Pages

Tuesday, September 1, 2015

Diabetes Social Media Burnout Day

Burnout. I've been there. In fact I just returned from about a two month hiatus from blogging. But my burnout was more self-imposed, independent from the happenings of the DOC. I've been fortunate that I haven't encountered any hurtful, argumentative, or mean comments directed at me or what I wrote. That doesn't mean they don't exist in the DOC, but I've never felt personally attacked. But I'm sure that has to do with my own level of involvement. The more you put yourself out there, the more you dive into the DOC, the more vulnerable that makes you.

With anything on the internet, if you search hard enough, you'll find information, opinions, and support for both sides of any issue. So while you'll find people who have the opposite viewpoint as you, you'll also find like-minded people. Everyone has opinions and everyone is not going to agree. But by putting your thoughts out into the vastness of the Internet, you have to be prepared for and strong enough to handle people who disagree with you. But that doesn't mean your thoughts are not still valuable to others.

When you reach a state of burnout for whatever reason, instead of thinking about why you stopped, remember why you started.

Why did you start blogging? Why did you first become active in the DOC? What was and is your purpose for being here?

I started blogging because I wanted to hold myself accountable. But more than that, I wanted to share my unique experiences with a shared community. I wanted to educate those who don't know what it's like to live with T1D. I wanted to connect with others. I wanted to be inspired and to inspire others. I started sharing my story so that others could see bits of their own life in my posts, and for me to find pieces of myself in theirs. I started so that together we would strengthen one another, support one another, and together help each other through the ups and downs. 

Sometimes I get so caught up in the day to day that I forget why I started. Sometimes when I don't get comments on or offline about my blog, my purpose starts to drift away. Comments aren't the reason why I blog, but they are good fuel. All it takes is one person telling me that they love reading my blog or commenting that I've inspired them to make some difficult changes that keeps me going. The hard part is remembering that even if no one tells me these things, there are lots of people who read my blog without commenting that still find value. 

So from this social media burnout day, I've decided that the next time that I feel like I need to step-back and take a break, that I instead will write 3 nice comments on someone else's blog. Because those comments might just be enough to help that person through their burnout.

Monday, August 31, 2015

Insurance frustrations

During the time that I was on my parent's insurance, I was pretty much removed from the entire billing and insurance process. I was lucky in that my dad took care of the paperwork and the phone calls. I lived in my nice little naive bubble where all I worried about was going to my appointments, ordering my supplies, and taking care of my health. I didn't worry if a certain device or procedure was covered by my insurance, everything just magically worked out. Oh what wonderful times those were.

Then I got a job and my beautiful bubble popped.

I know that I'm very fortunate that my job even offers insurance and that it has pretty good coverage. However, if you ever want to simultaneously raise your blood pressure while feeling like you want to bang your head against the wall, try calling your insurance company to argue a claim. 

Take a few weeks ago as an example:

It all started with an email notification that I got that a new claim was available to view online. It was about my most recent routine appointment with my endocrinologist. I followed the link to an EOB. I feel like I should be able to say that I speak "Insurance" since it often feels like I'm reading a foreign language while trying to decipher what is being said. I noticed that the entire bill was higher than the past 2 appointments. Scanning the paper, I found a tiny number leading to the appendix with the following text:

Our payment policy limits the number of times this procedure is allowed and that limit has been met.

Ummm huh??? I went back up to see what billing code this was referring to, thinking perhaps it was some unnecessary test or blood work that I may have unintentionally duplicated. 

GLUC MONITOR, CONT,  PHYS I&R 95251

Like I said, a foreign language. But whatever it was, I was being charged the entire amount of $120. But if it has to do with glucose monitoring, it probably is necessary. I called my insurance company. The woman explained that the billing code that the limit was referring to was 95251 (side note: I did some googling and this particular billing code can range from $35-$350!). With some simple googling I determined this billing code was referring to the following:

95251: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report.

Essentially it's downloading my CGM and interpreting the numbers. At this point I was starting to get both confused and angry. I checked the EOB. I was also charged for an Office Visit so it's not like it was the only thing they were billing for. But the part I was getting angry about was that downloading and interpreting my numbers is really all my appointments are since checking my a1c and blood work happens at an entirely different time and facility. 

I called back the insurance company, asking what the limit of visits are for that code: 2. I attempted to calmly explain that the standard of care for a type 1 diabetic is seeing their endo every 3 months, so 4 visits a year. How could they only be covering half of them?!?!

The insurance woman explained that I'm going to need my doctor to call the patient management team at the insurance company and get the additional visits pre-certified ahead of time for them to be covered and additionally to appeal the charges from the last visit.

Ugh. Really?? 

At this point I'm just annoyed. But I'm more annoyed at the idea of having to pay so I call the health system starting with their billing department. After explaining the issue, I was told that the doctor will have to call and that it's something that the billing department can't take care of. Okay fine.

I call the doctor, the receptionists says I should talk to billing. No, billing said to talk to the doctor. At this point I'm ready to hit my head against the wall. My doctor is not available so I leave a message explaining the entire issue. The receptionists assures me she will deliver the message. 

A week goes by. No response.

I call back. The person on the phone looks at my file. He tells me that it looks like it was seen and sent to billing. The person on the phone offers to have someone from billing follow up with me. Yes please.

I wait.

A few days pass and I finally get a message from someone from Billing. "I see the message in your file," she says. "It looks like they're talking with someone at the insurance company. I can call you back when I know more."

Ughhhh.

A few more days. "It looks like they are taking off the charge for your most recent appointment." "That's great," I respond "but what about the future appointments? I have one coming up in a few weeks. Are they going to charge me again? The whole point was to get them pre-certified." "Oh ummm, well I can tell them to look at the September appointment. You'll have to call ahead of time for each appointment and tell them to contact the insurance company."

Are you frickin kidding me?!?! Why is this so circular?!?! I thanked her, not sure exactly what was accomplished besides not being charged for the most recent visit. However, the fact that it took almost 2 weeks does not give me much hope if this is the process I'm going to have to go through twice a year, every year!

The funny thing is, I would consider this a successful encounter compared to some of the other arguments and conversations I've had with the insurance company. But it's amazing to me the number of phone calls it takes to accomplish even the simplest task. Working in the health care field and having a masters in public health, I consider myself to be more knowledgeable than perhaps the average person in navigating the health care system. And if I found this process to be arduous, I can't imagine that many people with much less knowledge are being successful in their efforts. 

If anything, I've become a much more assertive person through this process, but really I just wish that the whole system was fairer and simpler for everyone. 




Tuesday, August 25, 2015

No excuses

Ugh it's been too long! I feel terrible for neglecting you for so long! A lot has happened that I want to tell you about, and I will...eventually. But I feel like I need to rewind to the first notable thing that happened since my last post.

About 2 months ago I had an appointment with my endocrinologist. This is not unusual, I have one every 3 months. But I knew this appointment would be different.

When I was younger, I used to say on the day of my endo appointment, "I'm going to the doctor to get yelled at today." Now my doctor wouldn't really yell at me, but I knew that I wasn't doing that well and that they would in a nice and appropriate way, tell me to get my shit together.

I approached this appointment with a similar attitude. I was dreading the appointment. The previous three months were just not great. My numbers were all over the place, but mostly too high. Trust me I had my excuses ready...sicknesses, bent infusion sets, a bout of insomnia. But deep down I knew those really weren't the reasons for three months of high numbers. It was more like apathy, laziness, and lack of discipline. I knew that really I only had myself to blame.

I got my A1c back. It was high. The highest its been in 3 years. In fact it was the same number that prompted me to start this blog in the first place and make some major changes.

I wasn't surprised, but I was disheartened and disappointed.

My endo looked at me. "So what happened?"

My excuses were on the tip of my tongue. But I held back. I knew I had to take responsibility for my actions (and lack there of) and for the consequences of them.

"It's just been a bad three months."

She nodded. "Do you want to make some adjustments or do you want to try again?"

"I'll try again."

It wasn't a good appointment. But I have to admit, in many ways I feel proud.

I'm proud of myself for not making excuses, I'm proud of myself for taking responsibility for my health. I'm proud of myself for only momentarily becoming discouraged, and instead vowing to "try again" and do better next time. I'm not proud of my A1c, but I know I'll get back to what I was.

I found a quote online, "Every set back is a set up for a come back." Well watch out, because I'm making a hell of a come back!

Tuesday, June 16, 2015

Thursday, June 11, 2015

Explanations

I've learned over the years that I'm someone that craves explanations. I want things to make sense, I want to know why something may have happened. I need logic.

Granted, I don't always need to know exactly why something happened, sometimes we just don't know, but I find myself still wanting to make an educated guess. And when there is a disconnect between what happens and a proposed explanation, I get frustrated. "That's impossible! There's no way that what you just said could have caused that." Those close to me are all too familiar with my need for logical conclusions, and my irritated response when I'm not satisfied with the answer. 

But I know we don't always get answers. Why do bad things happen to good people? Life is random, mysterious, and unpredictable at times, it's part of what makes it both devastating and exhilarating. In many cases I'm perfectly content with the explanation that sometimes things happen that there are no logical explanations for, it's the universe at work.

My diabetes falls somewhere in the middle.

Too many times I've found myself frustrated with a high or low blood sugar, not understanding why it happened when it seemed that I did everything "right" to avoid it. I rack my brain trying to come up with a logical explanation, but sometimes there are just too many variables to consider. Was I really that far off in my carb counting? Is this a delayed effect from the exercise I did earlier? Is something wrong with the insulin? Is there a bend in the tubing? Is the insulin not being absorbed at the site? Am I getting sick? Am I stressed? So much to consider, I can't always draw a one-to-one connection for a high or low.

Last week I was shocked to see a blood sugar that was over 500. A rare event, my first thought was why?? Well really it was "Oh f*ck" but then why did this happen?!? I ran through the list in my head as I tested my ketones, gave myself a shot, and changed my infusion set.

You don't always get answers for everything in life. I've learned to accept it and move on with the information that is available.

But sometimes, when you're lucky, you get exactly the explanation you need.

bent infusion set cannula blocking insulin from being delivered

Saturday, May 16, 2015

Diabetes Blog Week Day 6- Favorites

Diabetes Blog Week

I have a lot of posts that I like, but this one from January 2013 might just be my favorite. It attempts to explain the complicated relationship that I have with sugar...



If my relationship with Sugar were on Facebook, it would say "It's Complicated".

I'm not sure when Sugar and I first met, it seems like we've known each other forever. I hadn't really paid too much attention to him when I was young, but I was always happy when he made an appearance. Sugar, or Sug for short, didn't really come around too often. I think he was intimidated by my dentist dad and health conscious mom. He did however show up at birthday parties, holidays, and other special occasions. He and I always had a good time together, especially eating candy at the movies, cotton candy at the fair, and ice cream in the summer.

When I was diagnosed with type 1 diabetes, my relationship with Sugar began to change, and has been evolving ever since. I think that was the first time I really took notice of him. He had that certain mix of sweet, yet dangerous. He'd make you feel good, but left you wanting more.

I couldn't stay away.

Sug and I began to spend a lot of time together. When we weren't together, he was constantly on my mind. There seemed to be two sides to him. On the one hand, he could always make me feel better when I was feeling low. I needed him, and he was always there for me. But on the other hand, when I spent too much time with him, he'd make me feel sick.

I know that Sug can be trouble. In the past few years he's started showing up at the bar where I'd be hanging out with my friends."He's coming over," my friends would tell me, "and he looks good!" He would approach the table with an invitation that is hard to refuse. Tripple sec, sour, orange juice, and cranberry juice. He was coming on strong tonight! He'd clearly already worked his magic on my friends, sometimes he could be so sweet that it was hard to say no to him. I eyed my other options, water, beer, vodka soda, but his smell was intoxicating. The thing about Sug is that you always have a good time with him, it isn't until later that you begin to regret your decisions.

We often get into arguments. I tell him that I don't want to hang out all the time with him and his friend Cal O'Rie, that the two of them are trouble when they are together. He accuses me of cheating on him with Complex Carbs, even though he knows it's not the same. In the end though, we always apologize, we both know that we need each other.

My friends and family often try to tell me that he is bad for me. “Look at how he makes you feel, your relationship with him just isn’t healthy." Sometimes they are right, he is bad for me. But even though our relationship is complicated, sometimes they seem so hypocritical. “How can you say that to me? I know you guys hung out last weekend. I saw the candy wrappers in the trash!” I would say. When they would tell me that I was better off without him, it just made me want to prove them wrong. "You don't know what you are talking about, we just shared that piece of cake together and everything is fine!" At least I wanted it to be. It truly is a roller coaster when we are together, but we face those highs and lows together.

I know my friends and family just want what’s best for me, but they don’t know him the way I do! Sure Sug comes over to their houses disguised as a tub of ice cream or chocolate, and they say he helps them through their hard times and pain, but it's not the same. No one can make me feel better the way he does, no one can take away my lows as fast, no one knows what it's like to need Sugar that badly sometimes.

It's hard to say if Sugar and I should be together or not. I know that he helps me, but he has the potential to hurt me as well. We have one of those relationships that other people might not understand and may not always be perfect, but in the end, it's pretty sweet.


This post is part of Diabetes Blog Week. Today's topic: If you have been blogging for a while, what is your favorite sentence or blogpost that you have ever written?  Is it diabetes related or just life related?  

Friday, May 15, 2015

2015 Diabetes Blog Week Day 5- Diabetes Personification Wildcard

Diabetes Blog Week

Even though this topic was my idea, I'm still struggling to imagine what my diabetes would look or sound like if it were a person. Let me tell you a little about my diabetes and then maybe by the end, we can piece together what it looks like.

My diabetes is for the most more rational than emotional. It's responses can usually be calculated. You do A, then B will happen. I don't see my diabetes as an empathetic, understanding friend that when you're running late and stressed, is caring and compassionate and will give you good blood sugars. No, my diabetes doesn't pick up on cues like that, it will send you low at the most inopportune time, maybe for it's own entertainment.

My diabetes is unpredictable and can kind of be a dick sometimes. Everything will be going great and we'll be getting along fine when out of the blue he'll send me shooting high or drop me really low. WTF diabetes! We can't be friends if you do stuff like that.

But that's the thing, we aren't friends. You choose your friends. I didn't choose my diabetes, we're stuck together. We're more like family along those lines. And since I know he's not going anywhere, we try to make the best of our situation.

So if we're family, and I think I've somewhere in the post decided my diabetes is male, is he an older or a younger brother?

Like a younger sibling, my diabetes sometimes tests my limits and my patience with his daily annoyances. But with some teaching and guidance, he can be pretty well behaved. But like an older sibling, my diabetes can be manipulative. He has a way of getting me to do what he wants. When he needs something, he makes himself known and heard, but otherwise he seems content to let me live my life. I know that the often shitty way he makes me feel is his way of protecting me, his signals and alarms are a way to watch over me so that something worse doesn't happen. Like an older sibling, he also ends up teaching me through our interactions.

So I guess my diabetes is somewhat like a protective yet annoying older brother. However I can't say that I have love for my diabetes the way that I love my sibling. In fact, I'm pretty sure I'd be quite happy if I never saw my diabetes ever again. It's a complicated relationship, we'll leave it at that.


This post is part of Diabetes Blog Week. The Wildcard topic: If you could personify your diabetes or that of your loved one, what would it be like?  What would it look like, what would it say, what kind of personality would it have?  Use your imagination and feel free to use images, drawings, words, music, etc. to describe it.