Friday, April 04, 2014

negotiated settlement

So after all this time, the nurse-manager of my endo's office finally called.  The MRI was denied, of course. I imagine the doctor throwing up her hands in frustrations (she's wonderfully expressive). The insurance company would approve a whole body scan now, but not Thyrogen, so I'd have to withdraw from my thyroid meds for 6 weeks or so.  The last time I did that, I was post-thyroidectomy, and it took me literally months to recover.  Plus, we have summer plans made and paid for, and a low-iodine diet and a nuclear scan would seriously get in the way.

I was able to move my next scan to October, though.  That means I can do the LID and get the scan during my fall break instead of over Christmas, because having to do the low-iodine diet over the holidays is just cruel.

It was hard to think about this situation again after shelving it for so many weeks.  It was hard to decide not to go ahead with the scan, too -- what if something horrible is happening and kills me because I decided to put off the scan for 6 months?  I scoff ("die-with", not "die-of" disease, remember) but at the same time, it bothers me.

In the rest of my life, things proceed apace.  I love my job, which of course has its blips but overall is so vastly improved over my last job that comparisons fail.  Apples, oranges, etc.  The kids' spring recital is this weekend, and they're all very well-prepared so I'm actually looking forward to it.   Next week, my students have their state standardized tests, so I basically have a week of baby-sitting which will give me a change to relax.  Even though I love my job, I'm still burnt out.  It's just too much, what with the vocabulary, website updates, notes, powerpoints, labs, handouts, etc.  But then after the tests, there are 2 weeks of instruction, then review for finals, finals week, and promotion week, then summer!

Thursday, March 27, 2014

forget it, for now

Insurance company denied the appeal.  Endo decided, OK, we'll settle for an MRI.  The MRI was also denied.  Whatever.  I am not apathetic to this situation but realize I have zero power so I'm not going to spin my wheels about it.

Plans are made for the summer, and I've found a master's degree program that I like, so I'll be looking into that, to start in the fall.  I'm looking forward to taking the summer off, well and truly.

Next year's school year will be busy, as my team has all agreed to take on another class (7 classes each! no prep hour!).  We'll get more pay and supposedly more help in the way of aides, but we'll see how that actually shakes out.   I'm looking forward to just having to update lesson plans and materials rather than creating them from scratch.  It means I'll get my weekends back  -- so of course, I'm going to use them going back to school myself.  I should be able to manage one class at a time without feeling overwhelmed.

(Later) I decided it wouldn't hurt to send an email to my doctors at MD Anderson and see if they wouldn't mind documenting that I don't need whole body scans anymore. They could refuse, and it would not harm my situation, but if they come through with documentation, that will help me to appeal MedSolutions' stupid decisions.

The MDA website has all my medical records from my visits there.  It's funny what I remember and what I did not -- for example, I don't remember my Tg being over 5 when I was there in August of 2006, and the endo there telling me it could be micro-metastatic disease.  My Tg dropped like a rock over the following months until it finally became undetectable, until it became detectable again. I remember so clearly Dr. C saying he got it all.... clearly, we remember only what we want to remember, even if we think we're remembering everything.


Tuesday, March 04, 2014

laissez les bon temps...

Today was a day of many whacks, if not to the head exactly, at least to the pysche.

In chronological order, then: One of my dear students very casually mentioned that many students really don't like me.  While I would love to be able to say it doesn't bother me, it does... and of course I would love to explore the reasons and discount whatever tween-age logic is dominating their thoughts, but the reality is, I have a job to do, and doing my job is exactly the kind of thing that some 7th- and 8th-graders are going to resent.

Some short but indeterminate amount of time later, I was meeting with another teacher and recapping events from our recent science fair, which was mostly horrible but ended on a somewhat high note.  The downer from this meeting was learning that many of the elementary school parents think, "We had all this new science fair stuff because we have a new science teacher," me.  Reality: we had all this new, and barely workable, science fair stuff because our district imposed it on us.  I had a chance to look over the packet briefly, but not to give any input, and can honestly say it had nothing to do with me: don't shoot the messenger.

Of course, I'm left with ~320 assessments to do, so if I spent only a minute on each it would still take me more than 5 hours, but given the rubrics I'm supposed to be using, it will be more like 5 minutes each, and I am (not so strangely) resistant to spending a  huge chunk of my upcoming spring break on grading science fair projects.  I need to come up with a solution, but I'm not sure what it will be.

Today was a testing day for my students, and my 8th graders continue to underperform, with a dismal 45% passing rate on a unit so easy they really should have been able to pass in their sleep.

And last but not least, when I finally left campus at about 5PM, I had a voicemail from my endo: my appeal for the PET scan was denied.  No other information, just that, and if I had any questions, please call  What are the next steps?  I have to call to find out.

Today is Mardi Gras.  I defrosted jambalaya for dinner and mixed up some Kentucky mules when I got home, and then moved on to Pancake's Big Day White.  Some part of me warns against self-medicating with alcohol, but it's not as if I'm actually drunk... it just took the edge off.  And now I'll go finish grading my tests and putting those grades in, and preparing lesson materials for tomorrow, because even though I have about 30 hours of grading hanging over my head, curriculum instruction continues.  Friday can't come soon enough.



Friday, February 28, 2014

we'll just pretend that never happened, then

Various calls to insurance companies and doctor's offices finally resulted in a call back telling me that I should have an answer by February 24, but that it was likely to be no.  February 24 came and went and I still have no news.

The suits at the insurance company are unlikely to approve my PET scan because I have not had a negative RAI whole body scan in several years.  It doesn't matter to them that my WBS are always negative unless I get a treatment (much, much larger) dose, and that my tumor marker is already half of what it was when I had my recurrence.

So I'm just going on the assumption that they'll refuse it, and when December rolls around again, I'll have the WBS (which will be negative) so they'll approve the PET scan.  Next year.  This is, after all, a slow-growing, die-with-not-die-from (usually) kind of cancer I'm dealing with.

I would feel a lot more relaxed about this if I didn't have an on-and-off pain by my collar bone, right by my scar.  It's probably an adhesion but it hurts, when it hurts, and it's different.  Still,  pain has nothing to do with metastases.  Usually.

In other news,  I am completely buried in work because we are in the midst of the science fair, which looks amazing -- the entire school's projects set up in the gym.  So much work on display, and much to be proud of (and quite a bit to inspire all the students who were lacking in motivation this year, for next year.)  On top of that, student-led conferences kept me at school until 7PM tonight, but DH grilled steaks for dinner so the evening was actually delightful.

Tomorrow DS1 heads down to Tuscon with his class for a field trip to U of A; he has to be at school at 6:30AM.  Last night was his performance in Antigone, a truly stellar production by his drama class. Sometime I'll find time to grade the 160-odd display boards and reports my students have turned in... spring break is only a week away and God knows I don't want to spend my entire break grading.

At the rate I'm losing time, I won't even notice until it's half over.

Sunday, February 16, 2014

adventures in health insurance

When I got my new job in July, I got new insurance.  For the first time in my adult life, I am not covered by Blue Cross/Blue Shield.  While I know a few people who have had major problems with BC/BS, they never hassled me, even when I went to M. D. Anderson Cancer Center in Houston for treatment of my first recurrence.

But now I don't have BC/BS anymore, and I'm finding out what life is like under Cigna.  Up until now, there haven't been any issues.  Thursday afternoon I got a call from AZ Molecular Imaging, the facility where I'm supposed to get my PET/CT scan, telling me that my pre-certification for the scan was denied.

Friday I spent about an hour on the phone, first with Cigna proper, who had no record of any request. Then back to AZMI, who told me that Cigna contracts out these approvals to a company called Med Solutions.  So then I had to call Med Solutions to find out why the authorization was denied. That's 3 sentences, but it took about 45 minutes.

Med Solutions has a checklist for cases like mine, and since the "negative RAI whole body scan" box could not be checked, they denied the authorization.  They don't know my history of perpetually negative scans, even when I had my recurrence in 2006, even though my doctor included her notes on my case.   My endo doesn't order WBS for me anymore since they are expensive and disruptive, requiring 2 weeks on the low-iodine diet, and if they're always going to be negative anyway, what would be the point? 

The next step is, my endo's office will appeal.  The insurance company has 30 days to respond, which I fully expect them to take, so I'll have this scan pending for another month, at least. If I'm lucky, I'll be able to make some plans for the short-term future by mid-April.

So, for now, I'm just trying to keep this whole "rising tumor marker, need a scan, can't get a scan yet" situation compartmentalized so it doesn't make me crazy.  Some days I'm more successful at that than others.



Tuesday, February 04, 2014

recurrence, again, eventually

I had my endo appointment last week.  As I feared, my Tg (tumor marker) went up again,  to 5.5.  That persistent node in my right cervical chain is still persisting, but doesn't look suspicious.  I think it's basically the last functioning node in my right cervical chain, so it gets enlarged trying to do the job of all the nodes that were removed in earlier surgeries.  It is, in a sense, a superhero node working permanent overtime.  Of course, it could also be a cancerous node, but even after all these years it doesn't ever present as one.

The tech also imaged a new, totally innocent looking smaller node on my left side.  Weird.

Since I had an MRI last year, we're going with a PET scan this year.  I intensely dislike these annual reminders that I have cancer, but we can't find it.  Nothing we can do, just have to wait and see if it ever gets big enough to treat.

I am slightly depressed over this.  I want to stay in bed and do nothing, but that's really not an option, so I end up not doing some things and choosing to do other, more random tasks, and just being extremely grumpy all the time, which is exhausting.

I don't like not knowing what's going to happen, and for now, I don't even know when the PET scan will be, so I don't know when I'll know what's going on with me.  I feel fine, mostly, just a little congested and chronically tired, but both are mostly caused by lack of sleep.

Here's the thing: there is literally nothing I can do about this.  I  dislike having so little control. I fully expect a negative scan, and to keep on getting negative scans, for at least another 10 years or so.  Eventually, something may light up and we'll have to go cut it out, but I don't see that happening any time soon. 

And on that happy note, it's off to bed.



Sunday, January 05, 2014

other people's photos

Mom was in much better spirits this morning, a good rest and a little ibuprofen helped tremendously.   My sister was there, and that helped most of all.  My level of upset yesterday was only a half-notch below 'panic', and that was worse than useless.  I'll have to try to moderate those responses when things like this happen again, because I know they will.

Now that I can think again, there were a couple of things I wished I had taken photos of when I was in Falmouth, but I didn't get a chance.  So, with appreciation, here are some other people's photos.

 I. Unconventional Christmas Trees on Main St.
 Main St in Falmouth is, as my sister perfectly put it, right out of Currier & Ives.  They wrap pine boughs around the street lamps and put wreaths around the lamps themselves, and the effect is incredibly charming.  The Village Green is a little wonderland of set-pieces, including Santa and his reindeer, a creche, a choir, a train, and a half-dozen other lighted displays.  But the most captivating decorations on Main St were these two trees, which were simply stunning.  Words don't do them justice, and the photo below only gives you an idea of what they are like.  Simply amazing.  I can't imagine how long it tool to wrap these two trees so thoroughly!  They are as I imagine Faerie trees would be.


II. Nature's Thermometers
My Mom doesn't have any rhododendrons of her own (the one I planted in the past few years didn't make it through the fall), but there are several in her neighborhood.  I love how they droop and curl up when it's cold out.  When DD and I got up on Wednesday morning, they were rolled up tight, but by the time we were leaving (and thus, driving by and able to take a picture or two), it had warmed up enough that they were all flattened out again.  I'd say I was disappointed but not really -- who needs to be out in sub-freezing temperatures? This adaptive behavior is one reason I love rhododendrons.  Among the others?  They are evergreen, they love the shade, and their flowers are gorgeous.  Now if I could just manage to plant one so it will survive at Mom's...