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Wednesday, June 29, 2016

Insurance Woes

Dear Diary,

Both the wife and I are still totally overwhelmed by magnitude and complexity of dealing with my medical issues. One of the biggest challenges is health insurance. The term is actually an oxymoron as it implies that one's health is insured. This is rubbish!
The new 'Phoenix Choice Gold HMO' plan that I enrolled in in January is is now becoming a problem. Basically, they're not paying for anything.
I have an $1800 annual deductible as well as a $4900 annual maximum out of pocket. When these are met, the plan is supposed to kick in 100%. Before that, the plan should be picking up 80% of accrued medical bills.
When I had my cardiac MRI done in June, the hospital requested a prior authorization for the procedure which they got without issue. The written report from the insurance company stated in writing that my annual deductible was met as well as $2500 of my annual out of pocket.
This hospital is in network meaning it is one of the plan's preferred hospitals.
Now, when we can get the insurance company to answer the phone, we are told that only $700 something has been met on the $1800 annual deductible and around 50% of the annual out of pocket.
So far, there has been no reimbursement whatsoever.
We have a grievance pending with the company but so far, they are choosing not to return our phone calls.
I wish I qualified for Arizona Medicaid but, unfortunately, we make too much money from SS to meet the federal poverty standard.

Something ain't right here! It's no wonder I drink!

We are living on slightly over $2000 a month trying to make bare minimum payments and still pay our electric bill and eat. Now, with the temperatures averaging over 110°, and the dew point at 60°+, we can no longer use evaporative cooling which sends our electric bill through the roof.

Now, with my PSA rising, it indicates that the cancer has opted to become active once again which will doubtless require hormone therapy to control. This will cost tens of thousands of dollars which the insurance should pick up at least 80% of.
I have no idea what is going to happen in the next few months so stay tuned.

Right now, we have a nice thunderstorm coming in and I'm going out and watch it.  :)


"Every day above ground is a good day".  -- Scarface

Saturday, June 25, 2016

Short Update

Dear Diary,

The good news is...I'm still alive. Whoopee!!

The weather here seems to have stabilized for a while. Not as hot as it was, staying around 110° to 112° in the shade. Typical summer in Paradise.

*Sips bourbon*

I'm currently working on weaning myself off oxygen. It promises to be a long, uphill struggle if, in fact, it can be done at all.
Unfortunately, most of the research I'v done so far strongly suggests that I may be on it for life even if the underlying disease process is not progressive.
Sitting here at the desk, I can usually hold 95% or better. That's if I remember to breathe!
I still can't move around the house like I used to without desatting down to the mid seventies. That level is considered dangerous hypoxia if it is allowed to continue for more than a few minutes.

It doesn't seem like there's any more progressive improvement which is worrisome. The heart surgery relies on this being resolved before we can proceed with it.
If this heart issue was an elective procedure, I wouldn't be so concerned. I have to have the surgery or risk the very real possibility of my early demise.

It's been too hot to walk outside lately so I've been trying to keep as active as possible here in the house. Unfortunately, that really isn't the kind of exercise I need.

I'll post again as things change.

"Every day above ground is a good day".  -- Scarface


Sunday, June 19, 2016

Father's Day

Dear Diary,

Ironically, this was also the day that I received my initial diagnoses of prostate cancer back in 2012.

Guys, get yourselves checked by a competent urologist on a regular basis.
Don't wait till it's too late like my father did.  :(

If not for you, then do it for your loved ones.


Saturday, June 18, 2016


Dear Diary,

It's 110° in the shade here today and expected to get hotter over the next few days. The wife and I are hiding out in our little, swamp cooled house for the duration.
With any luck, I won't have to go back in the hospital over the weekend. Lol!

Got my discharge follow up done this morning so the only thing coming up is the cardiologist for my INR on Monday. Of course, that is forecast to be the hottest day of the coming week with temps approaching 120° Not a good environment for much of anything.

We are now starting to titrate down on the prednisone. I started at 60mg/day for a week. Today, we begin 40mg/day for a week. So far, the oral prednisone seems to be easier on the glucose than the IV version. I'm not having to use anywhere as much insulin as I thought I would need. This is good.

Blood pressure is still running high in the 170s systolic. We have doubled the hydralazine dose from 10mg t.i.d. to 20mg t.i.d. Part of the issue may be fluid accumulation from the steroids so we are trying to offset that with Lasix™. Lasix is a loop diuretic and very effective. It is capable of inducing nearly constant urination for several hours. Obviously, I don't go too far from a restroom when I'm on it!

As far as the respiratory issue goes, we still have a suspicious area in the left lung base. They suspect it is atypical pneumonia. We are hoping this resolves on it's own. If it still is the same size or larger on the next CT scan in a couple of weeks, we will have to do a bronchoscopy with needle biopsy to resolve it. We are still in a race to get this resolved so we can proceed with the heart surgery ASAP.
Basically, we need to get my pulmonary capacity up to 50% or better before anyone will even consider me for surgery. Last pulmonary function test was 28%.

Wish me luck! Remember, I did promise more drama and action on this blog! ROTFFL!!


Thursday, June 16, 2016

Home Again...For A While

Dear Diary,

Just got back from the hospital with another bunch of fun stuff.

Was back in hospital for the past week because I thought I was having a recurrence of pneumonia and I was, in fact correct.

The oxygen saturations are intermittently better now. Supposedly I can go off oxygen totally if I'm really not doing too much. They want me to be on it if I'm going to exert myself at all or practice exercise walking.

I've been put on a month's worth of high-dose prednisone which has a tendency of increasing my weight which is something that I really don't need. Because of that, I am now also on injectable insulin for another month because the prednisone has an annoying tendency of making my blood glucose skyrocket.
I am a little concerned about the abrupt weight gain though, because I gained about 5 pounds since I started the prednisone. It is probably mostly water weight which will be fairly easy to get rid of. I'm going to have to be very careful with my diet until we get through this so that I don't put on any caloric weigh
It just gets better and better and more expensive.

According to my pulmonary guy, if we can get my lung function up from 28% to around 50% or over, we will go as quickly as possible to open heart surgery for the myxoma.

We're still looking for a heart surgeon willing to take on a high-risk case. A great deal of this is going to depend on who my current insurance will cover.

My upper body is covered with bruises from injection sites and IVs that are given when my blood is so thin. In the hospital, they were giving me something related to heparin which is a short-acting anticoagulant. I was put on
 that because it was a good possibility that I was going to have to have a bronchoscopy. That didn't happen so they put me back on warfarin at 5 milligrams where I was. That will soon be increased to 7.5 milligrams.
I'm including a small photo to show what anticoagulant can do even with one injection.
This is the result of one needle stick. Courtesy: Karen Niles

So, right now, the two of us are just sitting out on the front porch discussing 'plan b',
It's a beautiful night here in Paradise so we have to take advantage of it.

Have a nice day!


Tuesday, June 14, 2016

Back Home Tomorrow!

Dear Diary,

Hopefully, I will be discharged from the hospital tomorrow. There appears to be a significant improvement over the past five days and we seem to be winning the five month old battle this time.
As long as I am reasonably careful, I can now go all day without supplementary oxygen. This is including mild exercise. I am hopeful that this will be a permanent improvement. Time will tell.

We finally have a name for the condition. It is atypical pneumonia. Read about it here.
It is normally a mild infection however this one was fairly serious. I'm very glad that we were able to have it treated where and when we did as if it was left totally untreated, it is possible that it could have been lethal. This was a hospital acquired infection.
It will be good to finally get home but I will be on antibiotics, steroids and injectable insulin for at least a month The reason for the insulin is because the steroids really jack up my glucose a lot so we need to handle that with insulin until I'm off of them.

I will also be setting up appointments with my new urologist and prospective heart surgeon. (We don't have one yet.)

So, for now, the agenda for the near future is to get over the pneumonia and restore my respiratory system, get the heart surgery done and finally address the recurring prostate cancer issue.

Seems like enough for one year!

No bourbon to sip on here so I'm gonna sign off for the night. ;)


Monday, June 13, 2016

Back In The Hospital...Again

Dear Diary,

Well ok, here I am,  back in the hospital again, At least this time it's the right one. Lol!

Came down last Thursday morning around 2:00 am with flu like symptoms so the wife and I decided to go to the ED at Abrazo Scottsdale Campus to rule out a return of the pneumonia that I acquired five months ago.

It was a good that we did.

Turns out the pneumonia has returned and somewhat worse than before so, since I was going to be admitted at least overnight it seemed appropriate to aggressively pursue the O2 desaturation issue that's been haunting me for the past five months.
This problem has to be overcome before I can have the heart surgery.

I  am tentatively scheduled for a bronchoscopy tomorrow unless at least some durable improvement is seen. If improvement is seen, then the plan is to discharge me and return in 2 weeks for another CT scan. If the scan looks fairly good, I will have several weeks of Prednisolone therapy. The therapy will greatly increase my glucose levels so I will be using insulin in injection form to control that.

So as far as I can see, whenever I do get home, my first task will be to start interviewing cardiothoracic surgeons and getting into the best shape I can for the surgery.

More later.


Sunday, June 05, 2016

Another Setback

Dear Diary,

Today was not a good day. I received an email from the individual I normally work for part time informing me that I will no longer be receiving a monthly paycheck. Frankly, this was not totally unexpected as I have been unable to fulfill my obligations for around the past five months.
He has been allowing my checks to continue in anticipation of my health improving and subsequent return to work. It would appear that that is not going to happen anytime soon.
I greatly appreciate his generosity but this little change has really hit us below the belt.
In the grand scheme of things, the amount we're losing really amounts to pennies but in our current financial situation, every penny counts. The real clincher is, as I have said before, neither Karen nor I are marketable in either the business or the work world any longer and that is not going to change.
The ONLY way that I can return to the work world is if I can ever get off the oxygen.

For those interested, this is me getting ready for the MRI.

Cardiac MRI 06/05/2016

*Sips a bourbon* Nighty night!!


Saturday, June 04, 2016

MRI Done. Now We Wait.

Dear Diary,

Just got the High Contrast Cardiac MRI done yesterday. Damn thing took an hour! Imagine lying in a tube just big enough for your body staying perfectly still for a solid hour. It's a good thing lying around doing nothing is what I do best. Lol!

Here's what the machine looks like:
When the test is done you can wash and dry your clothes in it too!

They have another test where they stick a radio coil up your ass! I wanted that one but they just looked at me in a weird sort of way and said that didn't work for the heart.  ;)

We won't have any results before Monday afternoon. I hope this was worth it.

*Sips bourbon*

Truthfully, there really isn't anything else to report and it's 'triple digits' hot here so I'm gonna sign off and chill!