Category Archives: Health

To go to the doctor, or not go to the doctor – that is the question

High deductible health plans are great when you hit your deductible – except when they’re not. Specifically, they’re not great when over the course of the year you have to start over paying your deductible due to company health plan changes and/or changing companies. Thus, this leads me to move away from my former infatuation with the HSA-enabled HDHP.

In November, my $2600 deductible restarted. I figured I could survive until the end of the year without seeing a doctor. Then, I got pregnant. And then, I got sick. Sick with a cold / sore throat / lost voice that’s likely a virus that has no cure anyway… not worth a doctor’s visit and certainly not worth spending $300 on. I already made that mistake a few times this year when I didn’t realize my deductible had not only reset, but doubled (thanks to my former company who didn’t notify me that as of Aug 1 they switched plans and the $1500 deductible was now $2600 and reset *cough*bullshit*cough.*) Yes, that cost me $1000 in medical fees that I expected to be covered due to a series of “fuck I lost my job and I’m incredibly depressed” psychologist appointments (nothing like a surprise $1000 bill you fix your mental health!)

But now, I’m going back and forth on whether to go to the doctor. Being pregnant changes things. I’m five weeks, two days pregnant… and, 3 weeks, 6 days away from a brand new year of health insurance and deductibles. Since I’m switching to Kaiser, my medical costs are going to go way down next year (it’s a $1500 out of pocket max, no deductible,  no more surprise charges PPO BS. I hope I do not regret this decision.) Can’t I just stop talking for a few weeks (who needs a voice anyway) and hold out?

I do get to see my reproductive endocrinologist tomorrow – or at least the nurse – and perhaps they’ll be able to advise if I should do anything about this stupid cold. Luckily, my follow up appointments for my pregnancy at my RE are “free” (well, covered by my monthly $800 cycle fee) until I’m handed off to an ObGyn… so I’m hoping they can help at least provide some medical advice of what to do if I’m super sick and cannot talk.

The good news is I haven’t had a fever yet. I know fevers can be dangerous to baby and the second I get a high fever I’m paying that $300 and going to the doctor. For now, I think I just need to figure out how to get some rest and eat a lot of chicken soup.

Open Enrollment & Pregnant: Anthem or Kaiser? PPO, HDHP or HMO?

It’s quite the luxury to fall pregnant the month of open enrollment. This means hubby and I can (theoretically) make smart financial decisions when it comes to selecting health insurance for next year which covers both the birth of our first child and their first six months of medical care.

Even with this great fortune, it’s unclear which of our options is the right one. Luckily, my company provides relatively good insurance. Given how much health insurance costs in this country, the $200-$300 we’ll be paying a month as a couple (and $200 to $400 as a family) is nothing compared to what insurance on our own would cost. Still, I want to make a smart choice here.

It’s hard to make smart choices when the data is all hidden. Plus, not every decision in life should be based on financial impact alone. Delivering a baby is serious business, and having the option to choose my doctors (especially in case anything goes wrong) feels, to me, like a must have. My husband disagrees.

As a “Kaiser baby,” he speaks highly of the whole Kaiser health system (which also happens to be our lowest-cost option by far.) While some people report Kaiser is horrible, it seems to be that they have their shit together in California. Still, it makes me incredibly nervous to switch to a new health system now with its own style of care.

According to the calculator provided by the open enrollment system — with maternity care and other costs this year (for family of 2) our Kaiser total out of pocket costs would be $3000 or less for the year, whereas Anthem PPO (low deductible) would be around $5000-$6000 and Anthem HDHP would be $8000 (but also includes a $6900 contribution to HSA pre-tax, so that’s about a $3000 discount long term if we buy and hold.)

Financially-saavy me thinks — go for Kaiser — it’s clearly a lot cheaper and it’s not bad – just different. People who dislike Kaiser seem to have rare medical conditions that the organization doesn’t find fast enough since they have no incentive to spend more money on your health, and you have to advocate for yourself. Their maternity situation actually seems to be well regarded. It might not be a horrible idea to go to Kaiser and save $2000=$5000 next year. Lawrd knows we’ll need it for daycare* (more on that in another post.)

Before I was pregnant, I found an ObGyn who looks great (lots of 5 star reviews online) and she didn’t have an opening until January so I booked it a while ago. I planned to talk to her about infertility but now that I’m pregnant, it works out that it’s week 10 of my pregnancy and likely ok to be my first prenatal appointment (I’m assuming — especially since my Reproductive Endocrinologist provides ultrasounds and bloodwork until I’m turned over to the Ob.) I’m just not sure if that trade off is supposed to happen at 8 weeks or if 10 is ok… but I’ll find out.

So… I’m leaning towards Anthem… even though it’s a waste of money. If we start with Kaiser now, we’re stuck (I’ll have a pediatrician selected for my child through them, and unless that doctor is horrible, we’ll likely want to stay with that pediatrician for our child’s entire… childhood.)

Regarding the Anthem options – I’m torn between the HDHP and the PPO. The PPO is cheaper, according to the calculator, and for my husband it’s nice that it has a $250 deductible. The monthly cost is definitely higher and doesn’t include any company contribution, so that’s why it starts to even out. Then the HDHP has that HSA which I love so much, being able to invest nearly $7000 in pre-tax dollars in an account we can invest in and use for healthcare later in life. That $7000 invested over 10 years at 5% would be worth $9.4k – $2.4k back, plus the $3000 or so savings in taxes up front, which is $5.4k, which covers the cost of the difference between this plan and Kaiser.  And that’s with 5% growth and only over 10 years. So is Kaiser really cheaper? — That said, we’d have to pay $7000 up-front now out of our take-home income (though it would only feel like $3500 lost, comparable to the Kaiser costs, I think?)

Either way, I’m fortunate to have a job that pays well enough to be able to be able to decide on this. Keeping my job has never been this vital, and every day I step in the office I know I have to get my game face on and make this work. Somehow. I haven’t told my boss yet that I’m pregnant (one doesn’t do that until week 12 or so, apparently), but I’m nervous about sharing this news with him since I’m not covered by FLMA until 3 months after giving birth to my child. More on that, later…

I spent $2000 for a week at fat camp…

Did I really volunteer (pay $2000 to) work out 5+ hours a day and wake up at the crack of dawn six days in a row? I asked myself that quite a few times over the last week while I was doing my nth set of reps or sprints at the weightloss resort my friend and I had spur-of-the-moment booked a trip to — how could one week of health-based torture hurt?

I really wasn’t sure what I had signed up for — would it be military-style “yelling in your face” bootcamp, or something a bit more gentle? Would everyone there be morbidly obese – and I, just “barely” obese, would be the fittest in the bunch, outpacing the others and not pushing myself hard enough to get any value out of the program?

It turns out that the program we picked had quite the mix of people – from those who were really already quite fit seeking to lose a few pounds to people who were well over healthy weight. Many guests, to my surprise, were staying for multiple weeks — and quite a few were repeat visitors, which I saw both as a good thing (they liked the program enough to return) and a bad thing (they couldn’t stick to the healthy lifestyle on their own so they have to come back to the program again and again to lose weight.)

Even though I had quite a few qualms about the program, overall I think it was a very positive and worthwhile experience. My husband thought I was a nut to spend $2000 on a week weightloss program because you can’t actually significantly change your weight in a week. I know that. It took me six months to lose 40 pounds and six to put it all back on. But one can accomplish a lot in a week mentally. Sometimes you need to get out of your comfort zone to break through places you’re stuck.

While all the exercise was helpful in getting me from barely-able-to-move to sprinting for two minutes at a time again in a very short while, what really impacted me was the nutritional element of the program. We were fed breakfast, lunch and dinner every day, which amounted to about 1200 calories per day, and were provided with snacks (take as much as you want) which were limited to hardboiled eggs, almonds, fruit, and a few other protein items. We were supposed to be eating about 1500 calories per day.

When I lost 40 pounds last year, I did eat about 1500 calories per day on average, plus exercised 3 times a week for 1 hour (not 5 hours 6 days a week.) However, my diet was very unhealthy. I felt sluggish and hungry all the time. In this program, the chef made meals that were perfectly balanced so that we’d feel full and not hungry before our next meal, despite all the working out. I supplemented with two hardboiled eggs for breakfast and a fruit, and a serving of peanut butter before going to bed if my stomach was growling. We were also allowed unlimited access to the salad bar which was not so impressive but it did teach the lesson that one should fill up with salad before eating to help eat enough nutrients and feel full. Lunch always was a tasty soup around 75-95 calories and a main dish. Dinner included a main dish and a desert. Breakfast was a protein, a carb and a fruit, with one serving of fat – such as eggs, a piece of sprouted toast, small dab of butter, and a few pieces of melon.

For someone who typically eats NOTHING *or* Half-a-loaf-of-bread for breakfast (with half a stick of butter) — it was a new experience to be eating a healthy balanced meal every day at 9am, especially after already having worked out for two hours on a challenging (to me) hike.

By eating balanced, nutritious meals throughout the day, I rarely got hungry, and I also discovered my mood to be much improved. It may just be that I was on vacation, or that the endorphins from suddenly exercising five hours per day were making me loopy – but I could feel my blood sugar remaining balanced, which really helped me not experience the depression dips that I’m used to (and I went off my starter zoloft for the week because I didn’t think I needed it.)

At the end of the week I lost 3.5lbs (1.6% body fat) and about 2 inches in my waist. I still have a long way to go to be healthy (I wasn’t really healthy last year when I was 140 pounds, nor am I healthy now at 173.) But I’m going to try REALLY HARD to stick to this food lifestyle and eat 3 balanced meals per day. No more binging. No more wasting calories on sugar that mucks up my emotions. I really feel like I’ve experienced a substantial change and I’m ready to see this through – the rest of my life. I don’t want to be one of the people returning to the program year after year (nor can I afford it.) I want to be my own success story.

The Cost of Getting Healthy: Worth It

With my somewhat aggressive savings plan, my networth has eeked over the $480k mark, leaving “just” $20k left for the remainder of the year to hit my annual and “before giving birth*” goal of $500k. (*still not pregnant, so it’s looking more and more likely that I’ll hit this goal.)

While I’m far from frugal, I started doing some longer term calculations and realizing that perhaps I’m saving too much of my paycheck (is there such a thing?) I’m not a Mustachian — I have no desire to “retire early” — and maybe I don’t need $200k a year (after inflation) in actual retirement because I hope to always be able to work (albeit in a different, lower paid and more meaningful job once I’ve saved enough.) Continue reading

The Slow March of Death: My Father’s Cancer and Necessary Denial of Mortality

Yesterday, I joked with my husband that it’s difficult to say “poor dad” in any scenario. My father, with his chronic narcissism, is quick to blame you with a massive guilt trip for any slight mistake, to debate your opinion to the ground telling you you’re flat out wrong, and to make thousands of careless mistakes only to get extremely angry at you if you dare to call him out on any of them. Yesterday was a day when “poor dad” would be the tinge of empathy I feel for him bubbles to the surface.

It has been nearly 10 years since the doctors told him that he has an aggressive form of late-stage prostate cancer and he had “two years” to live. He is 67, and with all his health issues – his obesity, his diabetes which he fails to keep in check, and the cancer which was supposed to take his life long ago, has surpassed the lifetime of Carrie Fisher and many others who have died too young. Still, there is never a good time to die, and despite his personality shortcomings we all want him to live as long as possible and as comfortably as possible. I had a bit of a breakdown years ago about his looming mortality, and then as time passed and the drug concoctions they put him on started to slow down the growth of his cancer we all just put the thoughts of death out of our minds. He briefly lost weight and seemed a bit happier. Then he returned his old habits – overeating, yelling horrible things at my mother, and being his typical anxious, narcissistic, grouchy self. Continue reading

My Cousin Tried to Kill Herself

There is nothing harder to get through than adolescent depression. Not only are you dealing with the darkness that is a depressive episode, you are stuck in an environment where drama is amplified and your hormones are raging and you are trying to figure out where you belong in the world as you transition to adulthood. It’s really fucking hard.

Yesterday, my aunt texted to tell me that she was back in the ER with my 15-year-old cousin, I’ll call her Jen. I just visited Jen last week in a special group home for youth with various mental illness. I visited her twice in the 10 days she was in the home after previously giving her school counselor a note saying she had a plan to kill herself. The first visit went relatively well, but was short because I got there after work and they have an early curfew. Continue reading

PCOS Women: Avoiding BPA – is it possible?

BPA (bisphenol-A) – a synthetic estrogen used to harden polycarbonate plastics and epoxy resin – is a troubling element of most plastics that we use on a daily basis. It is proven to be an endocrine disrupter, which is especially worrisome for women who are trying to get pregnant, especially those of us with PCOS.

BPA-Endocrine Disorder (source):

  1. Reduces the number of oocytes (cell in ovary that may undergo meiotic division to form an ovum)
  2. Lowers successful number of births
  3. Changes gene expression
  4. Reduces the function of Estrogen Receptor Beta
  5. Negatively affects mitochondrial function
  6. Alters hypothalamic pituitary / increases testosterone
  7. Lowers progesterone
  8. alters GnRH secretion
  9. Increases glucocorticoids
  10. heightens response to stress, elevates levels of anxiety

Continue reading

In this Friday, July 8, 2016 photo, a pharmacist holds a package of EpiPens, an epinephrine autoinjector for the treatment of allergic reactions, in Sacramento, Calif. Price hikes for the emergency medicine have made its maker, Mylan, the latest target for patients and politicians infuriated by soaring drug prices. (AP Photo/Rich Pedroncelli)

The Giant American Prescription Drug Scam

In the US, we pay more for prescription drugs than ANY OTHER COUNTRY. By a lot – more than double. The reason for this is complicated. And the amount of attention brought to this issue ebbs and flows. Last week, a bunch of pissed-off parents made it clear that the epic price hike on the EpiPen (used for major life-threatening allergy attacks) was not an acceptable move on the part of drug manufacturer Mylan — the same company whose CEO received a 671% salary increase in just eight years from under $3M to over $18M.

[Sign the Petition Against EpiPen Pricing Here]

Luckily, I don’t have allergies or the need for an EpiPen – which now costs $400 per pen or about $415 after insurance for two pens. In Canada, a hop, skip, and snowshoe north of our borders, the pens are distributed by Pfizer and cost just $100 a pen. In France, the pens cost $85. Perhaps allergies in Canada are not as vicious as those in the States? Maybe French people are allergic to allergies so they just don’t get them? No — the EpiPen in all countries serves the same exact purpose… it’s just a lot more expensive to acquire in the US. Continue reading

The Big Bet: Weight Loss and $1000 On the Line

Last summer, following my engagement, I decided to put a significant amount of money on the line to commit to losing weight. At the time I was about 170lbs, and I refused to walk down the aisle that overweight. My healthy BMI, according to the charts, is – at its highest – 140lbs. My goal, then, became to walk down the aisle at a healthy BMI.

I found a site called HealthyWage which allowed you to pick your weight loss objectives, timeline to hit those goals, and how much you want to put on the line. I bet $1000 because I figured that was a very substantial amount of money – substantial enough that I wouldn’t fuck up. I gave myself 10 months for the weight loss… I had to lose about 30lbs in 10 months, which was less than 3lbs a month – totally doable.

Then, I went through a period of depression and gained back some of the weight I was losing. I still stayed under my max weight, but suddenly the easy weight loss goal became much more difficult. I hired a personal trainer. I found that even with eating healthy and working out 3x a week I was only losing four pounds a month on average. I wasn’t losing weight fast enough, and my final weigh-in was getting closer and closer.

Today, I have a little over 5 weeks to lose 10-11lbs. While that’s theoretically do-able, it’s extremely hard (it’s basically 2lbs per week consistently.) There is plenty of literature that says you can lose this much, but it gets harder the closer you get to your goal. It’s one thing to completely botch this exercise but to end up just 2lbs away from my goal will be emotionally devastating. It’s quite possible it will come to that. Or, I can figure out how to kick the final 11 pounds to the curb once and for all. It will take more focus and determination than I’ve ever exhibited in my entire life. But, as I’ve always said, if you aren’t going to be willing to kick your ass into shape for your wedding, when in life will you be willing?

I’m focused on increasing my cardio and a very low carb diet, taking one day at a time. I’m at the point where every calorie counts and no matter how badly I want to sleep in or go home at a reasonable time, I need to work out to force my body to lose those two pounds a week. I believe on a strict ketosis diet with substantial exercise (still eating a healthy calorie count) I can get to my goal, but it’s going to be very, very hard. With my average of 4-5 lbs of weight loss each month on a healthier-than-usual diet, my body may not be willing to part with the pounds. But I’m putting my best effort forward here and will not be eating sweets on Easter or giving in to drinking anything other than tea and water.

April, you are my clean eating month, my super healthy, shrink my fat arms and stomach down marathon. You are my opportunity to win $900 or lose $1000. To be a winner or to fail despite losing over 15 pounds.

By April 14, I need to be down to 145lbs. That is my current focus. Six pounds in a little under 3 weeks. There’s my two pound a week goal, and a good half way point to check in on. I don’t know why but I’m feeling optimistic here that I can do this. I really hope I’m right. I’ll do whatever it takes.