Why does Highmark Security Blue Make Medical Decisions instead of Doctors?

I am mad as hell.  And I’m going to take this entire post to complain.

If you’re a regular reader, you probably know that my dad fell and broke his hip in early February. From the hospital, he was admitted to an inpatient rehab facility. He was released from an inpatient rehab facility in mid-March, only to fall sick with pneumonia just ten days later, which nearly killed him.  Unable to breathe on his own, he was on a ventilator for nine days until his lungs improved. Then just three days later, his condition deteriorated again, and had to be put back on a ventilator for another five days.  The entire month of April is completely lost to my dad.  He doesn’t remember any of it.  And my dad’s mind is VERY sharp.

Okay, let’s back up a moment.

When he broke his hip, the doctors scared the bejeezus out of us with the statistics.  One-third of patients who undergo hip surgery to repair or replace a broken hip will be dead within a year.  ONE THIRD.

The doctors explained to us how to improve those odds.

GET UP AND MOVE!  Seriously.  Walking as soon as my dad was able.  Exercise that hip.  His in-patient rehab stay after breaking his was very beneficial from a physical and occupational therapy standpoint.  He had made decent progress.

Now, let’s fast forward to the more recent issue of the pneumonia.

So, when my dad was bedridden for a month with pneumonia following that progress he made with his hip in rehab, my sister and I were worried that his hip might never heal properly or worse, that he would become part of that one-third statistic.

In late April, when my dad was released from the hospital after the pneumonia, he had to go back to inpatient rehab again. Not bearing any weight on your legs for a month when you’re 73 years old makes you pretty damn week.  Oh, and when you just had a hip repair surgery a month before that, it seems to make things a lot worse.

My dad has been making strides in the inpatient rehab.  But it has been a slow process.  He is still terribly weak, unable to stand for more than 60 seconds. He is able to walk about 30 feet using a shuffling motion, but the physical therapists are working hard to improve his walking, so he can pick up his feet more and not run as high of a risk as tripping over your feet and falling.  He’s also not able to do things like get out of bed on his own or go to the toilet unassisted.

Highmark Security Blue Ends my Dad’s Coverage (Again)

So imagine my surprise yesterday when his Medicare supplement (gap insurance), called Security Blue through Highmark Blue Cross Blue Shield, made the unilateral decision that my dad had had enough inpatient rehabilitation and would need to be out by Monday.  Oh, you’re not able to care for yourself?  Oh well!  Oh, you want to appeal?  Sure, we’ll give you 72 hours.  Of course, it is the Friday before a long holiday weekend, so good luck with getting in touch with anybody!

The rehabilitation facility staff was great.  They started faxing 127 pages of daily physical therapy reports to Highmark Security Blue, which clearly indicate that my dad is not strong enough to be on his own yet.  I’m sure that’s exactly what the staff wanted to be doing at 4PM on a Friday, but they were also adamant that my dad was not ready to go home.

So, of course, this situation would be enough to make anybody mad, right?  Well, to me, it makes me mad as hell, but at the same time, I am not surprised.  At all.

Why?  This is just another instance in a long line of Highmark Security Blue making decisions about my dad’s health care, with complete disregard to doctors’ and other experts’ guidance.  You know, the people who TREAT HIM every day.

Pattern of Highmark Security Blue Ending Coverage too Soon  (Timeline of Events)

So, let’s go back to late 2012, when I first truly started paying attention to my dad’s health care.

  • My mom and dad were in a very serious car accident.  My mom died on the scene, and my dad was airlifted to a trauma center.  When it was time for my dad to be released, doctors said he’d need oxygen at home.  My dad had fractured a few ribs, making it painful to breathe, and his oxygen levels would drop below normal sometimes because he wasn’t taking deep enough breaths.  Well, guess what?  Despite the doctor’s orders for oxygen, Highmark Security Blue said, no, we won’t cover oxygen.  Broken ribs is not a medically allowable reason for oxygen at home.
  • My dad was also prescribed six weeks of in-home physical and occupational therapy after the car accident.  Highmark Security Blue decided that after about 2.5 weeks of physical therapy, that was enough for my dad, and they stopped covering it.  Nevermind that my dad was still so weak and in pain from the car accident.
  • So, needless to say, given how weak my dad was from the car accident, he fell down the steps in his home in early 2013, fracturing his shoulder and his pelvis. He needed surgery to repair his shoulder.  I kid you not, the “This is not a bill” statement of benefits indicated that my dad’s surgery to repair his shoulder and about a 5 day hospital stay was $160,000.  That’s ONE HUNDRED and SIXTY THOUSAND dollars.  Funny, if Security Blue had allowed my dad to continue with another four weeks of physical therapy after the car accident, he probably wouldn’t have fallen down the steps.  I’m not sure how much four extra weeks of in-home physical therapy would’ve cost, but something tells me that it wouldn’t come close to $160,000.  I should point out that surgery was not needed on his pelvis. He was just not allowed to bear any weight on it for like a month while it healed on its own.  He spent a month in inpatient rehab, but just a week or two after he was able to bear weight on his leg, once again, Security Blue decided that that meant my dad was well enough to go home.
  • Fast forward to the end of 2013.  My dad finally needed to get a knee replacement surgery he had been putting off for years.  After the surgery, he was released to inpatient rehab. Within about two weeks, Security Blue made the decision that my dad had enough inpatient physical therapy and ended his the coverage.  And what happens about four weeks later?  My dad develops a blood clot at his knee surgical site, which ultimately was misdiagnosed as an infection, leading my dad’s leg to literally BURST OPEN at the knee scar.  He needed emergency surgery to repair the knee, and the rupture also caused his muscle in his thigh (sorry, I don’t remember which muscle) to tear.  Perhaps if he had been kept in an inpatient rehabilitation facility a bit longer after his knee replacement, doctors would have noticed sooner the signs of a blood clot.  But nope, Security Blue had kicked him out of inpatient rehab, and they ultimately had to pay for another major surgery, as well as ANOTHER inpatient rehabilitation stay, since my dad was not able to bear any weight on his leg until the muscle healed.  Within DAYS of him being allowed to bear weight on his leg, once again, Security Blue ended their coverage of his rehab stay and sent him on his own.

You get the idea, right?  HOW IS IT NOT OCCURRING to Highmark Security Blue that perhaps they shouldn’t end the doctor and physical therapist-recommended treatment he needs?  Maybe if his coverage hadn’t been cut off so soon after his hip surgery, maybe he wouldn’t have developed the pneumonia? And now that he’s BACK in rehab following the pneumonia, how is it not occurring to them that by kicking him out, when he is still weak, might result in another fall and subsequent hospital stay?*

You know, I have a coworker who has a very elderly mother (maybe 90+), and she was in a nursing home.  My coworker and I were frequently sharing stories about how ineffective care is for the elderly because of insurance company shortfalls.

After one of the (several) times my dad was kicked out of inpatient rehab, I was telling my coworker how thankful I was that at least my sister lived close to my dad, and could keep an eye on him, and that my dad could even stay with my sister if necessary.**

So, I said to my coworker, “I mean, I wonder what happens for elderly people who get kicked out of these facilities and don’t have family and friends to take care of them?”

His response was short, matter-of-fact, and unemotional.

“Oh, they die.”

I was completely taken aback by that response.  Not necessarily because I found it upsetting (although it certainly is) or was shocked by the lack of emotion in his response, but mainly because of how illuminating those words were.

It had never occurred to me before.  People sometimes don’t get the care they need because insurance companies get to make medical decisions (not doctors).  And those decisions can ultimately kill people.

I want to know how we have gotten to a point in the country when things like medical care for the elderly has become so … broken?  I can’t even think of a word to describe it.  Why can insurance companies make these decisions?

I don’t have any good solutions to these problems.  But all I can say for now is that I dread the phone call that can come again saying that my dad has been injured from some other fall or injury.  I’ve had those calls a bunch these past few years.  They’re terrible. There’s really no other way to put it.

Hopefully Highmark will review their decision and not end my dad’s care so soon, so that I won’t have to get yet another one of those calls.


*I should also point out that my dad’s inpatient rehab stays have been by no means free.  Medicare only covers days 1-20 in a facility in a given year.  Beyond 21 days is $157/day.  He has well exceeded 21 days given his hip surgery and pneumonia have both been in 2015.  Gap insurance, such as his Medicare supplement, was supposed to help cover costs like that.  But nope, I guess it doesn’t.

**Staying at my sister’s house is difficult for my dad because my her house has a lot of steps.  Same with my house!

Healthy Progress!

Fitbit-screenshot-stats

So, I thought I’d bring you all up to speed on some healthy progress in our household. Since the last week in August, Ken and I have been eating healthier (well, eating LESS, not necessarily healthier), and we have some weight loss to show for it!  Ken has lost 14.8 pounds so far, and I’ve lost 11.6 pounds.  Not too shabby!  That’s more than 25 pounds combined.  We like lost a toddler or something.

We’ve been tracking our foods in MyFitnessPal, and attempting to fit in exercise when we can.  Ken has gotten into the habit of walking the 1.4 miles to his workplace every day, and I have been trying to get into the habit of walking to the metro station near our house instead of driving. I’ve also become really addicted to my FitBit!  Just the other day I climbed 31 floors in one day, and I didn’t even leave the house!  It’s motivating to see the quantitative results of just simple, everyday movement.

 

Fitbit-screenshot-stats

I try to limit myself to 1500 net calories every day, and Ken limits himself to about 2300 net calories.  (“Net” just meaning that we’ll eat whatever extra calories we burn through exercise.  So if I eat 1600 calories but burn an additional 200 through exercise (putting me at 1400 calories for the day), I’ll eat an extra 100 calories to bump me back up to 1500.  Sometimes I go over, but not by too much.

It was hard, especially the first few weeks.  We felt hungry ALL THE TIME.  I like to cook, but all of a sudden cooking was seeming like a chore because of all the measuring and weighing I was having to do (I am a strictly “eyeball it” cook!  I rarely use a measuring cup or spoon!)  But, I figure a little bit of extra effort in the kitchen should have some phenomenal effects on our health.  I also would normally enjoy a glass of wine (or two!) when I get home from work, and I’ve been trying to cut back since wine is high in calories.  I find that working out has just as much of a “relaxing” effect as drinking wine, but there is just something so indulgent feeling about sipping on a glass of wine in the evening.

I always forget how amazing exercise feels. It’s like an instant de-stressor. I sleep better and feel less, I don’t know how to describe it, but “wound up” throughout the day.  Although I was getting in exercise really regularly the first few weeks of our endeavor to lose weight, I have been slacking off (already!) and I can already feel the negative physical effects of not exercising. I definitely feel more restless!

Anyway, we’ll be keeping you posted on our progress, including how we’re modifying recipes to lower the calories in some of our favorite recipes.

 

Have you lost weight in the past?  What worked for you?

 

Health Insurance Rage

Let’s talk about health insurance for a few minutes.  Until the past few years, I never had any complaints about health care or health insurance.  In 2005 I was hospitalized and had surgery to remove my gallbladder, which had become infected.  My bill was literally $2.50.  And that was for using the hospital telephone while I was there.**  My statements from my health insurance company at the time showed that my stay, including the surgery, was nearly $20,000.  I was so thankful to have insurance.

I always thought those people that were complaining about exorbitant medical bills must have been doing something wrong.  That they weren’t reading their insurance paperwork correctly or that something else was amok.  Because I was always able to go to the doctor, get the tests and prescriptions I needed, and I would pay my copay and everything else would be covered.  No problem.

Well, the past 18 months or so has been a real wake up call for me.  After my mom passed away last year, I became actively involved in reviewing my dad’s medical bills.  He’s on Medicare, and has a great Medicare supplement, but we’re always running into problems.  A certain medication he needs isn’t covered.  Or he needs more time in a rehabilitation facility after a fall and the insurance won’t cover it.  Annoyances like that.  Things we should not have to worry about.  Because we have insurance.  That we pay a lot of money for.

So.  Remember my kidney stone problems back in December?  The ailment that led to two ER visits in five days?  Well, before I left for the ER, I made sure that my insurance, a major Blue Cross Blue Shield program in the DC area, was accepted at the Inova Health System hospital that I was going to, less than a mile from our home.  My insurance was definitely accepted as the Inova hospital was in-network, and all I would have to pay was a $125 copay.  Easy peasy.

Three days before I left for Russia, I got two random checks from Blue Cross Blue Shield.  One was for $115, and the other was for $300 or so.  I read the letter that accompanied the checks.  It said because I used out-of-network doctors during my recent ER visits, that they were only covering $415 of my stay, which was likely to add up to thousands of dollars.  I was very confused.  I had specifically verified that the hospital was in-network before I left for the ER.  So, I called Blue Cross Blue Shield.  After telling them I had received these random checks and explained to them that the Inova Health System hospitals were covered, this is how the conversation went:

Insurance Rep: Yes, the hospital is in-network, but the doctors that provide care at that ER are out-of-network.  So you are being charged for the doctors’ care, which totals $1312 for your two visits.

Me: How can a hospital accept my insurance but the doctors that work at that hospital don’t?

Insurance Rep: Most likely the doctors staffed at that ER are not actually employed by Inova Health Systems, but rather a contract company called ASE, which does not accept Blue Cross Blue Shield.

Me: That was never disclosed to me when I was signing in at the hospital.

Insurance Rep: It is common knowledge that this occurs.

Me: Common knowledge to whom?

Insurance Rep: To everybody!!

Me: I can assure you that it is not common knowledge.  I consider myself to be a reasonably intelligent person and I have never heard of it.  Plus, my father has been in and out of hospitals a half dozen times in the past year and I am very familiar insurance billing practices.  This has never happened, nor have I ever even heard it being a possibility.

Insurance Rep: It is VERY common knowledge.

Me: To whom?

Insurance Rep: I’ve already said, to everybody!

Me: What are their names?

Insurance Rep: Whose names?

Me: The names of people it is common knowledge to.

Silence.  And confusion.

The rep from Blue Cross Blue Shield tries to explain to me how things are billed from a hospital stay, and how medications are billed separately from x-rays and scans, and those are billed separately from nurse charges, etc.

Me: I know all that!! I know these things are always billed separately.  What I am taking issue with is that a hospital that accepts my insurance can get away with not telling me that a huge chunk of my care will not actually be accepted by my insurance!

He then tells me to take it up with the ER contracted physicians, as there is nothing they can do.

I posted to facebook about my ordeal, and there were four other friends that chimed in that they had experienced the same issue both at Inova Health System hospitals, as well as other hospitals around the country.  But each friend said they eventually got their bill taken care of, either by pressing the issue with the billing party, the insurance, or having their company’s HR departments advocate on their behalf.

At that point, I had not actually received a bill from the contracted physicians, only the insurance statement, so I just kind of forgot about it when we went on vacation.

Sure enough, after we got home from Russia, I had a bill from the physicians, called ASE Physicians, for $1312.  On the advice from one of my friends who had experienced the same situation, I called ASE and asked them to bill the charges as “in-network.”  The woman I spoke to was exceptionally rude.  I love dealing with rude people (seriously).  Because I can be as cool as a cucumber during a very heated conversation, and it just really ticks people off.  So she was getting very irritated with me, but I was making progress.

The conversation was lengthy, but here are the highlights:

  • My bill is “aging” as we speak (in other words, I’m a deadbeat that doesn’t pay my bills so it will go into collections).
  • If I want to file an appeal, I have to pay the bill first.  I’m shirking my responsibilities as an adult by not paying the bill.

So, I really took issue with this whole “having to pay my bill first in order to file an appeal.”  Have you ever heard of such a thing?  I haven’t, and I’ve dealt with many many insurance appeals.

The conversation was going in circles, so I decided to take a different approach.  Social media.  I started posting about my experience online.  I questioned the practice of having to pay my bill in order to file an appeal.  I questioned Inova Health System’s lack of transparency in not informing patients that the doctors employed at their hospitals do not accept my insurance, despite the fact that the hospital does.  Lo and behold.  Within THIRTY minutes I get a call.  My bill has been decreased from $1312 to $99.

Is this not some of the shadiest shit you’ve ever heard of?  And the guy was all like, “Okay, I’m going to work with you here on this bill.”

I kept my cool, but I was like, “I DON’T NEED WORKED WITH.”  “I WANT MY BILL TO COVERED MY INSURANCE.  LIKE IT SHOULD BE!”

So that’s where we stand right now.  My bill is at $99.  I’m going to try and get it down to $0, because that is what it should be.  You know, because I went to a hospital that accepted my insurance.  And kind of thought that the doctors would also be covered by my insurance.  Silly me.

Has anyone else had this type of issue?

 

A Very Kidney Stone Christmas

It has been a strange month.  For nearly 10 days, these were the thoughts that constantly passed through my head:

“Please, for the love of god, the next time I go pee, please let me piss out this f*cking kidney stone.”

That’s right.  I had a damn kidney stone.  Ken had one nearly two years ago as well, so at least I had very sympathetic company in the house.

Not Feeling Well

On Monday December 9, I wasn’t feeling well.  I was going pee very frequently and I thought I might have a urinary tract infection or something.  I figured I’d wait until Tuesday to go to my regular doctor, but late Monday evening my side started to hurt a little bit.  Knowing that side pain can be a sign of a kidney infection, I decided to hurry up and go to a local urgent care facility that was open until 10PM.  They diagnosed me with a urinary tract infection (UTI) as I suspected, but they said that my kidneys were fine.  If I had a kidney infection, I would have “jumped off the table” when the doctor pressed on my kidney.  No jumping off table = no kidney infection.

They sent me on my way with an prescription for antibiotics and a prescription for an over-the-counter medication that “numbs” the bladder and makes things like frequency urges better.

I went home, had some dinner, took my medications, and got ready for bed.  My left side still hurt a little bit, but I just figured it was all in my head and I was being a hypochondriac.  When I woke up on Tuesday, my side felt fine.  I didn’t have to go to work on Tuesday because it was a snow day here in DC and I was just lounging around the house.  Ken was working from home so he wouldn’t have to drive in the snow.

By Tuesday early afternoon, my side started to hurt a little bit again.  When Ken and I sit on the couch together, we frequently hold hands.  Ken noted how cold and clammy my hands felt, which he said was really unusual because I’m usually so warm.  By 3:00PM, my side was really hurting, especially every time I took a deep breath.  I was also feeling these random stabbing pains in the middle left side of my back.

I tried to calm myself down, “You just went to the doctor last night.  It’s just a UTI.  Give it a few days for the antibiotics to kick in.”  I was having chills and feeling nauseous, and thought I might have a fever.  I took my temperature.  98.4.  No fever.  You’re fine.  I took my temperature like every five minutes.  I was thinking to myself, “If I get a fever, I can just pass this off as the flu.  Nausea, chills, bad aches and pains.  You just need a fever and it will all equal a basic flu.  I never had “wished” myself to have a fever before.

I kept laying down in bed, trying to find a comfortable position, thinking if I could just take a nap, I’d wake up feeling better.  It hurt no matter which way I was laying down.  So I moved to the couch.  Then to my desk chair.  Then back to bed, then back to the couch.

By 4:30, my left side and back felt like it might explode.  It was like a professional MMA fighter was kicking me in the side and back constantly. I couldn’t even breathe without a stabbing pain in my left side.

I started to think about something that happened eight years ago.  I had had a random middle-of-the-back ache for nearly five days in 2005.  I woke up on a Saturday with the back ache.  By Thursday night I was vomiting with pain.  There was finally something that made me say to myself, “This is not a normal run-of-the-mill ache or pain.  This is weird.”  When I went to the Emergency Room that night in 2005, I learned that I had gallstones so numerous and large that it was causing a gallbladder infection and I would need to have surgery to have my gallbladder removed.  I was wheeled into surgery about 12 hours later.

So, I finally had that same realization about my side.  This was not some normal ache or pain that could be explained away by flu or a pulled muscle.  Something was weird.  And for me, weird = emergency room.  Better safe than sorry.

A Trip to the Emergency Room

I told Ken I was going to the Emergency Room.  I was convinced I had a kidney infection, even though I’ve never had one before and had no medical basis to assume I had one.  Ken joked, “Sounds like kidney stones to me!”  But I didn’t even really consider kidney stones.  When Ken had kidney stones, he was in the ER within like 20 minutes of experiencing the pain, so his was a very sudden onset of pain compared to my more gradual onset.  He also didn’t have any nausea, chills, or urination frequency like I was having.

I told Ken that I could drive myself to the ER since he was still doing some work from home.  Plus, I just figured the ER doctors would send me home within a few minutes saying that it was just a bad urinary tract infection or something.  Within a few minutes at the ER, the nurses and doctors were already telling me that I had every sign of a kidney stone and they would order a CT scan to confirm.  In the meantime, they started me in IV morphine and saline fluids.

I called Ken and said, “They think I have kidney stones.”  Ken said, “Kidney stones!  Welcome to my world!”  I told him that since I was getting morphine, I wouldn’t be able to drive home or anything.  He arrived at the ER a few minutes later.  (Luckily our nearest ER is less than a mile from our house!)

Doctors had ordered a pregnancy test out of an abundance of caution, and when a nurse came in and said, “You’re pregnancy test was negative, I can take you for your CT scan now,” Ken looked confused.  I looked at him and said, “Congrats, we’re not pregnant!” and quickly explained they have to do pregnancy tests to make sure it’s not something other than kidney stones.  When the doctor had asked me earlier if there was any chance I was pregnant, I told him that it would be very unlikely.  He said, “Well, I just have to check because there’s always one woman a day who doesn’t know!”

Although it had been about 30 minutes since getting the morphine, my side was still hurting (albeit less than when I first arrived in the ER). I had my CT scan, which was short and easy, and went back to my room in the ER to wait for the results.

 

kidney-stones-IV

My IV setup for morphine, saline fluids, Zofran (an anti nausea), and IV antibiotics

 

When the doctor came in with the results, he said that there was every sign of a kidney stone … except an actual stone.  My kidney was enlarged, my renal pelvis (which I didn’t even know was a thing) was dilated, and so was my ureter.  But no stone actually showed up on the CT scan.  He explained that A) I could have just passed the stone since getting to the ER, or B) the stone just didn’t show up on the scan because the scan only takes various “cross sections” and it might have missed it.

The doctor ordered some IV antibiotics in case the urine backed up in the kidney was in fact starting a kidney infection.  The IV antibiotics ran for 30 minutes.  Ken had called a friend of his that lives nearby.  Since we now had two cars parked at the ER, we had to get them both home.  So Ken drove my car home while I was getting my IV antibiotics, and his friend met him at our house and then drove him back to the hospital.  That way we just had Ken’s car at the hospital.

Relief

At some point while Ken was gone, I started to feel like a million bucks.  I was convinced that I had, in fact, passed the stone and that is why it didn’t show up on the CT scan.  My hands were warm for the first time all day.  So were my feet.  I no longer had pain.

I hit the nurse’s call button because I had to go to the bathroom and I was still hooked up to the IV.  A nurse disconnected it and I walked to the bathroom.

This next paragraph is going to venture into the way-too-much-information zone.

I peed SO MUCH.  For the first time in days, my bladder felt completely empty.  It was such a relief.  The previous few days, every time I would urinate, there would be very little urine, and within minutes I would feel like I had to go again.  So my empty bladder, coupled with the complete absence of pain (and probably also coupled with the morphine), I felt like I was on CLOUD NINE.  I felt like a million bucks.  Like I could leap tall buildings.  I was all smiles.

Ken came back, and it wasn’t very long afterwards that the doctor and nurses came in with my discharge instructions.  I was to follow up with a urologist ASAP.  They were prescribing me an antibiotic, different from the antibiotic I was prescribed the night before at the Urgent Care facility.  I was also prescribed pain medication and an anti-nausea medication.

After I was discharged, we went to Target to get my prescriptions filled.  D’oh, pharmacy was closed.  So we went to the local supermarket pharmacy, which was open until 9:00.  While I was waiting for my prescriptions, I literally felt like skipping down the aisles.  I just felt SO much better than I had a few hours earlier.  I was also starving, so after we filled my prescriptions, we went to the local pizza place in the same shopping center as the supermarket.  When I got home, I scarfed down my two slices of pizza.

Then I laid down on the sofa, and was feeling so relaxed that I knew I would fall asleep.  I went up to bed and that was the end of my crazy day.

Pain, pain, and more pain

Although I was feeling fine, I called off sick from work on Wednesday, and I guess it’s a good thing I did, because by Wednesday afternoon, my pain was back with a vengeance.  I guess I hadn’t passed the stone after all.  I asked Ken if he could leave work an hour early because I was terrified to be in so much pain at home by myself.  By the time he got home, the pain had mostly subsided.  Earlier in the day, I had called the urologist that the ER recommended.  They couldn’t fit me in for an appointment until the following Thursday, eight days from then!

Then the pain came back, I think worst of all, on Thursday evening.  I was literally crying with pain.  The pain pills they have prescribed for me (Hydrocodone), did not seem to be helping at all.  Luckily the pain subsided within 2 hours.

I spent Friday and Saturday mostly pain free.  Just a little discomfort.  I thought I had finally passed the stones.  Nope.

On Sunday I was in pain again, and the pain was not subsiding as quickly as it had on Wednesday and Thursday.  Also, I was having weird urination-related symptoms.  My urine was like very bubbly or foamy or something.  I re-read my discharge instructions from the ER and it said to come back if my symptoms changed or worsened.  After spending most of day in pain, I decided to take another trip back to the ER on Sunday evening.

They did more bloodwork (all normal), and a urinalysis (all normal too).  They did not seem concerned about the foamy urine.  One nurse explained that it could be a sign of the stone breaking into several pieces and the urine was developing bubbles as it “crashed” over the stones.

They gave me more IV morphine, a prescription for a stronger pain medication, and a prescription for Flomax, which they said would help “relax” my ureter in an attempt to allow the stone to pass more freely.  They also managed to get me an appointment with the urologist for the next day (instead of waiting until Thursday, which was the earliest appointment I had been able to make)

Once again, by the time I left the ER, I was feeling like a million bucks.  We went to (yet another) different pharmacy because apparently most pharmacies are closed at 6PM on a Sunday.  While waiting for it to be filled, we walked to Chipotle and grabbed some takeout.

Time to pee out these things out

On Sunday night around 11PM, I finally “caught” what looked like a stone in my urine strainer.  It was significantly smaller than Ken’s stone from two years earlier though.  But, I was happy!  The stone was gone.

Monday morning I went to the Urologist.  Not only was I the only woman in the very full waiting room, I was the only person under the age of 50. I guess 32 year old women don’t normally have occasion to visit a urologist.

The urologist said there were trace amounts of blood in my urine (something new compared to my  urinalysis at my ER visits), and he said that would be consistent with passing a stone the night before.  He told me to come back in a month for a sonogram, which would confirm that my left kidney was back to normal size, since the CT scan from the ER showed my kidney was enlarged.  Since there was no stone that actually showed up on my CT scan, I asked him something just for the sake of my sanity.  I said, “Is there anything else other than a kidney stone that could cause these symptoms like the dilated ureter and renal pelvis and enlarged kidney?”  He said no.  He said that occasionally people are born with a congenital defect that might cause those issues, but it certainly would’ve presented itself by my age.  He said that a kidney stone is the only explanation.  So that was a big relief.  I just get those random thoughts sometimes like, “what if it really is something rare or more serious than kidney stones.”

Monday was spent pain free, and I finally went back into the office on Tuesday.  I was at an important meeting on Tuesday afternoon, and I could feel the pain starting to come back.  I kept fidgeting and I was sitting in an insanely squeaky chair.  At the end of the meeting, I apologized, explaining embarrassedly my situation.  An older gentleman said, “Oh my god, I do not know how you didn’t get up to leave!  I had kidney stones 20 years ago and I still get phantom pains because of how bad it was.”  So, I had sympathetic company.  I went home straight after the meeting.

I was feeling very down in the dumps after I got home.  The new pain medication was helping more than the previous one, but I was still uncomfortable.  I was worried I was going to have to live with this pain indefinitely.  That it would ruin my Christmas.  I was feeling so resentful.  My Christmas season last year was a terrible one due to the death of my mother and serious injury of my father in a car accident in early December.  I just wanted to enjoy the Christmas season this year, and kidney stones were making that impossible.  I felt like a bratty little kid.  I had so much to be thankful for.  Excellent medical care, a non-life threatening diagnosis, and an easily treatable condition.  But I was still just so pissed off.  The pain made it impossible to do anything.

On Wednesday the 18th in the morning, now 8 days past my first ER visit, I caught two more tiny stones in my strainer.   And luckily, since then, I have been completely pain free.  I guess they’re finally all gone!

So, in addition to my gallstones of 2005, I can now check off kidney stones from the list of terribly painful conditions that humans can experience.  I’ll wear that like a badge of honor!

Eating Better

Settle in.  This is a fairly long post.

This has not been the greatest month.  In the past two weeks, at only 32 years of age, I went from being on zero prescription medications to being on four.  And I consider them to be for “old people” ailments, like high blood pressure and acid reflux.

High Blood Pressure Woes

Let’s start with the high blood pressure.  The past few times I’ve needed medical care, like for strep throat or for stitches after an unfortunate Thanksgiving Day kitchen knife accident, I’ve just gone to a local urgent care or emergency facility.  I never bothered to find a new primary care doctor since moving nearly six years ago!

On some of those occasions at the urgent care facility, they noted that my blood pressure was fairly high, like in the 140/95 range.  I never paid much attention and just figured it was because I was nervous to be at the doctor’s office.  On one occasion, the doctor recommended that I purchase an at-home blood pressure monitor to see if it would be high at home under normal circumstances.  While it was somewhat lower at home, it still fell into the moderate-high range.  Then I just kind of forgot about it and put the blood pressure monitor in my closet and didn’t really think about it much any more. At one of those urgent care visits, one physician told me that I should not underestimate the benefit that losing just ten pounds would have on my blood pressure. That losing weight would far benefit my blood pressure more than any low sodium diet.  I always just figured I would lose weight and that would help lower my blood pressure, but I never lost any weight.

Last month, I randomly convinced myself that I had a kidney infection (Thanks Doctor Google!).  My side was kind of hurting and I had a low grade fever.  I went to the urgent care facility again, where my blood pressure reading this time was 165/100!

I was told that I was at risk for all sorts of nasty health effects and needed to be started on prescription medication.  I pleaded, saying that I was too young, but the doctor told me that you’re never too young to have an aneurysm.  Umm, thanks.  Time to start me on high blood pressure meds. In addition to treating my infection, the Urgent Care doctor wrote me a prescription for Norvasc, a high blood pressure medication.  It was a 30 day supply, with stern instructions to finally find a primary care doctor for ongoing treatment.  He also ordered some bloodwork, to make sure there was no underlying cause of the hypertension.  Luckily, the bloodwork results were all normal.

I made an appointment for a physical with a nearby medical practice.  It was three weeks after starting Norvasc, so I assumed that my blood pressure reading would be down in the normal range.  It was only a few points (points?  Is that what they’re called?) lower, at 162/99.  So my new primary care doctor added Hydrochlorothiazide, which I would take in addition to the Norvasc. She took additional bloodwork, and told me to come back in three weeks for more bloodwork to ensure that the Hydrochlorothiazide wasn’t affecting my kidneys negatively (apparently a known side effect).  She also told me to record my blood pressure every day from home.

So, that’s where we stand now.  I’m not liking Hydrochlorothiazide much because, despite taking it in the mornings, I’m waking up at least twice per night to go pee.  Not cool.

Because of my high blood pressure and relative unhappiness with my medication, I’m starting to think I should get more serious about improving my diet and losing weight.

And, speaking of diet changes …

Laryngopharyngeal Reflux (LPR) Diagnosis

Completely independent of my infection and high blood pressure issue, I finally decided to see an ENT specialist for this annoying and persistent throat clearing cough I’ve had for at least five or six years.  I’ve mentioned it in passing to previous doctors, who recommended Claritin and a Over-the-Counter saline nasal spray.  Those recommended remedies never worked, so I assumed I would be stuck with clearing my throat every 20 minutes for the rest of my life.

About two years ago, I went to a nearby ENT practice because my ear was really clogged.  I mentioned the throat clearing issue to them and they said that when I was ready, I could make an appointment to have a camera put down my throat so they could examine and diagnose me more effectively.

Well, the thought of A CAMERA GOING DOWN MY THROAT WHILE I WAS AWAKE did not sound appealing, so I put off making the follow up appointment.  But one night a few weeks ago, after spending like five minutes futilely trying to clear my throat, I decided then and there that I would make an appointment with the ENT.  I called the next morning.

Well, the ENT appointment was very illuminating.  I described my chronic throat clearing, and after many many follow up questions, he said he was going to use a thin tube-like camera that would go up my nose and into my throat.  I told him I was nervous, and I’m glad I did.  While he was maneuvering the camera, he was very reassuring saying things like, “You’re doing great,” and “We’re just about done.”

The entire procedure was MUCH easier than I expected.  No gagging, no pain.  A pap smear or one of those terrible swab tests for strep throat are actually much worse on the discomfort level. And it probably took less than 20 seconds.

While the camera was in my throat, he kind of poked at a particular area with the tube.  He said, “Is this where you throat feels scratchy?”  I enthusiastically said, “YES!” and he pulled out the tube.

The doctor told me he could see the irritation, and what I had was actually a type of acid reflux called laryngopharyngeal reflux, or LPR.  I was a little confused.  While I might get some very occasional heartburn once every few months after a heavy meal or something, I certainly didn’t consider myself to be someone that had acid reflux.  He told me that LPR can sometimes cause heartburn, but not always.

He prescribed me medication for Omeprazole, which is an acid reflux medication also known as Prilosec, as well as a prescription for Flonase because he said my nose was also very congested (which is its own interesting story deserving of a separate post).  He left the exam room and came back with an informational pamphlet about LPR, including a list of foods to avoid.  As he read them off, “Cheese, wine, chocolate, eggs, dairy …” I interrupted him.  I said, “You do realize that you’re listing every food I eat, right?”  He chuckled and told me that in clinical studies, LPR sufferers who adopt diet changes actually fare better at eliminating LPR symptoms than those who are just prescribed medication without adopting diet changes.  He also told me how important it was not to lay down within three hours of eating.

It’s been 9 days since starting Omeprazole, and the jury is still out on whether my cough is improving.  I think it’s better, but I’m still experiencing some throat clearing issues.

 

Setting Healthy Eating Goals

Thanks Melissa, great stories.  Can you get to some sort of point now?

Yes, here’s the point.  I’m going to make a concerted effort to improve my diet.  In order to A) Get to a point where I can lower my blood pressure naturally and don’t have to take stupid prescription medications, and B) Improve my LPR symptoms without having to stay on acid reflux medicines long term.

Back in 2004, I managed to lose 40 pounds on Weight Watchers.  By 2008, I had regained all that weight and am now even heavier than what I was then.  So, I know I CAN lose weight.  And I have made a few efforts, but constantly fail.  It’s disheartening.  But, it’s also disheartening to be only 32 years old and now be on multiple prescription medications for ailments that can easily be treated by diet changes.

I’m a firm believer that diets don’t have to be ridiculously complicated.  Your calories consumed should be less than calories burned.  And with that, you have weight loss.  So I think eating even rich foods, as long as they’re within your caloric limit, can lead to weight loss.

But my problem is that I really like to cook, and the foods I make are really delicious.  So, because they’re so yummy, I have a difficult time with portion control.  Why would I want to stop eating such a great meal?  Ridiculous, I know.

I’ve been looking around, and I think I might try some experimentation with the Mayo Clinic’s DASH Diet.  DASH stands for Dietary Approaches to Stop Hypertension.  Since hypertension seems to be my primary health issue these days, it seems like a good start.  And it’s not some fad-like diet.  It’s actually endorsed by the National Institutes of Health and the Mayo Clinic.  With the exception of the dairy requirement in the DASH diet, it also seems to be pretty compatible with the dietary restrictions for lessening my LPR symptoms.

It’s a little difficult to find consolidated information on the DASH diet.  There’s no single resource website for it like WeightWatchers or anything.  So, it’s been a challenge consolidating and parsing all of the information that’s out there.

So, there you have it. Perhaps making a commitment to eating better just 11 days prior to Thanksgiving isn’t the greatest idea, but I figure if I can make it through the holidays, I can make it any time!