It's always my intent to keep this blog, our thoughts and words positive. However....when it comes to dealing with insurance companies and government entities - That ain't the way to have fun, son!
Not so breaking news: Anthem Blue Cross denied the claim for my allograft. To recap: the allograft is a joint sparing technology which implants living bone and cartilage into my knee. The technique has a high success rate of 80% to 100%
Once given the insurance companies decision, I then went through the exercise of submitting all the information to what's referred to as an Independent Medical Review through our friends, the California State Department of Insurance.
The case was sent by the State, to an Independent Contractor. The contractor is paid by the State (you and me, folks) to hire three "Doctors in good standing" to review and determine whether or not the insurance company denial should be upheld.
Their decision:
Dr. Shyster: Treatment is not the best option
Dr. Needelman: Treatment is not the best option
Dr. Cutter: Treatment is the best option
Two out of three win, so I'm all on my own, dear readers.
It was my understanding that the government's job was to serve and protect. These three doctors (I made up the names, if you didn't guess) do not reveal their names and have never met or examined me. Gee, I wonder if perhaps the State hires doctors that may side with them. Could it be?
For anyone who thinks it's a great idea to have the government in charge or our health care, think again. You just may end up at the mercy of Dr. Shyster, Dr. Needelman and Dr. Cutter.
Meanwhile, let's remain positive. Okay - I'm positive they turned me down!
Thursday, February 10, 2011
Monday, February 7, 2011
Dog Day Afternoon
My grand-dog, Victor Jose Snaggles, had surgery last week. The surgery was to remove a large bladder stone. It was highly successful.
My daughter adopted Victor from the animal shelter three years ago. He was found wandering the streets of Irvine, frail and hungry, weighing 4 pounds. It seems to be the ecological thing to do these days; own a rescue dog. I suppose now we'll have to start driving a Prius "smug alert-smug alert", buy an eco/ego house, and switch to only natural fiber clothing.
Today, Victor weighs 5 pounds and is living in the lap of luxury. The only problem is, nobody has gotten word to Victor that he only weighs 5 pounds. He loves people, but he's not much for other dogs. He takes on Rottweilers and Great Danes. When you take him for a walk, it's a bit embarrassing, really.
The night before his surgery, Surfer Boy and I walked Victor on the beach where he once again went ballistic when he spotted a worthy opponent, this time a full grown Doberman Pinscher. Kerry tugged at the leash and told him "Stop it! You're about to undergo surgery tomorrow. You're supposed to be contemplating the meaning of life."
But you see, that's what keeps Victor out of trouble. His ability to live in the moment and his inability to think, analyze, dissect, ruminate, marinate, obsess and worry.
Years ago, when I lived out in the country, many of our neighboring dogs ran free and got bitten by rattlesnakes. I was asking the vet about it one day, and he said that it's really no big deal. What? Why not? He told me it was because dogs don't go into shock the way humans do. They simply give them the anti-venom, keep them overnight, and back they go to frolick on the trail. Humans, on the other hand, freak out when bitten by a rattler.
With my knee surgery coming up, who knows when, I'm going to take a page out of Victor's book. As I write, he's relaxing in the sun, enjoying the warm California weather and ocean breeze. Wait a minute! Didn't anyone tell him that he just had surgery?
Once again, my theory is proven: No brain, no pain!
Today, Victor weighs 5 pounds and is living in the lap of luxury. The only problem is, nobody has gotten word to Victor that he only weighs 5 pounds. He loves people, but he's not much for other dogs. He takes on Rottweilers and Great Danes. When you take him for a walk, it's a bit embarrassing, really.
The night before his surgery, Surfer Boy and I walked Victor on the beach where he once again went ballistic when he spotted a worthy opponent, this time a full grown Doberman Pinscher. Kerry tugged at the leash and told him "Stop it! You're about to undergo surgery tomorrow. You're supposed to be contemplating the meaning of life."
But you see, that's what keeps Victor out of trouble. His ability to live in the moment and his inability to think, analyze, dissect, ruminate, marinate, obsess and worry.
Years ago, when I lived out in the country, many of our neighboring dogs ran free and got bitten by rattlesnakes. I was asking the vet about it one day, and he said that it's really no big deal. What? Why not? He told me it was because dogs don't go into shock the way humans do. They simply give them the anti-venom, keep them overnight, and back they go to frolick on the trail. Humans, on the other hand, freak out when bitten by a rattler.
With my knee surgery coming up, who knows when, I'm going to take a page out of Victor's book. As I write, he's relaxing in the sun, enjoying the warm California weather and ocean breeze. Wait a minute! Didn't anyone tell him that he just had surgery?
Once again, my theory is proven: No brain, no pain!
Sunday, February 6, 2011
Sunday Morning Surf Session
Phone calls made last night, three out of five invited showed up. The weather: a balmy 49 degrees, but the water is 58 degrees so it's warmer in the water. Perhaps it might feel that way. If it weren't for the heavy fog. As I paddled out to the lineup I felt amazingly grateful that my upper body is in great shape and I can paddle. So what if I'm not engaging in my favorite sport of trail running? The best part about cold water is that it brings the swelling down! I'm able to stand on my longboard in a fairly comfortable position for the knee. And gosh darn it - I look good in my wetsuit!!
Afterwards is the most important part. Breakfast at the San Clemente Cafe, which is, oddly enough, in San Clemente. Join us next week, will you? I tell really corny jokes such as: "Two peanuts were walking down the street. One was a salted" (assaulted) I warned you they were corny.
Wednesday, February 2, 2011
Ultra Running!!!!
Tuesday, February 1, 2011
It's Only Money!
Day 32 of officially being on the donor waiting list for the bone and cartilage transplant of my knee. C'mon, the next Kobe Bryant has got to expire soon! God rest his soul.
Insurance update: How exciting, my wonderful insurance company, I won't name any names, Anthem Blue Cross, has decided they don't want to pay for the surgery.
Here's how the process has gone: The insurance company denies. Tons of red tape, paperwork, letters to the California State Board of Insurance, an independent medical review by three orthopaedic surgeons deciding whether or not the insurance company denial should be upheld. Two out of the three say NO GO.
Why?
1. My advanced age of 52 (age discrimination is illegal)
2. They consider the graft experimental (it's not as it has an insurance code)
Bottom line: They will be happy to pay for a healthy, high functioning, high level athlete who has taken amazing care of her body all of her life to have a knee replacement which includes screws, bolts, metal and drilling instead of the graft which will prevent a knee replacement. Why? Gee, could it be because it actually might work?
I give my surgeon, Dr. William Bugbee, a lot of credit for forging the way and being a leader in his field. He's actually trying to help patients have a better quality of life without turning them into living breathing Frankensteins complete with metal bolts protruding out of the sides of their necks. What a concept.
By the way, for those interested in how much the "rich doctors" make: the surgeons portion of this expensive surgery is only $2,500
So folks, here's my plan: Next lifetime, I am going to come back as a high priced Beverly Hills plastic surgeon. Here are the benefits:
• No fooling around with pesky insurance companies
• My average fee for a boob job, face lift, tummy tuck, eyelid surgery will be around 15K
• I will have patients lined up at my door, begging for me to work on them
• I accept cash, 90 days same as cash and all major credit cards, including American Excess!!!
You can't beat that with a stick.
Insurance update: How exciting, my wonderful insurance company, I won't name any names, Anthem Blue Cross, has decided they don't want to pay for the surgery.
Here's how the process has gone: The insurance company denies. Tons of red tape, paperwork, letters to the California State Board of Insurance, an independent medical review by three orthopaedic surgeons deciding whether or not the insurance company denial should be upheld. Two out of the three say NO GO.
Why?
1. My advanced age of 52 (age discrimination is illegal)
2. They consider the graft experimental (it's not as it has an insurance code)
Bottom line: They will be happy to pay for a healthy, high functioning, high level athlete who has taken amazing care of her body all of her life to have a knee replacement which includes screws, bolts, metal and drilling instead of the graft which will prevent a knee replacement. Why? Gee, could it be because it actually might work?
I give my surgeon, Dr. William Bugbee, a lot of credit for forging the way and being a leader in his field. He's actually trying to help patients have a better quality of life without turning them into living breathing Frankensteins complete with metal bolts protruding out of the sides of their necks. What a concept.
By the way, for those interested in how much the "rich doctors" make: the surgeons portion of this expensive surgery is only $2,500
So folks, here's my plan: Next lifetime, I am going to come back as a high priced Beverly Hills plastic surgeon. Here are the benefits:
• No fooling around with pesky insurance companies
• My average fee for a boob job, face lift, tummy tuck, eyelid surgery will be around 15K
• I will have patients lined up at my door, begging for me to work on them
• I accept cash, 90 days same as cash and all major credit cards, including American Excess!!!
You can't beat that with a stick.
Friday, January 21, 2011
Colon Hydrotherapy-Try it. You'll like it
Since I am getting ready to undergo this wonderful surgery in which I am to receive the next Kobe Bryant's knee, I decided now would be a great to time to do another major body detoxification.
A couple of years back I found this wonderful center called Living Water Rejuvenation Centers. They specialize in colon hydrotherapy.
I can hear you now. Eww. Gross.
Not so. It's really a lot of fun and feels great!
Ever wondered why so many of us walk around with pot bellies or what the guys like to macho-like refer to as beer bellies?
There's no way to politically correctly say this: Most of us are walking around with 5 to 15 pounds of accumulated crap in our colons. How does this affect me, you may ask? Many ways, one, being that you're not much fun to look at in a bikini. The others are more profound, such as all that junk hindering your body from absorbing nutrients. The intestines and colon become so impacted that all that great food you're now eating cannot be utilized by the body. Heck, how else are you going to get the nutritional benefits of that quarter pounder?
With the surgery looming, off I went to the Living Waters Rejuvenation Center for my colon cleansing with my absolute Angel of a therapist. She's cute, fun, funny, young, energetic and makes the whole experience one to look forward to.
The procedure itself: yes, they stick a speculum up your butt, then from there it's smooth (to use a worn out term) sailing. You're slowly filled with nothing more than body temperature water which loosens up all the gunk, then it's released and, here's the part I know you're going to love, you get to watch, through a viewing tube, quite fascinatingly, all the junk that comes out of your body. How could that've been inside of my gorgeous body?
I asked my guardian Angel therapist what were some of the strangest things she has ever seen eliminated.
• A barbie doll shoe that a grown woman had swallowed as a child
• Purple fruit stripe gum. They kept seeing these gummy purple strings and finally the patient recalled having loved the gum so much as a kid that she chewed, then swallowed it.
• A fistful size of worms. The worms got all riled up after the first session. The client came back the next day with a swollen belly. As soon as they hooked her up to the machine, bingo! The therapist tried to hide her shock as she witnessed so many worms meeting their watery grave.
Do you want all that stuff in you? No! Colon hydrotherapy. It just may be your new best friend. And....by the second treatment, I've already lost three pounds. Now I've got your attention.
A couple of years back I found this wonderful center called Living Water Rejuvenation Centers. They specialize in colon hydrotherapy.
I can hear you now. Eww. Gross.
Not so. It's really a lot of fun and feels great!
Ever wondered why so many of us walk around with pot bellies or what the guys like to macho-like refer to as beer bellies?
There's no way to politically correctly say this: Most of us are walking around with 5 to 15 pounds of accumulated crap in our colons. How does this affect me, you may ask? Many ways, one, being that you're not much fun to look at in a bikini. The others are more profound, such as all that junk hindering your body from absorbing nutrients. The intestines and colon become so impacted that all that great food you're now eating cannot be utilized by the body. Heck, how else are you going to get the nutritional benefits of that quarter pounder?
With the surgery looming, off I went to the Living Waters Rejuvenation Center for my colon cleansing with my absolute Angel of a therapist. She's cute, fun, funny, young, energetic and makes the whole experience one to look forward to.
The procedure itself: yes, they stick a speculum up your butt, then from there it's smooth (to use a worn out term) sailing. You're slowly filled with nothing more than body temperature water which loosens up all the gunk, then it's released and, here's the part I know you're going to love, you get to watch, through a viewing tube, quite fascinatingly, all the junk that comes out of your body. How could that've been inside of my gorgeous body?
I asked my guardian Angel therapist what were some of the strangest things she has ever seen eliminated.
• A barbie doll shoe that a grown woman had swallowed as a child
• Purple fruit stripe gum. They kept seeing these gummy purple strings and finally the patient recalled having loved the gum so much as a kid that she chewed, then swallowed it.
• A fistful size of worms. The worms got all riled up after the first session. The client came back the next day with a swollen belly. As soon as they hooked her up to the machine, bingo! The therapist tried to hide her shock as she witnessed so many worms meeting their watery grave.
Do you want all that stuff in you? No! Colon hydrotherapy. It just may be your new best friend. And....by the second treatment, I've already lost three pounds. Now I've got your attention.
Wednesday, January 19, 2011
The Bionic Babe - Chapter One
Who am I? An existential question, to be sure.
Statistics:
Female
Age 52
135 pounds (need to lose 10 pounds)
Two beautiful daughters (nobody admits to the ugly ones)
Married to my surfer boyfriend for 3 1/2 years
Retired
This blog is going to be more of a tell all journal of what's going on in my life. Previously, Angela and I, before she started working so much, shared fitness tips and it was all so positive.
Mama told me there would be days like this.
When I was 15, I got a book through the book of the month club which gave detailed instructions along with artists conceptions of yoga postures. I started practicing the postures in my 90 degree, humid Miami, Florida bedroom every morning. Sometimes after a few tokes of the good stuff. It was the 70's. I was making my own yogurt, reading books like Be Here Now by Ram Dass and going bra less. I refused, however, to wear Birkenstocks because they're just flat out ugly.
As the years went on, I put the bong away, went into corporate America, became a top salesperson, a mother of two, a step mother of three and have had more husbands than I care to admit. Okay, three. Most of the time, however, I've lived on my own and became fiercely independent.
Enter ultramarathoning. I found the perfect sport that combined my love of nature, trail running, God, Goddess, runners high, in short, the perfect stress relief and my church. It was through the many thousands of hours on the trail that I discovered how independent I can be and at the same time, a wonderful sense of community through my fellow ultra runners. Even dated a fit body or two.
A year and a half ago, I was diagnosed with a torn meniscus and underwent surgery to correct the issue. The doctor made it sound so routine. Long story short, I have not run in a year and a half because it's just too darn painful.
Me? Perfect me, who never had a sick day in her life? No!!!
After doing all the voodoo stuff, meeting with at least ten doctors, including the specialists at UCLA, I finally found a surgeon, Dr. William Bugbee, who specializes in osteochondral grafts. In English please? There's a hole in my knee. We wait for a suitable donor to expire (the next Kobe Bryant) The graft is harvested and must be used within seven days. The procedure involves cutting the defective portion of my knee out and replacing it with living bone and cartilage. The body then gets to work re-stitching and reintegrating the new material as one cohesive whole. If you were 20 years old, they'd give you a 100% success rate. At my advanced age of 52, they offer me a 75% success rate. I've been on the donor waiting list for exactly 21 days now. It's exactly what it sounds like. A waiting list. There's no chance of not waiting - that's the name of the list.
Meanwhile, hormones are going out of control. I haven't had my period since May. All the usual symptoms: hot flashes, night sweats, loss of libido, itchy, bitchy, sleepless nights. I sought relief with my husbands doctor, who specializes in anti-aging and bio-identical hormone replacement therapy. Evidently, once a person is no longer fertile, the brain signals the body that it's time to be eliminated from the planet, hence all the symptoms of aging. Once I started researching what happens when hormones start plummeting, OMG, it's not a pretty picture. Bone loss, heart problems, hair loss, loss of libido, dry skin, the list goes on and I, for one, am not going to take it!!!!! I'm currently taking bio identical estrogen, progesterone, testosterone, DHEA in the form of a cream that gets rubbed onto the skin. You don't want to mess with taking synthetic hormones. They're made from horse urine and have been linked to cancer. I am starting to feel better. Sex, and sleep, blessed sleep! It's still a work in progress. I've decided to take it a step further by going to Dr. Prudence Hall who specializes in "cycling" BHRT. They vary the dose based on the time of the month, thus tricking your brain into thinking you're 25 again. Her center also focuses on anti-aging medicine. How exciting!
I am amazingly grateful for all the great things I can do: Surf (mostly paddling) yoga, mountain biking, but all workouts are accompanied by my good friend, pain.
Being retired at such a young age brings another set of challenges. Who am I? What's my purpose? I love my family, friends, people. In the past, I visualized that when I finally had the time, I would spend it doing all the athletic endeavors I love. It seems like life has other plans at the moment.
When Kerry (age 62) and I sat down to our heart healthy glass of red wine last night, I told him "Our life is not going to become about sitting in rocking chairs talking about doctors, insurance coverage, back aches, joint problems and hormone loss" (even though it has) No! We've decided to jump out of our rocking chairs! Just make sure you don't spill the wine when you jump up!
My goal with the blog is to inspire others and help someone who may be going through some of the same stuff I'm dealing with. I will tell you everything I'm learning, how it's working, answer questions. Together, we all help each other along this path called life.
P.S. Yes. I do color my hair.
Statistics:
Female
Age 52
135 pounds (need to lose 10 pounds)
Two beautiful daughters (nobody admits to the ugly ones)
Married to my surfer boyfriend for 3 1/2 years
Retired
This blog is going to be more of a tell all journal of what's going on in my life. Previously, Angela and I, before she started working so much, shared fitness tips and it was all so positive.
Mama told me there would be days like this.
When I was 15, I got a book through the book of the month club which gave detailed instructions along with artists conceptions of yoga postures. I started practicing the postures in my 90 degree, humid Miami, Florida bedroom every morning. Sometimes after a few tokes of the good stuff. It was the 70's. I was making my own yogurt, reading books like Be Here Now by Ram Dass and going bra less. I refused, however, to wear Birkenstocks because they're just flat out ugly.
As the years went on, I put the bong away, went into corporate America, became a top salesperson, a mother of two, a step mother of three and have had more husbands than I care to admit. Okay, three. Most of the time, however, I've lived on my own and became fiercely independent.
Enter ultramarathoning. I found the perfect sport that combined my love of nature, trail running, God, Goddess, runners high, in short, the perfect stress relief and my church. It was through the many thousands of hours on the trail that I discovered how independent I can be and at the same time, a wonderful sense of community through my fellow ultra runners. Even dated a fit body or two.
A year and a half ago, I was diagnosed with a torn meniscus and underwent surgery to correct the issue. The doctor made it sound so routine. Long story short, I have not run in a year and a half because it's just too darn painful.
Me? Perfect me, who never had a sick day in her life? No!!!
After doing all the voodoo stuff, meeting with at least ten doctors, including the specialists at UCLA, I finally found a surgeon, Dr. William Bugbee, who specializes in osteochondral grafts. In English please? There's a hole in my knee. We wait for a suitable donor to expire (the next Kobe Bryant) The graft is harvested and must be used within seven days. The procedure involves cutting the defective portion of my knee out and replacing it with living bone and cartilage. The body then gets to work re-stitching and reintegrating the new material as one cohesive whole. If you were 20 years old, they'd give you a 100% success rate. At my advanced age of 52, they offer me a 75% success rate. I've been on the donor waiting list for exactly 21 days now. It's exactly what it sounds like. A waiting list. There's no chance of not waiting - that's the name of the list.
Meanwhile, hormones are going out of control. I haven't had my period since May. All the usual symptoms: hot flashes, night sweats, loss of libido, itchy, bitchy, sleepless nights. I sought relief with my husbands doctor, who specializes in anti-aging and bio-identical hormone replacement therapy. Evidently, once a person is no longer fertile, the brain signals the body that it's time to be eliminated from the planet, hence all the symptoms of aging. Once I started researching what happens when hormones start plummeting, OMG, it's not a pretty picture. Bone loss, heart problems, hair loss, loss of libido, dry skin, the list goes on and I, for one, am not going to take it!!!!! I'm currently taking bio identical estrogen, progesterone, testosterone, DHEA in the form of a cream that gets rubbed onto the skin. You don't want to mess with taking synthetic hormones. They're made from horse urine and have been linked to cancer. I am starting to feel better. Sex, and sleep, blessed sleep! It's still a work in progress. I've decided to take it a step further by going to Dr. Prudence Hall who specializes in "cycling" BHRT. They vary the dose based on the time of the month, thus tricking your brain into thinking you're 25 again. Her center also focuses on anti-aging medicine. How exciting!
I am amazingly grateful for all the great things I can do: Surf (mostly paddling) yoga, mountain biking, but all workouts are accompanied by my good friend, pain.
Being retired at such a young age brings another set of challenges. Who am I? What's my purpose? I love my family, friends, people. In the past, I visualized that when I finally had the time, I would spend it doing all the athletic endeavors I love. It seems like life has other plans at the moment.
When Kerry (age 62) and I sat down to our heart healthy glass of red wine last night, I told him "Our life is not going to become about sitting in rocking chairs talking about doctors, insurance coverage, back aches, joint problems and hormone loss" (even though it has) No! We've decided to jump out of our rocking chairs! Just make sure you don't spill the wine when you jump up!
My goal with the blog is to inspire others and help someone who may be going through some of the same stuff I'm dealing with. I will tell you everything I'm learning, how it's working, answer questions. Together, we all help each other along this path called life.
P.S. Yes. I do color my hair.
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