Single/Diabetes/No Children. Married/Diabetes/No Children

I should have titled this post: Single/Diabetes/ No children. Married/Diabetes/No Children.
Sometimes It's A Choice, Sometimes It Isn't - either way, don't be a jerk.
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Recently, I attended a friend's work function and was having a good time, meeting interesting people and enjoying my night out. 
Midway through the evening I was introduced to a friend's work acquaintance, who informed me (after quizzing me on my lack of children/single status,) and one too many drinks: Well... it�s your own fault you don�t have kids - you should have made it a priority in your early 20�s and gotten married - even if you got divorced, you'd still have a kid.
I wanted to tell her to fuck-off. 
Instead, I turned around and walked away.
Walking away doesn�t mean I wasn�t hurt or angry by what she said, because I most certainly was.
I could feel my face turning red and my eyes were starting to sting.
I walked away when all I wanted to do was rip her a new one,  because I refused to argue with someone who was at least two martinis in.
More import, I was attending a friend's work function where I was a guest  and I needed to be considerate of my friend and her employers. 

And I'm better than that - at least I'm better than the MartiniHarpy. 

And FTR, I always wanted kids - and I still do. 
And every day I struggle with the reality that it most likely isn't going to happen.
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Outside of the DOC, I am a single woman without children - to many I don�t count - or at least that�s how it feels.

And inside the DOC there are times when I still don�t count. 

I�ve gone to events where they have support groups for young people with diabetes, married people with diabetes, parents who have diabetes, parents whose kids have diabetes, grandparents whose grandkids have diabetes, pregnancy with diabetes, change of life with diabetes, seniors with diabetes - just to name a few. 
ALL, GREAT & MUCH NEEDED Diabetes SUPPORT GROUPS - And I'm so incredibly glad they exist.
 But when you�re single without children/married without children and not sure it�s ever going to happen/or it�s your choice for it to not happen, you don�t fit into any acknowledged or considered groups - things get awkward quick and feelings get hurt.

Bottom line: Everybody needs support. 

I don�t want society or my community to overlook us - I don�t want you to feel sorry for us either - but I do want you to consider us and remember us.

When a woman or a man is struggling with accepting not having children (because of life, diabetes, infertility issues, because it�s their choice,) it�s a very emotional issue that is always there - even when you think you�re �OK with it.� 

It only takes one insensitive remark to realize that �it� still hurts. 

Remarks like: 

What�s wrong with you? 

Is it because of your diabetes? 

Is it because you have diabetes complications? 

Who will take care of you when you�re old? 

Well... it�s your own fault you don�t have kids - you should have made it a priority in your early 20�s and gotten married - even if you'd divorced, you'd still have a kid.

Here�s the thing: Like living with diabetes, people will say whatever they want to you if you don�t have children. They feel it is their right and that they are doing you a favor - never once considering your feelings or circumstances. 

Or they ignore you. 
  
Or they brush you off by saying: You wouldn�t understand, you don�t have children.
And true or not, that statement cuts many of us like a knife - so don�t say it.

Personally, I always wanted children, I always thought I would have children - biologically, through adoption, or both. But I don�t have children, and I mightn't ever - and it's hard to to accept. 

And sometimes it makes me really sad. 

But not being a parent doesn't make me any less of a person.

That doesn�t mean I�m not maternal or a "kid person"( I am both,) and if I was neither, that doesn�t mean that it�s OK to overlook others like me, because it�s not.

Not being a parent doesn�t mean I�m stone hearted or invisible - though invisibility would be an awesome super power to have. 

Being "childless," doesn�t mean I haven�t loved, mentored, and been there for my nieces and nephews, my friends children, and children/teens I�ve become friends/mentors with because of diabetes. 
Now more than ever - I make it a point to be there for all of the above - to be an aunt for other peoples children - and to be there for others who struggle with the same issues I do - and many issues I don�t. My world isn't childless. 

If you're my friend, I'm there for you. 
If you have diabetes or someone you love has diabetes - I'm there for you, no matter the type. 

So why am I writing this? 
  1. I�ve struggled with these feelings for a long time
  2. I get emails on this subject from women in the DOC who don�t have children 
  3. I�m friends with many women and men in the DOC and outside the DOC who struggle with this issue
  4. **See above paragraph in blue. Then use it as a reminder that kindness, empathy, and compassion count. That what you say/how you say it matters, that opinions are like other parts of our anatomy, and that in the world and in the DOC, it does indeed take a village. 
And our village is made up of all types, each with a story to tell - and every member in our village needs support.

    How to get health insurance if you missed open enrollment

    If you missed open enrollment and didn't sign up for health insurance by Jan. 31, 2016, you may have to wait until next year's open enrollment period, unless you have a life event that makes you eligible for a special enrollment or you qualify for Apple Health (Medicaid).
    Such events include, but are not limited to:
    • Losing health insurance, including an employer plan or individual health plan
    • Losing Apple Health (Medicaid) because you no longer qualify
    • Giving birth to or adopting a child
    • Permanently moving to a new area where your current plan doesn't provide coverage
    • Your employer not paying your COBRA premiums on time
    • Your COBRA coverage ending or reaching the lifetime limit
    • Your dependent turning age 26 and losing their coverage on your employer plan
    • Getting married or entering into a domestic partnership
    • Getting divorced or ending a domestic partnership
    • Cancelling your Washington State Health Insurance Pool (WSHIP) coverage
    • Your health plan no longer being offered for sale in Washington state

    Most special enrollment periods are limited to 60 days from the qualifying event. Keep in mind that you won't qualify for special enrollment if you voluntarily cancel your health insurance or if your insurer cancels you because you didn't pay your premium.

    If you don't qualify for special enrollment, here's some resources that may help you afford medical care.

    Next year's open enrollment for individual and family coverage starts Nov. 1, 2016.

    Health Care and Ambulatory Care

    Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

    According to Modern Healthcare magazine, there is a new trend toward building medical facilities that focus on treating and releasing patients on an ambulatory basis. One of the big drivers of the trend toward bedless hospitals is cost. Under pressure from insurers and consumers, hospital systems have been shifting to lower-cost outpatient care, from which they generally earn higher margins than inpatient care.

    But a lot of this also is driven by consumer demand and the evolution of technology. Many health systems are forgoing traditional hospital expansions and building free-standing emergency centers away from main hospitals. More details about this topic are located at this site: http://www.modernhealthcare.com/article/20150912/MAGAZINE/309129973.

    Patients do not stay overnight in the facility, according to the Virginia Department of Health. The term "ambulatory care" encompasses a large variety of healthcare settings that include but are not limited to physician offices, urgent care centers, dialysis facilities, ambulatory surgical centers, cancer clinics, imaging centers, endoscopy clinics, public health clinics, and other types of outpatient clinics. Information and studies are available at this website: http://www.vdh.virginia.gov/epidemiology/surveillance/hai/ambulatory.htm.

    According to Healthcare Design, the prospect of this greatly expanded customer base, along with a focus on wellness and incentives to deliver care more efficiently, has U.S. hospitals and health systems looking at how and where they treat patients who will be more actively engaged in their own health and well-being.  Going to where the customer is�out in the community�is a primary strategy that has hospitals and health systems around the country busily forming networks of ambulatory care centers, physician practices, and urgent care centers.

    To attract patients who will have a number of choices for where they receive their healthcare, providers are also upgrading facilities to support a new model of delivery that will rely heavily on technology and teamwork. Details on this topic are located at this site: http://www.healthcaredesignmagazine.com/article/ambulatory-care-centers-make-their-move.

    A body of research dedicated to patient safety in ambulatory care has emerged over the past few years. These efforts have identified and characterized factors that influence safety in office practice, the types of errors commonly encountered in ambulatory care, and potential strategies for improving ambulatory safety, according to the Patient Safety Network.

    Ensuring patient safety outside of the hospital setting poses unique challenges for both providers and patients. A new model for patient safety in chronic disease management, modified from the original Chronic Care Model. This model broadly encompasses three concepts that influence safety in ambulatory care:
             The role of patient and caregiver behaviors
             The role of provider�patient interactions
             The role of the community and health system

    Part of the overview of ambulatory care includes the quality of patient safety both during and after treatment. Improving outpatient safety will require both structural reform of office practice functions as well as engagement of patients in their own safety. While Electronic Health Records (EHRs) hold great promise for reducing medication errors and tracking test results, these systems have yet to reach their full potential.

    Coordinating care between different physicians remains a significant challenge, especially if the doctors do not work in the same office or share the same medical record system. Efforts are being made to increase use of EHRs in ambulatory care, and physicians believe that use of EHRs leads to higher quality and improved safety. Tools to help track and improve patient quality of life and treatment options during and after release need continual review for efficacy and improvement.

    Patient engagement in outpatient safety involves two related concepts: first, educatingpatients about their illnesses and medications, using methods that require patients to demonstrate understanding (such as "teach-back"); and second, empoweringpatients and caregivers to act as a safety "double-check" by providing access to advice and test results and encouraging patients to ask questions about their care. Success has been achieved in this area for patients taking high-risk medications, even in patients with low health literacy at baseline. More detailed info is located at this website: https://psnet.ahrq.gov/primers/primer/16/patient-safety-in-ambulatory-care.

    According to the US Bureau of Labor Statistics, industries in the Ambulatory Health Care Services subsector provide health care services directly or indirectly to ambulatory patients and do not usually provide inpatient services. Health practitioners in this subsector provide outpatient services, with the facilities and equipment not usually being the most significant part of the production process. If  you are considering a career in ambulatory care, this site provides an in-depth overview of that trend in healthcare as well as the growth potential: http://www.bls.gov/iag/tgs/iag621.htm.

    Additionally, the Accreditation Association for Ambulatory Health Care (AAAHC) was founded in 1979 to: "encourage and assist ambulatory health care organizations to provide the highest achievable level of care for recipients in the most efficient and economically sound manner. The AAAHC accomplishes this by the operation of a peer-based assessment, consultation, education and accreditation program." If you are a patient in an ambulatory medical facility, you�ll want to know if that location and its staff are part of this organization. More information on the AAAHC is found at this website: http://www.aaahc.org/about/history/.

    Ambulatory care is getting more traction in the medical community due to changes in the overall healthcare environment. Ease of access, quality of care, and cost are contributing factors to its growth in locations and popularity. Although not a complete answer to all medical needs, ambulatory care helps cut the expense of unnecessary inpatient medical care.  


    Until next time.

    Orange Glucose Tabs

    For some reason when it comes to Orange Glucose Tabs - I'm just not that into them. Nope, I�m more of a Cherry, Mixed Berries or Tropical Fruit glucose tab, kind of gal. 
    FTR, I�ve never actually tried Grape or Green Apple flavored glucose tabs, but I think I could deal with the Green Apple. 
    With that being said, I have two opened bottles of Orange Glucose Tabs (one in my car and one on my nightstand,)  and I'm not about to waste them. 
    The other day before I left the the parking garage, I did what I always do before driving, and checked my blood sugar. I was 93  - with 1.10 units of active insulin. 
    So I did what I had to do and ate 4 glucose tabs immediately, washed them down with 1/2 a 20 ounce sports bottle filled with water, thought happy thoughts and stuck the key in my ignition. 
    An hour and a half later I pulled into my driveway with a blood sugar of 140 - and all was right in my world.
    In the past, I�ve treated my lows with things that I have truly detested, because that�s all I had on hand. I�ve treated with spoonfuls of both pure molasses and rice syrup - fine for cooking, gross IMO, for eating raw. 
    I�ve forced disgusting jelly filled cardboard cookies down my throat,  because at the time I was dropping fast and they were right in front of me at the dessert table. 
    And once back in college when my friend and I visited her grandmother, I treated a low blood sugar with prune juice, because that�s the only juice that was in the fridge at the time. 
    That was.... interesting. 


    In the grand scheme of things, Orange Glucose Tabs are not a problem or a deal breaker. They are a solution to a potential low blood sugar or treating an actual low blood sugar - and I am a lucky duck, indeed. 

    Health Care and Rosacea

    One of the most embarrassing health maladies is the skin rash that appears on your face and is known as Rosacea. Many people suffer from redness and the bumps that accompany it. This dermatologic condition is uncomfortable and irritating to deal with if you�ve ever had it or know someone who does. Because of its red-faced, acne-like effects on personal appearance, however, it can cause significant psychological, social and occupational problems if left untreated.

    According to the National Rosacea Society (NRS), this common but poorly understood disorder of the facial skin that is estimated to affect well over 16 million Americans -- and most of them don't know it. In fact, while rosacea is becoming increasingly widespread as the populous baby boom generation enters the most susceptible ages, a NRS survey found that 95 percent of rosacea patients had known little or nothing about its signs and symptoms prior to their diagnosis. Much more information is located at this website: http://www.rosacea.org/ .

    Rosacea often begins with a tendency to blush or flush more easily than other people, according to the American Academy of Dermatology (AAD). The redness can slowly spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be red all the time. With time, people who have rosacea often see permanent redness in the center of their face.

    Rosacea can cause more than redness. There are so many signs and symptoms that rosacea has four subtypes:
             Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels.
             Papulopustular rosacea: Redness, swelling, and acne-like breakouts.
             Phymatous rosacea: Skin thickens and has a bumpy texture.
             Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.  
    .
    Most people, according to the AAD, who get rosacea are:
             Between 30 and 50 years of age.
             Fair-skinned, and often have blonde hair and blue eyes.
             From Celtic or Scandinavian ancestry.
             Likely to have someone in their family tree with rosacea or severe acne.
             Likely to have had lots of acne � or acne cysts and/or nodules.

    Women are a bit more likely than men to get rosacea, according to the AAD. Women, however, are not as likely as men to get severe rosacea. Some people are more likely to get rosacea, but anyone can get this skin disease. People of all colors get rosacea. Children get rosacea. Much more detailed material is located at this site: https://www.aad.org/public/diseases/acne-and-rosacea/rosacea.

    Doctors do not know the exact cause of rosacea but believe that some people may inherit a tendency to develop the disorder. People who blush frequently may be more likely to develop rosacea. Some researchers believe that rosacea is a disorder where blood vessels dilate too easily, resulting in flushing and redness, according to the National Institutes for Health (NIH).

    Factors that cause rosacea to flare up in one person may have no effect on another person. Although the following factors have not been well-researched, some people claim that one or more of them have aggravated their rosacea: heat (including hot baths), strenuous exercise, sunlight, wind, very cold temperatures, hot or spicy foods and drinks, alcohol consumption, menopause, emotional stress, long-term use of topical steroids on the face, and bacteria.

    The NIH reports that although there is no cure for rosacea, it can be treated and controlled. A dermatologist (a medical doctor who specializes in diseases of the skin) usually treats rosacea. The goals of treatment are to control the condition and improve the appearance of the patient�s skin. It may take several weeks or months of treatment before a person notices an improvement of the skin.

    Some doctors will prescribe a topical antibiotic, which is applied directly to the affected skin. For people with more severe cases, doctors often prescribe an oral (taken by mouth) antibiotic. The papules and pustules symptomatic of rosacea may respond quickly to treatment, but the redness and flushing are less likely to improve. Recently, a topical gel was approved that can ease the redness associated with rosacea. A significant amount of info on this malady is found at this website: http://www.niams.nih.gov/Health_Info/Rosacea/.

    What causes one person�s rosacea to flare may not trigger a flare-up for another person. This is why dermatologists recommend that patients with rosacea learn what triggers their flare-ups. Avoiding these triggers can reduce flare-ups. Follow a rosacea skin-care plan. Skin care plays an important role in keeping rosacea under control. Many skin care products are too harsh. This can make rosacea worse. More information about treatment is found at this site: http://rosacea-treatment.org/what-is-rosacea/.

    According to the Mayo Clinic, although there's no cure for rosacea, treatments can control and reduce the signs and symptoms. Most often this requires a combination of prescription treatments and certain lifestyle changes on your part. Prescription drugs used for rosacea may include:

             Antibiotics. The antibiotics used for rosacea also have anti-inflammation effects. They may come in the form of creams, gels or lotions to spread on the affected skin or in pills that you swallow. Antibiotic pills are generally more effective in the short term, but they can also cause more side effects.

             Acne drugs. If antibiotics don't work, your doctor might suggest trying isotretinoin (Amnesteem, Claravis, others). This powerful drug is most commonly used for severe cystic acne, but it also often helps clear up acne-like lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects.

    The duration of your treatment depends on the type and severity of your symptoms, but typically you'll notice an improvement within one to two months. Because symptoms may recur if you stop taking medications, long-term regular treatment is often necessary. Enlarged blood vessels, some redness and changes due to rhinophyma often become permanent. In these cases, surgical methods, such as laser surgery and electrosurgery, may reduce the visibility of blood vessels, remove tissue buildup around your nose and generally improve your appearance. Much more information can be found at this site: http://www.mayoclinic.org/diseases-conditions/rosacea/basics/definition/con-20014478.

    Rosacea can affect the eyes, according to the American Osteopathic College of Dermatology (AOCD). How severely rosacea affects the eye is not related to how severe the facial rosacea is. Symptoms that suggest ocular (eye) rosacea include a feeling of dryness and grittiness in the eyes and inflamed bumps (chalazions) on the lids. The eyelashes may develop scales and crusts, often misdiagnosed as seborrheic dermatitis. 

    A persistent burning feeling, red eyes and light sensitivity suggest the more severe problem of rosacea keratitis. This rare complication can lead to with blindness without treatment. All patients with significant symptoms of ocular rosacea should be seen by an ophthalmologist for a thorough examination.

    The most effective treatments are oral tetracycline and similar antibiotics and low-dose oral Accutane. Mild cases can be controlled by gels or creams such a Metrogel, Cleocin-T, Azelex, or sulfa. Often, full doses of pills are needed only for a short while. Maintenance treatment can be intermittent doses or just topical creams. For rosacea of the eyes warm compresses to lids (hot towel) for 5 minutes twice a day, liquefies the oil in the gland ducts-can be very helpful.

    Makeup can be an effective aid in rosacea, will not make it worse, and even some male rosacea sufferers use a bit. A slightly more olive color than usual helps to hide the redness. For some women, hormone replacement pills may be given to reduce menopausal hot flashes. Many advances have been made in recent years. Regular visits are advised for most rosacea patients. More details on rosacea are located here: http://www.aocd.org/?page=Rosacea.

    Rosacea is treatable. If you are symptomatic, see your doctor or a health care professional. Your care as well as your wellbeing are at stake. More severe cases can be dangerous to your overall health if left untreated. Although rosacea is embarrassing to most people, it can be managed.


    Until next time. 

    Diabetes MacGyverism #601: The Art & Convenience Of The Origami Pre-Filled Insulin Reservoir ~


    Living with diabetes forces us to become creative and embrace our inner Diabetes MacGyver whenever and wherever we need to. Like Last week, when I was getting ready to go to a fundraiser and heard the all to familiar, 20 unit countdown alarm on my pump. Sometimes (and even though I hate, hate, hate to do it,) I find that I have to switch out my insulin reservoir when it�s hovering around 20 units or less because that particular reservoir seems to have lost its efficiency. 
    Other times, my reservoir works perfectly - and I can go wear it until it�s down to 5 units.
    FTR: I�ve talked to many people who wear different pumps re: this issue - this is not a  specific pump brand issue.
    Sidebar: If I do have to switch it out around 20 units - I save the reservoir, calculate the bolus on my pump and manually inject the units because throwing out insulin is not an option.
    The reservoir that was in my pump happened to be one of those amazing �good to the last drop,� reservoirs and my blood sugars were not only behaving, they were positively angelic - which of course meant my blood sugars could go all demonic at anytime, because diabetes. 
    I was going out for dinner, I didn�t know what type of food was being served and I�d rather be safe than sorry when it comes to having enough insulin on my person and in my pump. 
    I went to the fridge, grabbed my open bottle of insulin (which was on it�s last stand,) and filled a reservoir with the entire contents of the bottle- just over a hundred units of short acting insulin.
     Then I placed the reservoir back in its half opened wrapper....
    and proceeded to origami the pre-filled reservoir all neat and pretty, and secured it with a fabric hair tie.
    Then I placed the freshly filled reservoir in the small zippered compartment inside my handbag and said freshly reservoir was locked, ready to be loaded and now safe from handbag debris - and I was proud that I once again embraced my inner Diabetes MacGyver. 
    I do this particular origami reservoir trick when I don�t feel like taking an entire bottle of insulin out with me - which is a lot and stems from me once losing 3/4 filled bottle of insulin over decade ago that had some how fallen out of my handbag and still haunts me to this day. 
    If for some reason I needed to manually inject - I can still do that with the pre-filled reservoir, and if God forbid I lost it - I wouldn�t be freaking out as much as if I�d lost an entire bottle of insulin. 
    I also do this trick when I�m flying. And YES, I keep my insulin bottles(s) in my carry-on bag AT ALL TIMES, but I find keeping an origami filled reservoir in small ziplock bag and tucked in a zippered compartment in said carry-on, makes it much easier to access and saves time when I�m uncomfortably crammed in a small space with limited elbow and leg room, and flying in a narrow, metal, germ filled tube of strangers. 
    If you feel like sharing one of your Diabetes MacGyverisms, that would be great, because I'm all for learning something new and useful to add to my Diabetes MacGyver repertoire! 

    Who determines how much my totaled car is worth?


    We hear from many consumers who are trying to resolve their auto total loss claims with their own insurer or another insurer. A total loss is when a vehicle is in a collision and the insurance company determines it would cost more than the vehicle is worth to repair it, so they �total� it.

    Once an insurer declares a vehicle a total loss, they owe you the retail market value of your car, plus sales tax. But how do you know if the amount the insurer offers you is a reasonable estimate of the retail market value? Many consumers don�t know they have the right to, and should, ask the insurance company for a total loss valuation report, which shows the comparable auto data the insurer used to calculate your vehicle�s value. Most insurance companies don�t automatically provide the report to consumers and there�s no requirement that they provide it without being asked.

    Insurers can either give you cash for your vehicle�s retail value or offer to replace your vehicle with a comparable vehicle in your area.

    Read more about auto total loss on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

    Of Eye Exam Stress & Spreading The Word About Spare A Rose~


    I dragged my feet getting to my eye appointment this morning - and that�s nothing new. 
    I am perpetually late for my eye exams because of the stress that those exams cause me.
    Since the whole one in a million thing that forever changed the way I see the world, I get incredibly stressed out when it comes eye exams. 
    And FTR, I HATE BEING LATE for anything because ironically, beings late stresses me out.
    The practice I go to is large, has offices in three states, and the staff at my office understands the stress I feel (and every other patient they see,) and are always incredibly kind. 
     I drove faster than I should have and I was still 20 minutes late - and they still welcomed me with smiles. 
    My eye pressure was great, digital scans looked good, and my Doctor was all sorts of happy and positive. 
    At the end of the appointment when he asked me if I had anything I wanted to discuss. 
    I mentioned that it was #SpareARose time again and that Valentines Day was next week, and that for the cost of one red rose, (actually, it's cheaper than a red rose -at least where I live,)  they could save a life of a child with diabetes in need of insulin.

    Sidebar: For the past two years, the Spare A Rose Campaign always falls during one of my eye exams. 

    Dr Eye: Break it down for me again, Kelly - I know we participated last year.  
    I reminded them that if they went to SpareARose.Org, they would find that the cost of one red rose ($5,) would provide a bottle of insulin (a 1 month supply,) for a child in need.
    So even if my Doctor bought his wife 11 roses - he could provide the 12th in the form of insulin - and printout a Certificate(s) of Awesome ~
     Dr Eye: And if I donated $10? 
    Me: That would provide 2 bottles of insulin, and $15 dollars would provide 3 bottles of insulin, etc.

    The Doctor was enthusiastic about Spare A Rose and told me he was in.

    His Physician�s Assistant chimed in and said something along the lines of: This is really a great cause  - I�m writing the website down and will go over it with the staff - I�ll also email the link out to my address book. 
    Me: Thanks - that would be great - a little goes along way and $5 really does save a life. 
    And as the PA walked me out, she told me that I could count on her to participate and help spread the word and closed with, �it�s such a terrific cause, how could I not?�

    I thanked her again - for everything  - and vowed that I would be on time for my next appointment. 
    She laughed and told me not to stress.

    And as I sit here at my computer, still anime eyed and looking like I�m hopped up on the goofballs, I am thankful for all sorts of things, and feel happy and blessed to be able to pay it forward via #SpareARose. 

    Health Care and Medical Bankruptcy

    Medical bills can pile up quickly if you have a catastrophic health care event, such as a heart attack, stroke, major accident, or need an organ transplant. Even the costs for common procedures can add up fast, especially if you�re uninsured or underinsured. These days, due to the changes in the health insurance game, many people have switched to a high deductible plan that requires first dollar payment until you reach your deductible. If that amount is high, like $5,000 or $10,000 or higher, you may struggle to make those payments to the medical facility.

    What if you�re diagnosed with a form of cancer or another debilitating disease? What if you�re in a car accident or get hurt in some type of major injury requiring a trip to the hospital emergency room. Those dollars escalate in a hurry, and you are left to deal with the financial burden of payment to the hospital and attending medical staff, and some of those may be out of network for your insurance plan if you have one in place.

    Regardless of percentages and political leanings, some people are going to have to use up all their savings to pay off their medical bills. Many will be unable to pay for basic necessities like rent, food and utilities. Some of them have children. A lot of them even have medical insurance. To save money, some will cut corners with their treatments, not taking their prescription drugs as indicated, skipping doses, taking less medicine than prescribed or delaying a refill.

    Here are a few interesting stats about medical bankrutpcy:
    --�Medical Bills Are the Biggest Cause of U.S. Bankruptcies� � 2013 NerdWallet Health study.
    -- �56M Americans under age 65 will have trouble paying medical bills [in 2013]� � 2013 NerdWallet Health study.
    -- �The percentage of people under age 65 in families having problems paying medical bills decreased from 21.7 percent in the first six months of 2011 to 20.3 percent in the first six months of 2012� � 2013 Center for Disease Control study.

    Although passage of the Affordable Care Act has shown that there is a slow decline in personal bankruptcies due to medical debt, many families are still struggling to afford to pay their bills from medical care. It�s understandable that so many Americans are being compelled to think about bankruptcy and medical bills as a potential answer to severe medical debt. But unfortunately, the downsides to bankruptcy are so severe and end up affecting individuals for years beyond making the decision to file.

    According to USA Today, But the Affordable Care Act hasn't eliminated the problem. In 2013, medical debt was the largest cause of personal bankruptcy � 1.7 million people lived in households experiencing bankruptcy because of health costs. Many states haven't expanded Medicaid and even those with insurance can rack up big bills, a problem exacerbated by the growing number of plans with high deductibles.

    The health law brought regulations that limited for the first time the cost-sharing in plans. An individual plan sold on an exchange can't include out-of-pocket costs greater than $6,600. In practice, the average deductible, or portion a consumer must pay before insurance kicks in, varies based on how expensive a plan is. But the regulation still only applies to providers and specialists specified by the plan as "in-network." The narrower the network, the more vulnerable consumers are to incurring medical debt by visiting unapproved doctors or hospitals.

    Some numbers suggest a decline in people facing medical debt. About 64 million Americans struggled to pay medical bills in 2014, according to a survey by the Commonwealth Fund � that's a drop of about 10 million since 2012. Experts have celebrated the decline but cautioned that high-deductible insurance plans could put a damper on those gains.  Of the 64 million the authors said were struggling to pay for care, 38 million, or 59%, were insured the whole year.

    There's been some improvement: The same report found 29% of the insured had medical debt or difficulty with medical bills, a drop from 33% in 2012 � while the pool of insured adults grows larger. But analysts caution that absent a significant change in industry or policy, even this group will likely continue to face the prospect of medical debt. More details can be found at this website:  http://www.usatoday.com/story/news/2015/02/01/consumers-still-struggling-with-medical-debt/22587749/#.

    The New York Times reported earlier this year that among those who reported having problems paying their bills despite having insurance, 63 percent said they used up all or most of their savings; 42 percent took on an extra job or more work hours; 14 percent moved or took in roommates; and 11 percent turned to charity. In partnership with the Kaiser Family Foundation, the study found that roughly 20 percent of people under age 65 with health insurance reported having problems paying their medical bills over the last year. By comparison, 53 percent of people without insurance said the same.

    Unlike other polls, which have focused on the ways that insurance affects health care, the new Times-Kaiser survey explored the effects of medical bills on people�s daily lives well beyond the medical system. We found that medical bills don�t just keep people from filling prescriptions and scheduling visits to the doctor. They can also prompt deep financial and personal sacrifices, affecting their housing, employment, credit and daily lives.

     People without health insurance, of course, are more vulnerable to medical bills than those with health coverage. The study found that the people most likely to report bill problems were uninsured, poor or disabled. However, the majority of people struggling with bills are insured. Of the people in the survey reporting difficulty with their medical bills, 34 percent lacked health insurance, 39 percent had insurance through work, 14 percent were covered through public programs and 7 percent had purchased their own health plans. More info is located at this website: http://www.nytimes.com/2016/01/06/upshot/lost-jobs-houses-savings-even-insured-often-face-crushing-medical-debt.html?_r=0.

    According to the American Journal of Medicine, out-of-pocket medical costs averaged $17,943 for all medically bankrupt families: $26,971 for uninsured patients, $17,749 for those with private insurance at the outset, $14,633 for those with Medicaid, $12,021 for those with Medicare, and $6545 for those with Veterans Affairs/military coverage. For patients who initially had private coverage but lost it, the family�s out-of-pocket expenses averaged $22,568.

    Among common diagnoses, non-stroke neurologic illnesses such as multiple sclerosis were associated with the highest out-of-pocket expenditures (mean $34,167), followed by diabetes ($26,971), injuries ($25,096), stroke ($23,380), mental illnesses ($23,178), and heart disease ($21,955).

    Hospital bills were the largest single out-of-pocket expense for 48.0% of patients, prescription drugs for 18.6%, doctors� bills for 15.1%, and premiums for 4.1%. The remainder cited expenses such as medical equipment and nursing homes. While hospital costs loomed largest for all diagnostic groups, for about one third of patients with pulmonary, cardiac, or psychiatric illnesses, prescription drugs were the largest expense.

    The AJM interviews indicated the severity of job problems caused by illness. In 37.9% of patients� families, someone had lost or quit a job because of the medical event; 24.4% had been fired, and 37.1% subsequently regained employment. In 19.9% of families suffering a job loss, the job loser was a caregiver. More details are found here: http://amjmed.org/under-aca-medical-bankruptcy-continues/ 

    Due to higher medical expenses and fluctuations in insurance coverage, many families are forced to max out credit cards and chip away at their savings or retirement accounts, and once these funds have been wiped out, the only option left may be bankruptcy. An illness or medical emergency shouldn�t have to become a financial nightmare or lead to so many financial sacrifices. 

    With the right resources and information, there are ways you can deal with your medical bills effectively to prevent yourself from falling into medical bankruptcy, according to YouCaring.com. They offer some great tips how to deal with medical bankruptcy at their website: https://www.youcaring.com/blog/2016/how-to-avoid-medical-bankruptcy.

    Bankruptcy was designed to resolve debt and get people that second chance they deserve. Ask a local bankruptcy lawyer if filing Chapter 7 or Chapter 13 bankruptcy could eliminate your debts. An attorney that is versed in bankruptcy laws would be able to provide counsel to you based on your personal situation. Be careful in your choice, and do your research before you choose a law firm that insists they can help alleviate your financial pain and suffering due to an overdose of medical bills. The quick fix may not always be the best answer for you. Everyone�s situation is different based on the amount they owe and their personal financial situation.


    Until next time.

    Not sure if we can help you with an insurance problem? Ask us anyway

    Recently, a Washington consumer posted a story on Facebook about her brother, who was on the waiting list for a heart transplant but was being put on hold because of �paperwork� issues with the insurance company. She asked her Facebook friends to file a complaint with the Insurance Commissioner, resulting in more than 40 complaints to our office.

    One of our consumer advocates looked into the complaint and determined that the insurance provider was Apple Health, our state�s Medicaid program that is overseen by the Washington state Health Care Authority. In other words, we have no authority over the plan. But that didn�t deter our consumer advocate from trying to help.

    First, we reached out to the Facebook user and asked her to let people know that they should contact the Health Care Authority with complaints about Apple Health. Then our consumer advocates reached out to the Health Care Authority to make sure this complaint was received and addressed as a high priority. The next day, we got an email from the concerned sister that said, �Thank you so much for your response and directing my complaint to the proper department. Today (my brother) got his insurance straightened out and is back at A1 status. Thanks again!�

    We want people to be aware of this for two reasons: First, helping consumers access insurance is one of our missions, even if it�s not something we regulate. So even if you�re not sure if we can help you, reach out to us anyway. If we can�t help, chances are that we know someone who can. Second, social media is a powerful tool and is a way to quickly escalate a consumer problem. We have a robust social media presence, so don�t be afraid to reach out to us on Facebook or Twitter. We will make sure to get you to the right person.

    Here�s how you can reach us:

    Things Have To Change: The High Cost Of Insulin & Other Drugs - It's Not Only An Eli Lilly Issue - It's A Pharma Issue.

    This post was supposed to go up late last week, but between life and real people  sick hitting hard towards the end of the week, it didn't happen.
     I've thought long and hard the subject matter. Like every person living with diabetes, the cost of diabetes medications and supplies is so very personal to me,  not to mention on a professional level. 
    So many emotions and feelings and so much to consider - and if you live with a chronic illness you never stop thinking about the cost of staying alive.
    On Saturday I found out that a family friend who didn't have diabetes, owned her home outright and had a good job and health insurance, lost her home because insurance wouldn't cover her anti rejection medications after a transplant (because they were considers experimental and her only choice,) and she was forced to pay cash. 
    On Sunday I read a Facebook post showing a friend from high school's pharmacy bill that totaled almost $600 for his monthly medications because of his new plan's extremely high deductible.

    I'm not against pharma or profit, but things have to change. 
    ###### 
    Like many people, when I first read the article in Marketwatch quoting Lilly CEO John Lechleiter's n the Eli Lilly quarterly phone call, I was mad at John Lechleiter�s responses and reasoning behind the continual price increases.
    �Asked on the earnings call about the current debate over drug pricing, John Lechleiter, chief executive officer, said higher prices make sense because it helps the company fund the research needed to find better treatment methods or a cure. 
    Yes, they (drugs) can be expensive, but disease is a lot more expensive,� and added, �In 2016, we aim to continue revenue growth, margin expansion and value creation for our shareholders, all while sustaining a flow of innovative medicines from our pipeline to improve people's lives."

    FTR: I know that Lilly is a for profit company and I'm not against dividends or profits. 
    People are angry and rightly so with the wording and the reasoning, and I know their stock price has taken a hit since the MarketWatch article.

    This kind of thinking brakes my heart and infuriates me on so many levels. 
    First: his statement made no sense and in my opinion, show a lack of empathy for people living with diabetes. 
    Yes, living with diabetes IS incredibly expensive, but continually marking up insulin prices steadily over the years to the point that the cost of for single bottle of Humalog sans insurance is $472 ( and it's been off patent for years,) is a big contributor to the high cost of living with diabetes and nobody can tell me that it isn't. 
    FTR: The exorbitant cost of insulin is not only an issue with Lilly because it most certainly is not. This reasoning runs across the board and in tandem with other Pharma companies including Sanofi and Nova Nordisk when it comes to insulin pricing. 
    When one company raises the price on a particular drug, in this case insulin, the competition immediately follows suit - matching the increase dollar per dollar and within days.
    It's called Shadow Pricing. This article from Bloomberg (and be sure to listen to the audio - VERY important,) explains it drug per drug and dollar per dollar. 

    Insurance companies are also to blame for the price increases because they want their cut of the insulin take. 
    Many in pharma point to high deductibles adding to the cost and those in the insurance arena say that prices would go down if insulin was available in generic form, adding to the cost of brand insulin with insurance and damn near bankruptcy for those without insurance.

    The continual increase in insulin prices have gone for years - well before deductibles went up and well before Obamacare came to be. 

    And as far as taking/developing a generic form of insulin, in theory that sounds great. 
    But in actually, I don�t want to take a bio similar generic insulin (and if said insulin were actually available,) because I believe that like certain generic time released drugs used to treat depression - bio similar generic insulins won't work as well - because molecularly, they wouldn't be able to work as well.
    I think if generic forms of a drug will never be an option because of bio similar specifics,  Congress needs to step up to the plate and pass laws requiring insurance companies to make allowances for bio-similar brands that don�t punish the patient in the form of high cost for needing to take name brand drugs. 

    Insulin is not a luxury drug, we take insulin because it keeps us alive as people with t1 - and for many with t2 and LADA - it keeps them healthy. 
    Without insulin people with t1 diabetes would be dead.
    Dirapram is not a luxury drug either. 
    Anti rejection drugs aren't luxury drugs either.
    Most drugs that insurance pays for or a portion of, aren't a luxury - they are a necessity in order for the people prescribed them to live.

    Insulin has been on the market for over 90+ years and Eli Lilly's was basically given the North American patent rights so insulin could be mass produced and save lives, asap.

    On a very personal level, I feel like Lilly has been part of my life forever because it has. Regular and NPH were my first insulins and I�ve been relying on insulin to survive every day for 38.3 years. 
    Not only has it been a part of my life, but my two t1 aunts started insulin therapy as children in the late 1930�s and 1940�s. My t1 father began insulin therapy in the early 1950s, and my two oldest t1 sisters started insulin therapy in the 1960s. Eli Lilly kept them alive. Eli Lilly is one my dad was able to live to have six children, instead of dying from diabetes in his early 30's as a young father of two.

    I�ve toured Lilly�s facilities, I�ve met the dedicated Lilly scientists who work diligently to make smarter insulins and I know people who work at Lilly and I know Lilly does good things for people with diabetes - and I'm glad and grateful. 

    I know how insulin is made and it�s precarious and incredibly precise process - it�s not something that is done in a few minutes or a few days. 
    I also know that if there�s one misstep in the insulin making process, be it cellular or in the bottling process - they have to start from scratch - and it�s not cheap. 
    I absolutely get that.
    But I also know the cost of a bottle of insulin far out ways the cost to produce a bottle of insulin without insurance - and in many cases with, and things have to change. 

    I reached out across the internet to one of my contacts at Lilly and let her know that people with diabetes weren�t happy - and we set up a time to chat.
    We talked about the frustration of the cost, I mentioned how people with diabetes found no comfort in John�s words or other companies continually increasing the price of  insulins - including insulins that are off patent, like Humalog
    There was sympathy on the other end of the line and at one point I was asked what I would do to decrease costs. 
    After the obvious - not charging a $472 for an off patent insulin... or an insulin on patent. 
    I suggested that pharma needs to step up to the plate and start to police themselves regarding the continual price increases for insulin and other drugs, because soon, (and thanks to Pharma bro and asshat Martin Shkreli for putting the international spotlight on Pharma companies exponentially increasing the price of drugs, both old and new,) the government will do it for them - and they will make up for lost time because that's how elections are won.
     Increasing the price of drugs to the point of where it has people with diabetes and other illnesses choosing between mortgage payments and life saving medications is now a point of politics and is mentioned in speech after speech. 

    If pharma doesn�t start policing themselves and act with empathy now, the government will not only do it for them - but in my opinion, will punish the industry for many reasons.
    1. Putting the shareholders before the patients
    2. making up for lost time
    3. Lawmakers and the FDA deflecting the blame from themselves for not setting limits on the price of drugs years ago.

    I don�t claim to have all the answers, nor do I wish to demonize pharma companies or the majority of the people who work for them  - sorry, Martin Shkreli is the devil. 

    Things MUST change so people living with diabetes and other chronic illnesses can afford the drugs that keep them alive, while shareholders still receive their dividends - there has to be a middle ground where shareholders are happy and patients can afford the drugs that keep them alive - all of our lives and livelihoods depend on it

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