Wow, my 100th Post!! And a little story about prescriptions.

I think that my 100th post deserves some confetti and streamers, don’t you?  It’s taken a long time to get to 100, but the fact is that I’m still here, and I’m still Phat.  But that’s for another day.

For my 100th, I’m going to tell you a story.  It’s about health insurance. And Health insurance companies. I make my living in the insurance industry and I’m not proud of this story and sadly I know that this is a small example of what goes on.

Two weeks ago was my regular visit with the rheumatologist. I told him that it was time to think about replacing my right knee.  The one that’s missing half of the miniscus.  It’s been quite painful and disruptive lately and if I’m going to do it, why wait?  He absolutely said that I shouldn’t be doing it yet – I’m too young and active and will wear out a knee too fast.  ”Why not try the Supartz injections that we did several years ago?” he asked.

Supartz, aka, joint fluid therapy, is a series of injections made directly into the knee joints. This therapy is designed to reduce pain by improving lubrication in the knee, replacing the synovial fluid that lubricates the knee.  Supartz is made from a natural chemical found in the body and is found in particularly high amounts in joint tissues and in the fluid (synovial fluid) that fills the joints.

I had great success doing this several years ago – I was able to walk down the stairs normally and had much less pain.  My health insurance has changed since that time and I now have a $5,000 deductible.  The first time, this was considered an in office procedure and subject to my standard office copay.  I attempted to do this earlier this year and it’s now considered outpatient surgery and subject to my full deductible and not the office copay.  The doctor had to order the Supartz and I had to pay for the medication out of pocket.  CVS Caremark is who my health provider has me use and they called me, and the cost was $1,463 for the 3 injections.  I thought it was highway robbery and I just wasn’t going to pay it.  OK, my employer does reimburse me for anything over $500 of my deductible, but I still thought it was excessive.

During the discussion with my doctor 2 weeks ago, he suggested he give me a script and I see if I could get it filled for less.  Of course I was enticed by all the Canadian pharmacy online ads but during a visit with my primary care physician in the midst of all this, he scolded me for even thinking about mail ordering to Canada.  So I remembered a good client of mine owns a large, independent pharmacy in the area.  I called him and last week I picked up the script for $600.  Less than half of what CVS Caremark wanted.  Someone is making an awful lot of money on prescriptions and it’s not me.

If you have any wonder why health insurance is so costly, this is only a small example of the excessive costs with medical care today.  Oh, and my large, independent pharmacist cannot supply me with my monthly Enbrel.  No, my health insurer insists that CVS Caremark send that to me.

Pain Meds

Yesterday afternoon I had a routine visit with my Rheumatologist.  He’s cool – he walked in the room and asked about skiing and how was my knee and we compared notes on our ski trips.  I mentioned that perhaps it’s time to revisit the knee replacement issue, but he talked me right out of it and actually I think he helped me come to a good solution with Synvisc shots in the bad knee.  I had them in 2010 and had such good results – my knee felt brand new.  Unfortunately, they do ultimately wear off.    My current medical insurance provider considers the injections out patient surgery and therefore they’re subject to my deductible ($5,000 – not a misprint!) and the cost was like $1400.  I’ll keep you posted on the alternatives he and I discussed and maybe that will resolve itself.

When I was in the waiting room waiting to schedule my next appointment, he called me back into the office and asked me to wait in the exam room.  Soon he came in with a form that I had to sign which is from the State Department of Health.  I’m required to sign it because he prescribes pain medication for me.  Any patients that receive certain narcotics are required to sign it and the Doctor keeps a copy and files one with the Department of Health.

There were 12 points on the form.  I agree to use the meds exactly as written, no changes can be made between visits – any changes have to be made during a visit.  Only the primary rheumatologist can prescribe pain meds – not a covering doctor.  I can only use 1 pharmacy for filling pain meds; I agree not to use any illegal drugs of any type and I agree to periodic random drug screenings.

Obviously this is a reaction to the abuse of pain meds that seems to be common.  The Department of Health is trying hard to stop abuses and establish proper prescribing techniques for narcotics.  We have all read articles about abuse and dependence.  I can’t imagine it happening to me – I take pain meds occassionally, but not regularly and I never get a high from it.  I guess because I have pain – or so I’m told.

I signed the form, assuring the doctor that I use them as prescribed.  Besides, I promised my mother years ago that I would take care to prevent abuse and addiction.

 

St. Patty’s Day

It’s St. Patty’s day and it’s a low key day here.  No big celebrations as we just returned Friday night from a 2 week vacation to Switzerland.  What a fabulous time we had – it’s a beautiful country and I love visiting.  This is the view from the balcony of our hotel in Wengen which is in the Jungfrau Region.

Beautiful isn’t it?  We extended our stay for 2 days after our group left to visit with a old high school friend of mine who has lived in Switzerland for about 30 years.  She went as an au pair years ago, stayed when she met her husband and has raised her family there.  We have kept in touch and visited either there or in the States when we could.

What I took home from my visit was the total quality of life in Switzerland.  They emphasize family time and meal time far more than we do.  They exercise – it’s part of their daily life – walking, biking and hiking.  While we were skiing, there were many that were hiking the walking trails aside the ski slopes.  They have these wonderful meals – fresh produce, meats and pastas, with beer and wine as well.  And dessert!  Perfectly portioned and with the exercise that they include in their day – they are almost all fit.

Drive thru’s don’t exist.  Coffee in paper cups is rare, although with the proliferation of Starbucks, that is starting to change.  However, the Swiss relish their coffee and they take the time to sit and have a cup and relax with friends or coworkers.  They take 60-90 minutes for lunch and leave their office.  This gives them a renewed work ethic when they come back for the afternoon.  And don’t get me wrong – they appear to work very hard. There is no slacking off here.

It all just stacks up to a charmed life.  Even our friends that we visited with said that they are blessed and have a terrific lifestyle.  I sure would love to try to emulate their way of life and Mr. Phat and I both want to try to implement one of two of their habits into our lives.  I want to include more daily exercise, more fresh fruits and vegetables and perfectly proportioned meals.

See you on the slopes!!

What's really hard?

Reblogged from :

Not too long ago, some of my colleagues created a new channel on YouTube titled the "I'm Only Human Project".  The genesis behind this was to give people who had experienced the weight loss journey a longer forum to share their story.  One of the (many) aspects of advertising that is frustrating is that we only have 30 seconds to try to tell someone's story.  

Read more… 947 more words, 1 more video

Intro from Phat50chick:  I loved this blog post from David, the CEO of WW. He's very candid in his approach, tells it likes it is and I relate to most everything he says in his posts. In today's blog I could especially relate at the end under Feeling Strong. He says that "the absolute most important thing to do is keep on doing." That's what I'm doing. Keep on keeping on. Enjoy.

Rheumatoid Awareness Day

As a person with Rheumatoid Arthritis I’m very happy that they have created an awareness day for us, and they are renaming it Rheumatoid Disease.  RD is different from Osteo Arthritis and it affects other parts of our bodies besides the joints.  So as to stop confusing the two, they’re renaming it Rheumatoid Disease.  Often when I tell somebody that I have RA, they’ll say “oh, my grandmother has that.”  Probably what I have is so much different than what your grandmother has.  It’s not your grandmother’s arthritis.

Below I have posted the RD Awareness Ribbon and part of the press release!

Rheumatoid Patient Foundation (RPF) announces the establishment of Rheumatoid Awareness Day to be held each year on February 2, giving people with the chronic illness known as rheumatoid arthritis, or rheumatoid disease, a day of recognition. Because the disease is commonly presumed to be a type of arthritis, awareness is lacking, causing problems with disability accommodations, clinical care, healthcare reimbursement and research funding.  The Rheumatoid Patient Foundation will support the first annual Rheumatoid Awareness Day with a campaign aimed at raising awareness and educating about rheumatoid disease.

I’m very excited about Saturday.  Hopefully I’ll be doing something that my Dr can’t believe I still can do – skiing.  Meantime, it’s Monday night.  Time to inject my methotrexate.  Have a good night all.

New Year’s Resolution

Where have I been? Well as you can see, I’ve been busy.  My favorite season is finally here!  December was a brutally busy month – it’s always a tough work time because my office is so busy working commercial insurance renewals and this year seemed tougher to get competitive pricing from underwriters.  We also had a big event with my step son-in-law finishing at the academy and becoming a State Trooper.  We’re very proud of his achievements.

Also December is Mr. Phat’s birthday so I had a small dinner party one weekend, and then of course there’s Christmas.  By New Year’s Eve, Mr. and I had done enough entertaining and socializing, we ended up sitting alone in our house with some dinner and champagne. It was, by far, the funnest evening of the month.  We sat together and giggled together all evening – went to bed and woke up to watch the ball drop.

As a rule, I don’t make resolutions.  I’m not very good at keeping them.  However, this year I did make a small resolution regarding my office and my job.  That one I will be able to stick to as it’s just a slight behaviour change – nothing big.  In addition, I had some unexpected help in the “getting healthy” department from Mr. Phat who decided to try out something he read about in Men’s Health online.  He’s doing 30 days of drinking strictly ice water.  Which is so big for him because he loves Pepsi and when he thinks he’s had too much of that, he switches over to juice or vitamin water.  I suspect he consumes 500 – 700 empty liquid calories per day.  So I’m doing it along with him, although I cheat with black coffee in the AM, and did have 4 glasses of wine this weekend.

Plus, I had 2 weeks off from the trainer due to the holidays.  But that all ends tomorrow afternoon when I head back in for some more butt kicking.  Wish me luck

Lifestyle change

Everything that I read says that I’m doing this the correct way.  Eat less fat.  Move more.  Make better choices.  This is not for the short term, this is a lifestyle change.  This is forever.  I will have to hit the gym a couple times a week forever.  I need to have planned food cheats forever.  I need to think about everything I eat and drink before consuming.

In support of my pattern of making better choices, I had a telling day yesterday.  It wasn’t my best morning – I had a disappointing result at my job and that made me sad and upset. It was one of those days that makes you want to say screw it and to heck with all the goodness.  I hadn’t slept the night before and was tired.  At 3pm I called Mr. Phat and said that I couldn’t decide about the gym.  I was feeling so lousy, I wanted to just come home and hang.  He didn’t let me.  He reminded me “you know how good you feel after the gym no matter what.  Go to the gym and I’ll cook dinner for when you come home.”

I dragged my ass to the gym for class at 5pm.  Which is hard on a Friday.  But I did it, I participated and said “screw it” to the disappointing day.  All is forgotten and today is a new day and Monday will be a new day at work.  I also love the way my body feels the day after a hard workout.  It’s sore and always reminding me that I DID work out.  Do you know that feeling?

I found a photo from last Christmas

And this is from a few weeks ago:

I know I see a difference. Do you?

Thank you Mr. Phat for pushing me to go to the gym and Thank You, Cathy for giving me the push when I get there!!