental prep to get me in to the lab for bloodwork.  So the idea of me laying on a table with needles sticking in me was pretty overwhelming at first.  But these needles are totally easy to handle.  They are tiny and flexible.  Sometimes I didn’t even feel them going in.  It turned out to be a very relaxing and rejuvinating experience.  The worst part was when I would feel chilly.  Anyway, the cost was my main hang up.  Scheduling time for the weekly sessions was also tough.  Once things got too crazy with my time and finances it was the treats like accupuncture that had to go.  I do think that it is extremely helpful for combating the chronic pain of R.A.  There are a lot of other things that it can help – which I read up on  – but, for me, the almost instant relief from joint pain was the deal maker.

So to add to my wonderful debt, I bought a Wii.  I’m not sure if I’m keeping it yet.  I’ve been wanting to get one for a long time.  Since I like the idea of interactive play, this seems to be a justifiable purchase.  I am thinking of taking it back because I can’t afford it.  I also can’t believe that I can drop the weight I need to drop and get my health to where it needs to be by playing video games.  That is a lot of money to gamble with on that notion.  I once bought a PS2 and barely even played it because I’m just not good at video games.  I’m already annoyed with the tennis games because I’m standing up and swinging like I would if I was actually hitting a ball and it messes up the shot and I end up hitting the net or hitting wide.  I almost just have to wrist the shots to make them go in.  I have one more week to figure out if I’ll keep the Wii or not.  Maybe I can see if my health insurance will pick it up.  Just kidding.

And regarding that whole health care issue: the government initiative thing.  I wish that I could understand the concept better.  I’m smart and I feel like I can wrap my mind around complex stuff – but, this gets me confused.  At times I think that one fair government-based health plan might be a good thing;  but then on the flip side I can not deny that we have an amazing state-of-the-art medical system that has thrived on competition and the capitalistic nature of our society.  We have “The Best” because we have created a market where one can buy the best.  If we level that field, then I’m not sure what will happen.  It is extremely complicated.  I’m glad to see that really smart people are at work on the problem.  I’m not sure what is really going to work to convince me one way or the other.  I fell asleep during the press conference – I was tired from working out.  I also can sense a lot of spin from the ultra-conservative side of the media.  I’m not liberal and I’m not conservative.  I guess I try to be ethical and educated when I feel a tug of war in things where my one little opinion is supposed to matter.  That is why I can’t say what I think.  Is re-vamping the system smart?  Not sure….Is it ethical?  Not clear.  So, for someone like me with a life-long battle ahead combating a disease that will spawn other medical conditions where I will want the very best care from the most adept and highly qualified doctors that benefit from cutting-edge advancements at pristine facilities paid in part from an insurance policy that I’ve worked hard to earn by getting my higher education and certificates and by paying into the benefits that my career allows me to enjoy….well, I guess, I’m just not so sure about this.  I guess I just want to see and know that I can be taken care of by the best.  But, at the same time, I want that for my fellow citizens too (as that is ethical).  The whole thing feels like a catch-22.

So what can I learn from this?  1. I got better.  2. I value alternative medicine and wish that I could afford to keep up with it.  3. I’m skeptical about the Wii actually keeping me motivated and on track (but that is all about me and nothing that an eletronic device can combat).  4. I can’t sort out the reality of our country’s health care dilema.  5. I’m way to wordy.

My ambitious nature is truly a double-edged sword.  In most cases, my drive helps me to launch into things with vigor.  However, when I do run full throttle, it is hard to hit the brakes.  There have been many instances where only some sort of outside force will become that figurative brick wall that I hit head on – which then, finally, does stop me…dead in my tracks.

This past Monday I went back into the gym and hit it…hard.  I was only twenty minutes into an hour workout when I could already feel my very unused muscles screaming at me.  My hamstrings were cramping up, I could feel that uncomfortable tension behind my kneecaps and up at the base of my butt.  Then my quads started to burn.  At about forty minutes in I dared to attempt two sets of 20 reps of a kettlebell thing.  I’ve never done this type of lift/swing thing and it looked simple enough: do a half squat, grip the thing, explode up in the legs sending the weight up in front of my chest, then use my core and legs to counter the weight as it swings back down, use momentum to repeat the swing in a steady rhythm.  This might have been doable had my legs not already been trashed.  Since they were, I think that I used my lower back to produce the lift and the swing.  This was a terrible, terrible move.  After my first set I could feel a sharp shooting pain seizing up.  Since I was trying to be “tough” I did not listen to this warning sign.  I just powered through in pain.

Pain is something that RA folks just deal with.  Even with medications, pain is still ever present and a part of life.  I’ve been dealing with pain and other health things for so long that I just didn’t believe this back pain to be any different.  So after a little rest I did the second set of the kettlebell lifts.  Even though I could feel the sting of a sharp pain in the first move, I clenched my teeth and gutted out 19 more.  I knew that I would be sore, sure, I’ve done that before where I killed my hammies and could barely stand up a couple of hours later.  I just figured it would be like that.  So, I cooled off with some very painful stretches on the floor and then went to grab my bag from the locker and head off to teach some tennis.

As I lifted my bag up, I couldn’t even clear my head to sling the strap across my shoulder.  The pain was electric, hot, and frightening.  I dragged myself to my car and lumbered to get into the seat.  Then as I was driving, I was stuck in traffic behind a truck that had caught fire.  Thus, I  ended up sitting for close to 40 minutes before I arrived at the tennis courts.  As I had been sitting in the car I could feel my back and my legs tightening up.  I turned off the engine and cringed as I tried to open the door.  My legs were so heavy and I had to use my arms to help swing them out of the car.  As I tried to stand up, I felt something twinge – slip – pinch – wobble…it hurt…and then it didn’t stop hurting.  There was no way I could stand up fully.  I was trapped at a high school parking lot with my tennis classes about to start across the street.  Fantastic!

That was Monday morning.  I quickly got my classes covered with other coaches and went home to begin ice therapy and I-Be_Hurtings (ibuprofen)…800 Mg geltabs.  I popped the Advil and hobbled to the floor.  I thought that I was hurting pretty bad for DOMS (delayed onset muscle soreness – have had it before with legs and just thought that this was an extreme case).  I didn’t sleep as the pain just continued to get worse.  So I phoned my sister who had some pretty bad back issues a while back.  She agreed I should just keep icing it and see if it gets better.  It got worse.  Later that night I couldn’t move without clinging to a wall, countertop, on the bottom of my putter as I used it like a cane.

For three days I had endured and only ever felt a little okay when I was sitting still with an ice pack in place.  Finally, I got to the doc’s today.  Herniated disc.  No big shock there.  So he wants me to take prednisone.  Ahhhhh, no!  He also said no lifting…terrific, there goes my trying to get in some extra hardcore workouts before the crazy schedule of school started again.  Now, I’m taking even more steps away from fitness because I let my ambition get the best of me.

I will listen to my doctor about not lifting, since I can’t anyway.  He suggested that I walk in the pool in order to keep mobile.  I’ll listen and do that too.  But I’m still not so sure about taking the roids.  I just don’t like the thought of that.  So, even though not listening to my body got me into trouble in the first place, I’m still not sure that I will take the prescription.  In any case, I pushed too hard and now I’m paying for it.

December 2017
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The Sacred Balance by David Suzuki