WEEKEND — keeping up, keeping track

By week end my 4-wheeled walker is still the borrowed one from the PT folks at the rehab facility.  There was no word from the approved provider that was going to see about one with 7.5 inch wheels. Likewise, there was no word on my request of a review of the “approved for a new PT place” so that too is still on hold. Timely apparently is not part of the concept of health care recovery.

Late-week mail brought two interesting items.

1. Back on Dec. 14 & 16 (Nancy is in the ICU) something was done by the cardiologists and described as “Subsequent Hospital” and billed for $120 each time.  A statement arrived dated Jan. 29 indicating the insurance would not pay for these two things and we should send $240.  John tried to call but got a phone-tree and so he wrote a letter stating his understanding of the insurer’s denial to pay for something “Subsequent Hospital” when the patient was still in the hospital.  Now we have a new statement.  This one seems to indicate that the bill was resubmitted to the insurer and they then paid $99.60 which settled the 12/14 debt of $120 but left the other untouched.  Again, there is no explanation of what these charges are for nor why if the insurer can get by with paying only $99.60 of $120 we still have to pay the full $120.  Also, were these things the same (the code of 99232 and description and cost is the same) and, if so, why didn’t the insurer pay both of them?  We are still left wondering what we are being asked to pay for and why.

2. In response to a self-serving survey form from the insurer about a Case Management nurse calling program (talk-talk-nurse program) John wrote a letter.  A couple of weeks ago we were called by a nurse from Spokane.  She was the expected replacement in October for a nurse that called occasionally from Kennewick who was booted out of the process by the insurer when she didn’t agree to move to Spokane. This new talk-talk-nurse, in a response to a question from John, referred us to our EOBS.  John slowed her down, stopped her, and had her back up and explain what our EOBS were.  When the company pays a bill, or doesn’t pay, they then send a printout to you with the title “Explanation of Benefits.”  This is an EOB. The talk-talk-nurse was surprised we didn’t have any EOBs.  Because we did not have any we had no idea about the cost of Nancy’s long hospital and rehabilitation stay.  The nurse promised to alert the company’s computers and have our EOBs printed and sent.  A packet of about 40 arrived on Saturday.   The $$ amounts are frightening.  We will summarize them for you later.  One item, the blood for the open heart surgery, exceeded $10,000.

Change of topic:  Saturday we did go to a retirement community and I walked in with John’s help, my pillow, and him with my violin .. and took a chair I could get up from.   We had a great turn-out and most everyone joined in singing many songs (the Irish ones, we provided words for).  We went home for an hour, and then off to the Children of Chernobyl fund raiser with a dinner, program and silent auction.  We got in at the front of the line with my walker and proceeded along the buffet with servers adding small dollops of things to my plate that was riding on the seat of the walker. I managed to eat a good meal, encountered many friends and enjoyed the program.

Now today, Sunday, is a non-event day.  We have been resting and doing computer email.  I was able to write a letter of recommendation for a former student from Thailand that I had in an Intro GIS (Geographic Information Systems) class two years ago.  He is applying to graduate school in Texas and California, and, via computer, I contacted both places today.  Until ex-students settle firmly into careers these sorts of chores crop up.

With no outings planned, after lunch we walked up the driveway and back, for my daily exercise. There were lots of small birds at the feeder including a small woodpecker, a Downy, we think. Tomorrow we’ll take the camera, walk farther, and see more.

Nancy

THUR-FRI — feeling better

Our life is slowly morphing into a different form.  Two things are driving this.  One is that I am feeling better.  I sleep a lot, but eat and do little, but I can and do – do things. The second thing is that I no longer have a schedule, what with my release from the rehab facility and the falling apart of the insurance supported out-patient rehabilitation.  So, as I gain the strength to do more – I don’t have to do anything.  How strange is that?  Yes, we have much to do but that isn’t the same as having to do something.

In keeping with this notion, today was a slow day until afternoon and evening.   We went to the Rehab center to play music (this is the place I spent so much time after Jan 20th and where they taught me to walk again.  It is always special to go back there to entertain.  Also, tonight was the second night of final presentations for Intermediate GIS. This too was a real treat.  I went because I could, not because I had to.

We will probably not have any news till Sunday, because nothing much is happening tomorrow, except for calls about insurance and maybe my walker will be delivered.  We’ll see.  Saturday will be so busy that we likely won’t get a blog written till Sunday.  We are going to play (music group, Kittitas Valley Fiddlers and Friends), at a retirement community, for their St. Patrick’s Day celebration.

Tentative play list (with Irish music mixed into our normal fare), is below:

1. WHEN IRISH EYES ARE SMILING; 2. IN THE GOOD OLD SUMMERTIME; 3. RAKES OF MALLOW, COTTON-EYED JOE, SKIP TO MY LOU; 4. MY WILD IRISH ROSE; 5. WILDWOOD FLOWER/BUFFALO GALS; 6. TUR-A-LUR-A-LURA (IRISH LULLIBY); 7. REDWING; 8. IRISH WASHERWOMAN; 9. MOLLY MALONE; 10. LEAVES; 11. JUST BECAUSE; 12. BELIEVE ME IF ALL THOSE ENDEARING YOUNG CHARMS; 13. GARY OWEN; 14. THE GIRL I LEFT BEHIND ME/DOWN BY THE RIVERSIDE; 15. YOU ARE MY SUNSHINE; 16. DANNY BOY.

Saturday night we are attending a Children of Chernobyl fund raiser with a dinner, program and silent auction.  http://www.chernobyl.org/pages/hosting.htm

Look for a return on Sunday.

Nancy

WEDNESDAY — back to school

[written Wed. evening]

I made scant progress getting approval for physical therapy.  Maybe tomorrow.  Maybe never.

Most of the rest of the day was uneventful and I didn’t do all the exercises I should have, but at 4:45 we drove to the University so that I could participate in the final presentations of Intermediate GIS.   I was scheduled to teach this class and had signed in many of the students from previous classes – before I went missing.  My replacement kindly invited me to return.  It was nice to be there and see a few familiar faces and to view their projects.

Although I can walk I didn’t want to sit in the classroom chairs as they would be hard for me to get up from, so, I followed my walker into the building and up the elevator.  I discovered two problems.  The seat of the walker is a fine idea poorly executed.  Comfortable it isn’t – even with a cushion.  And the second problem is that I no longer have the built-in padding I’d learned to live with. But this is a condition I do want to learn to live with so I’m not complaining – just stating a fact. Did I mention it was a 90 minute class?

It was also my first time back on campus since before Thanksgiving.

Nancy

TUESDAY — doubly amazing today

[Tues. was the 9th; this was posted on the 10th]

At noon we left for Yakima Regional Medical Center to visit the fine folks of the ICU.  I was simply amazed. As we entered the parking lot John spotted the nun that floats around the wings, wards, and operating rooms offering support to all.  She showed up in the operating room just before my open heart surgery to see me off.  I couldn’t get out and run so John had to maneuver around rows of cars, other visitors, and a few in wheelchairs and caught up with the lady just as she was crossing a grassy strip and leaving the grounds.

Then, back at the front entrance, John dropped  me off, unloaded the 4-wheeled walker, and left to park the car.  I made it through the large double automatic entry doors to the front desk and there found the young woman that delivered all the e-cards ya’all sent.  After she paged the ICU Director for me I turned and encountered 3 of my caretakers. One had just delivered a patient in a wheelchair to a family’s van; the other two were just passing through.

Before we made it to the elevator we met my early morning blood drawer – she showed up and poked a needle in me most mornings at 5:30 and so John had never met her.  We had an elevator cage to ourselves but when I stepped into the hall we got an echoing “hello” from way down the hall from the mom  of one of my former students.  She is the nutritionist that keep me fed via a tube for many days and then kept after food services to see that I was served proper meals.  At the phone outside ICU where one has to call to get “buzzed in” a male nurse was pushing through the doors on his way out. He had been with me for many 12 hour days when I was in my worst condition and was always cheerful and helpful.  He meant so much to John and me through the stay.

Finally we made it through the doors.  This is a difficult place to “just visit” because every bed is occupied by a very ill person and those on duty are committed to keeping them alive.  Knowing this, we were amazed to find folks squealing with glee to see me walking again.  I got many hugs, and even John did.  It was a special day.  The on-floor doctor was about the only person that did not know me and he seem amused at all the fuss.  Nurses came out of several of the rooms, gave me a hug, and quickly went back to their patients.  We stayed no more than 15 minutes because we didn’t want to take folks away from caring for those needing the care as I got while in there.

Back in the hall we headed for the elevator.  A person had just turned into a door way, backed up, and addressed me with —  “Nancy, is that you?”  Well, I was in street clothes, up right, and walking – none of which she had seen from me before – and it has been 6 weeks since I was there, and still she knew me.  We met another nurse outside the big doors with a freshly emptied wheelchair and a flipped over name tag so I couldn’t see her name.  She knew me though and gave me a hug, remarking how good it was to see me walking.

Off to grab a milkshake for me and a hamburger for John, and then on to my surgeon’s last check up on me after the Dec 29th surgery.  It was another great meeting when my progress was noted as “exceptional”.   I think the surgeon and the nurse are exceptional too, but they are professionally through with me.   They will now pass me back to the cardiologist – that visit is for April 14th.  After that I should be released to our family doctor (in Cle Elum), also known as my primary care provider.

Finally, we hit the road for home with no further events, except a stop to get some lemonade for me.  Arrived home just about 4:00 p.m.

There I had a phone call reminding me about a play date, so we left for town again at 6 for me to play music with The Connections.  It is mostly singing (& playing) religious music, plus sing-alongs by the residents with anthems from a book that has the words.  Tonight someone chose The Old Rugged Cross, and Leaning on the Everlasting Arms, and others.  I still do not have a singing voice, but the others did fine and have strong voices.  I played my violin on all songs.  It was great to be back.  We ended with Amazing Grace.

Nancy

MONDAY — Nancy says . . .

Today was a most frustrating day all day from the initial contact with my insurance company until 5:00 p.m. with another call to them to check on what supposedly had been changed on the referral to Physical Therapy.

I’m not allowed to use the words on the blog that emanated from my mouth several times today.  I’m sure this is a test of my stress level and I guess I passed it.  I’m still alive.  I do not know how truly “sick” people deal with the system.  It stinks big time.

Started at 8:00 a.m. with a call to my principal insurance provider about an incorrect facility in the referral for outpatient physical therapy.  I was put on hold for 20 minutes while the agent checked on it to be sure, after I asked if a new referral with the correct place needed to be sent from my doctor.  She returned to say that it was the only facility they would pay for because I was no longer a resident of the Rehab center.  She said my doctor could request a change but it would likely be denied and the appeal process would take 30 days.  I won’t need it after that, most likely.

Then I called my doctor’s nurse to explain what happened.  The accountant in charge of such things called my provider and put in a changed location for the provider.  I didn’t hear until 4:00 p.m. today that it was approved, but we have nothing in writing, and only an authorization number.  I called the insurance company again and gave them the authorization number and was told it was still to the old facility.  So back on the phone to my doctor’s office and the woman who had just called to report nothing had changed.  I wanted to know before I made another appointment at the Rehab center that I would have to break.  She called again and found the paperwork had apparently not been updated in all the right places.  Now we await verification.

Let’s see .. what else today?   I spent loads of time on the computer responding to folks all over.  John took the 3 horses to get them their flu shots.  The wind started blowing again, fiercely all day, but that did not affect his getting them into our trailer and taken down for their appointment.

Oh, another call this morning to the HEBB (health benefits for the state), satisfied them that our wedding date was indeed July 12, 1969.  I never heard the other date they had.  He actually said the correct one before I had to tell him.  Also they were asking for his and my Medicare cards, which we thought had been submitted with the application.  Sure enough, they were in the file.

Finally, I made another call to the provider of my 4-wheeled walker which may not get delivered until I no longer need it.    They didn’t have any in stock with 8” wheels but no one thought to call me since last Monday when I refused to accept the 5” wheeled version.  First, the person contacted today said 2-3 weeks and he’d have to order; then he found they had one with 7.5” wheels and perhaps I will get it as late as this week.  Wow.. more frustrations.

Did I say ?  Something is wrong with this system, and I wonder how others are treated.  Certainly they don’t get any better “customer” service than I have experienced.

Actually, there is good news with my eating ability.  I managed to eat ½ piece of pizza john made for himself for dinner.  That was before my bowl of soup.  So I’m improving a little.  Not fast enough for John’s wishes, however.

Nancy

[from JFH:  Have you ever noticed how things seem troubled when the wind blows?]

SUNDAY — recumb & fly at the same time

We started the morning filling the pill box, our second time.  We have seen pictures of folks going through this routine.  One pill is only once-a-week, on Monday morning, and likely only for a month or two.  Some I’ll take for the rest of my life.  Some are twice a day.  Some need to be broken in half because I don’t want to try and swallow the big ones whole.  Some are tiny.  One is dark green.  One is bright yellow. One is chewable.  One says don’t chew or break. Others have to take many more than we are currently dealing with.  Sorry folks!  And some folks have very expensive pills to pay for.  Sorry again, but these are relatively inexpensive.

Today brought long distance phone calls from family and friends. Otherwise, the day was uneventful. I made time for leg exercises and to eat 3 meals (I’m still a light eater), and take my pills.  Then we worked on some ‘Thank You’ stuff.

So while we were at home basically on cruise control a friend went flying for us – into the winds of an approaching storm. John wanted an air photo of the location of the weather station – it’s so new it wasn’t there when currently available photos were taken.  We asked and she said she had to fly anyway – but whether that “had to” was a required time-in-air thing or a psychological thing she didn’t say.  Late afternoon she called to say that despite getting jostled about some she got a batch of photos.  Now she will export to her computer, create a CD (because of large file sizes), then John will upload, resize, crop, and annotate.  Then one will become part of a public (viewable on-line) weather station atlas.  The technology is as amazing as that found in intensive care hospitals — even if what transpired today hasn’t saved my life I’m still impressed.

I’m still working through the batch of emails that have piled up since November, and responding to current ones.  John goes in and out but returning frequently to see what I need.  I’m spending time in a recliner chair and while I can get down and up, I can’t make the thing lay back in the recumbent position and a recliner isn’t much good if it won’t recline.  John is the power unit that makes the silly thing recumb.

Nancy

SATURDAY — frayed edges

If I was still healthy and teaching, today I would have participated in a GIS workshop with 9-12 year olds from around the region.  I and other CWU folks (including, in my case, students, graduates, and a mom of a graduate) host the visitors in a program called Expanding Your Horizons.  It is to introduce “science” to these kids by having them participate in what we do at the university.  It’s a great program that I have participated in for many years (even back to being involved at the University of Idaho before coming here in 1988.  That I choose to tell you about it says that I missed doing it.

It was a wonderful night and I slept well.  My appetite is not the best though, and that is causing concern, especially to John who, when he fixes it, has to eat what I don’t.

Breakfast and lunch were late, but John was working much of the day on the newsletter he puts together for our Kittitas Valley Trail Riders group.  Their meeting is next Thursday night at 7:00.

This was supposed to be a non-eventful day; however, we still had to deal with crazy paperwork things.  Problems of the day meant writing correspondence to insurance companies and  Friday’s mail brought additional misunderstandings from Medicare, the State Health Board, and my primary provider of insurance.  Referral for physical therapy was approved at the wrong facility.  The first time we can straighten this out will be Monday morning.  One agency has different dates for our marriage. How that happened we cannot understand.  We don’t know if we have to prove this or just state the date (July 12, 1969), which neither of us would have filled in wrong on a form.  What a mess is all the paperwork associated with health care. We sure hope someone thinks of a way to simplify this but that doesn’t seem likely.

John also had to go to town to mail the newsletters and while there picked up the correct Iron Supplement I was supposed to be taking. The system somehow spit out 27 mg rather than the 325 mg the doctor wanted me to have.  John caught the under dosage by comparing notes and pill bottles – explained his find to the doctor – and now it is fixed.  Moral: check everything.  So, I have had an under dose for the past week, for my anemia.  It’s no wonder I’m anemic with all the frequent tests and their demand for blood.  One young cute female tech told John it only looks like a lot but isn’t – and he believed her!

I continue to try to catch up on all the emails that came to me — and John saved. Thanks to all of you who were supportive all those many weeks and continue to call and check up on me.  While I was in Yakima and EBRG my cell phone worked well, but not now from home. The best telephone line to use now is the land line (509-925-3304) because our cell phones don’t work well in most of the house.  The nearest tower is about 12 miles away through most of the house and the trees to the south.  Our best reception is in the middle of our 7-acre pasture, but that is uncomfortable in bad weather and won’t do for me now.  Standing by the window in a storage room on the correct side of the house often works and often doesn’t.

After John bought his first cell phone in December he got a letter from AT&T from a vice president saying how much they loved him and how willing to serve him they were.  So he wrote back with a few comments, including a suggestion of a small hill in our neighborhood where they could place a tower.  The letter was returned as undeliverable.  Either the address or the man or both are bogus.  Go figure!

Carry on and we’ll talk soon.

Nancy

FRIDAY — close wouldn’t do

Today started with leaving at 9:50 a.m. for Cle Elum for a doctor’s visit.  We spent a long time with him, seeing a change in some meds, review of my bettering condition, and finally more blood drawn for lab work there.  We stopped afterwards at the accountant’s office for John to ask questions about Medicare A & B and changes, if any, to our relationship with the Clinic beginning April 1 when the group health policy via the University will no longer be our major provider.

My weight is holding steady and my body parts are healing nicely – they are all in good shape for the shape they are in.  Still, finding a good place to stick a needle to draw blood  took a bit of searching.  I’m thin where I haven’t been thin since the mid-60s.  My lower legs are attractively thin but not pretty – the peeling or scaly sun-damaged look is gone but the flesh tone is more red than bronze.  There are reasons for that and we’re working on them.

I might as well have been in a cave for the past three months, so, short term, I’m taking a mega dose of vitamin D, extra calcium, and iron.  Those are in addition to the several other things related to the heart issue.  We bought a 4-times by 7-day multi-chambered plastic pill box.  Now John and I can fill that once a week and cut down on sorting through the containers and the strange names.

This next isn’t part of my story but it almost caused me to pee my pants which I would have done 10 days ago – progress.

John wanted to find the waste treatment facility because they have recently installed a new set of instruments to report weather data.  An on-line atlas of weather stations is being completed by volunteers and this site, operational only since last September, has not yet been included.  The place, though easy to see, is behind a gate and the protocol is to have permission.  Getting permission was easy enough but took a little time.  Across the road but within sight was a store.  The lady inside didn’t know what to do but she did know whose land one had to cross to get to it.  She called Andy (names are changed to protect the … just kidding).  Andy said the gate appeared to be locked but usually wasn’t and, anyhow, the combination was WXYZ.  So the lady called the Chamber, which we visited by driving back across town and the ladies there said they didn’t control it but to see Bill in city hall.  Bill was eating lunch but Jane called Tom at the sewage treatment plant.  She held the phone up and Jane, Bill, Tom, and John discussed the issue.  It is a small town – John was the only stranger.

Soon we were headed back across town, opened the gate, drove in, closed the gate, signed in, took notes and pictures, back in the car to the gate, opened the gate, drove out, closed the gate, and headed to the nearest gas station/mini-mart because the Subaru and I were very thirsty.  Almost as soon as we passed the “leaving town” sign I knew I had to go.

John said if I started to do so in the car he would reach across, open the door, and roll me out.  He didn’t say he would stop first.  I’ve already told that I made it home.

Just one more little accomplishment on the road to recovery.

THURSDAY — in the range

Slept in again, but won’t get to tomorrow a.m. because I have an appointment in Cle Elum at 10:45 to see my regular doctor, or as current jargon has it – my primary care physician.  John and I both go to Cle Elum because when I first arrived in Ellensburg the office being touted as the place to go wanted $25 just to have me complete a survey and still would not commit to seeing me.  We like our doctor and so have never thought of switching.  We keep telling him not to retire.

Today, I played the fiddle at a skilled care facility called Royal Vista with the Kittitas Valley Fiddlers and Friends.  We had a lot of people there:   guitars, violins, accordion, flute, clarinet, bass fiddle, and banjo.  One of our group works at Royal Vista and she joined us with both a flute and a guitar but not at the same time.  We interspersed Irish music as we are practicing a few tunes we are not familiar with.  In a prior post I mentioned we have been asked to play at Briarwood, four days before the “wearing of the Green.”    [For fun:  http://www.history.com/topics/st-patricks-day-symbols-and-traditions ] We actually worked on Danny Boy twice because of a resident’s request.  It’s a favorite of many, but seems sad nonetheless, although the meaning and history are somewhat muddled: http://www.karlsenfineart.com/article-Ireland-song.htm

Afterwards I had to go to the Kittitas Valley Community Hospital for a blood draw (supposed to be a standing order) to check my INR for Coumadin dosage.  Of course, when I walked to the laboratory, they had no record of a request, so my wait time increased while they contacted my doctor.  Now I know what to say the next time.

Came on home and never took a nap, but we caught up on emails.  Also had a phone call from my doctor reporting on the blood draw showing an INR of 2.4 which is in the good range of 2.0 to 3.0 for a person taking an anticoagulant and so I continue the dosage of 2.5 mg of Coumadin.

[ This link explains about the test and INR:

http://en.wikipedia.org/wiki/Prothrombin_time

the next one explains about rat poison, er.,  Warfarin, and Coumadin:

http://en.wikipedia.org/wiki/Warfarin

and the history section in this is interesting.   JFH ]

John’s cooking supper (meat loaf) as I write this.

So for me, each day shows some improvement.  Hope you all are well.

Nancy

WEDNESDAY — start slowly, work hard

We had light rain all last night but lovely weather today, becoming sunny with billowing puffy white clouds around the blue sky.  The drippy and gray early sky made for a great morning to sleep in so I did.  Then I had a late breakfast, followed by pills, and then I worked on the laptop awhile still catching up on emails on a couple of accounts.  I still need to check all those messages saved by John in my absence.  Also, they keep coming in to nancyh@ellensburg.com — still the best contact for us.

We skipped lunch during the noon hour and headed to out-patient physical therapy for an hour.  Did well, happily.  I completed several walks around without a walker and then climbed high-riser stairs.  While resting from that, my therapist set up an obstacle course.  It had things to step over, then I had to walk on a foam cushion (springy) the size of a single bed, step up on a high stand, and then over another circular piece and finishing via a serpentine route through a set of cones.

After that I rested again to stabilize my heart beat, and then I went to a recumbent bike-like machine that includes both arm and leg (stepper) functions.  Legs first for 5 minutes and then another 5 with using my arms.  Finally, after resting from that, I did one more balance with my eyes closed and the therapist pushing my body in different directions and I had to regain (sustain) my balance.  I did well on that.  Then he had me raise one foot and stand only on one.  That is a bit harder, but I was doing better on the hard foam pad than I had last Friday on the hard floor.  So, I’m making improvement.  [Unlike some others there with whom improvement is barely noticable and, sadly, seems destined to continue as such.  JFH]

We came on home for a late lunch and spent the rest of the afternoon catching up with a backlog of things, especially online.  John was sorting through a stack of papers and found letters to each of us from Medicare that had arrived a few days before Thanksgiving.  They had a form they wanted filled out and returned within 10 days.  Oops! I called and worked through a phone-tree to a real person.  Then we answered the questions.

I’ve been getting an afternoon nap but it didn’t happen today with the late morning start and the trip to physical therapy.  We’ll have lights out early tonight.

Nancy