Foot Update #2

MRI results:

Multilevel mild to moderate degenerative changes are present within the lumbar spine, with level by level analysis outlined above.

MRI Lumbar Spine Noncontrast:

HISTORY:
Radiculopathy

COMPARISON:
Radiographs are referenced

FINDINGS:
Conus medullaris is normal in morphology and terminates at the T12-L1 level.
Lumbar spine vertebral body heights are preserved. No acute marrow edema.
There are small, chronic Schmorl’s nodes at the inferior L1 and L4 endplates.
Mild accentuation of lower lumbar lordosis, without evidence of significant subluxation.

L1-2:Right paracentral disc protrusion slightly effaces the ventral aspect of the traversing right L2 nerve root. Otherwise, no significant stenosis.

L2-3:No significant stenosis

L3-4:Disc bulge without significant stenosis.

L4-5:Disc bulge and small superimposed central protrusion. Mild ventral thecal sac effacement, as well as mild bilateral subarticular stenosis, with crowding of bilateral traversing L5 nerve roots. There is bilateral facet hypertrophy and moderate right,
mild/moderate left foraminal stenosis.

L5-S1:Broad-based disc bulge. There is a right paracentral annular fissure. Bilateral facet hypertrophy and mild bilateral foraminal stenosis.

DH found this Cleveland Clinic webpage about that last thing:

So… that is exactly my symptom.  From what I understand (but I could be wrong), the foraminal stenosis affects a nerve in my back which affects a nerve in my foot which makes the left side of my left foot itch/tingle.

I’ve been referred to a pain specialist, but the earliest available was late May.  So far the inserts don’t seem to be doing anything, but it’s supposed to take 6-8 weeks for them to work.

Update on my itchy foot

After being blown off by my “put lotion on it” GP, I went to a podiatrist.

The podiatrist narrowed it down to something bothering my plantar nerve and took x-rays in case it’s a back nerve issue (apparently back problems cause foot nerve problems?).  He prescribed some shoe inserts.  He was really nice and explained all the things it could be and said I definitely wasn’t crazy and lots of times people are afraid of seeming crazy so they put off nerve problems until they’re really far gone.  He didn’t think it was likely that a lipoma was pressing against a nerve, but did think it sounded like I might have a back problem since the foot itching happens when my knee is bent, so had me get x-rays.

The x-rays came back with a “back nerve issue”– no details in the email, just that I’m going to need an MRI.  I’ve been referred for that and to a “pain specialist” though do I have pain?  Does my back always hurt and I’m just used to it?  Is itching pain?

Based on the email (the MRI/pain management), DH thinks it’s a disc problem.  I assume one of these days the actual information will get uploaded to the test results section of my online portal.

Update:  The radiology xray report got uploaded.
Minimal lumbar spondylosis with no acute osseous abnormality identified.
FINDINGS: 5 lumbar type vertebra are present. No evidence of fracture or acute subluxation is identified. Minimal degenerative disc disease and facet joint osteoarthritis. Vertebral body heights and spinal alignment maintained.

MRI is scheduled for Saturday.

#middleage

Ask the grumpies: High deductible health care hacks?

First Gen American asks:

Hacks on saving money on healthcare expenses with high deductible plans. I know sometimes you can price compare on big expenses like MRIs. (For example, I bought a cheap blood sugar monitor for $20 on Amazon when I was worried about being pre diabetic. Much cheaper than a doctors appt. I would have gone if the readings were high.)

We’ve got nothing on this one.  (We don’t have high deductible plans…)

Here’s a link for people who can’t afford health insurance, which has some of the same ideas re: shopping around.   This one has some other stuff, like double checking your bills or considering medical tourism.  Stuff to do with your HSA if not using it for medical expenses.

Grumpy Nation:  Any better suggestions for FGA?

 

DC2 got a booster!

We were finally able to get DC2 a Covid booster.  So far no side effects other than taking a nap the next day.

Try 1 (when they were first available):  We made an appointment on the Walgreens website.  Vaccines.gov said they had shots for 5-11 year olds.  We got there and they said shots for 5-11 year olds hadn’t been approved yet, which was not true.  The pharmacy tech allowed it might have been a Walgreens policy.  A few days later vaccines.gov took Walgreens off their site for the 5-11 year old shot and Walgreens put a note announcing they didn’t have vaccines for ages 5-11 yet.

Try 2:  https://www.vaccines.gov/ said that a Walmart 1.5 hours away had shots for ages 5-11 available.  Walmart’s website said they didn’t.  We didn’t call.  Later these would no longer be listed on vaccines.gov.

Try 3:  https://www.vaccines.gov/ said a local grocery store in the next town had shots for ages 5-11 available (though the one in our town did not).  The grocery store chain website agreed but didn’t have an online appointment option.  DH called just to be sure since it’s a 20+ min drive.  They said they did not and had not and did not know when they would get any in.  These would also be removed from vaccins.gov.

Tries 4-x:  Just lots of monitoring vaccines.gov and finding nothing in a two hour drive.  An occasional call to CVS and regular checking of Walgreens.  Nothing.

Try 5:  https://www.vaccines.gov/ said that the other grocery store chain in our town had vaccines at the store on my way to work.  The grocery store’s website disagreed and said it didn’t.  DH decided to call anyway.  The person on the phone said, yes, they did have the new Covid vaccine for kids age 5-11 and just to come on in, no need for an appointment (which is good, since the website wouldn’t let us make one for DC2).  There was no line.  No wait.  Very peaceful compared to Walgreens.  DC2 got the booster and we came home.

Moral:  The only way to know for sure is to call.  

Have you and yours been successful in hunting down a new Covid booster?

RBOC

• Tracking food again and I definitely have a problem with some cheeses causing indigestion.  Spanakopita is problematic which sucks because our grocery store has a good one in the freezer section.  It didn’t used to be problematic but what can you do?
• DC1 has mild scoliosis but has apparently stopped growing (they can tell because some part of the hip bone has fused?).  So there will be a 6 month check-up and x-ray but if there are no changes, then nothing will be done.  Apparently if it had been a 25-50 degree angle and zie had still been growing, then zie would have had to wear a brace for at least 13 hours per day until zie stopped growing.  What this means is that DC1 is slightly tilted (not really noticeably though) and needs to start doing exercises to increase lower back strength to prevent future back pain that may or may not occur.  All of us at desk jobs should probably do such exercises.
• We had to drive 2 hours away to find a doctor able to take hir! Everyone closer was not accepting new patients at all.  Apparently it’s easy to find an orthopedic surgeon if you’re an adult, but not so easy if you’re a kid.
• My pressure headaches go away beautifully as soon as it starts raining.  Like clockwork.  (Only get headaches before it rains, then when it actually starts raining they clear up.)
• I don’t know why but I’m really excited about DC1 getting to sign up for classes and placement exams and stuff.  My parents were so hands off and I’m trying to be less helicoptery, but also it’s a new step in DC1’s life and I’m eagerly watching.  Though it probably would be a good lesson if DC1 missed hir registration period and failed to get into preferred classes, but better to not learn that lesson, right?
• DC2 is starting to really get into organizing things.  Instead of undoing my alphabetization of books (younger DC2 was an agent of chaos), zie is reinforcing it.  Zie has organized the catch-all stationery drawer where we keep all the pens and pencils and other assorted writing paraphernalia.  Zie even spent some time sorting a jar full of pennies in two different ways, though those just went back in the jar (with a few Canadian pennies and special old pennies removed).  It’s really hir fault for refusing to go to more daycamps, but there are worse ways to spend time.  Oddly, DC1 sorted and organized a lot as a little kid and then really grew out of it and is now the complete opposite.
• I’m really hitting Europeans-not-checking-their-email-in-the-summer right now as an editor, to a much greater extent than previous years.  I wish they’d check and just say no so I can move on!  One of my coeditors is European at a US institution and he says he misses not spending all summer working.
• It takes a month to get an appointment for a driving test.  (We could pay extra money to a driving school and I think zie could do the test with a driving instructor, but we’re not quite sure how that would work around here.)  DH and DC1 went and they were like, you have the wrong form 4753 (form number changed for privacy purposes).  There are actually TWO form 4753 and this is the one you needed to get your permit.  You need the one to get your license.  And they couldn’t print it out because it’s all outsourced to a private company and DC1 had to watch some videos to be granted access to said form anyway.  Why do they have two form 4753s and why wasn’t this noted in all caps (or at all) on all of the lists of what to bring to your driving exam?  Or on the first form itself?  We don’t know.  So they came home and made an appointment for a month later and DC1 watched the videos and filled out the form.
• This did interfere with our plans for DC1 to drive DH home from his colonoscopy (they make another driver sit there the entire time waiting instead of being able to get an uber), and it meant I had to drive DC1 to and from hir math camp counseling job for a week.

Ask the grumpies: What are you doing for long term care/end of life planning?

First Generation American asks:

What are you doing for end of life care planning if anything? Have you calculated how much you need or considered LTC insurance?

… not that much.

We have done our wills.  We have life insurance until DC1 turns 25 (DC2 will be 20 and only have a little college left at that point), although even without it the kids would likely be ok at this point (we should probably change who DC2 lives with upon our deaths once my sister gets married, I dunno).  We’ve signed the medical things you can sign in a lawyer’s office (though I punted and put that decision on DH). I buy the optional disability insurance through work.  DH doesn’t have any so he hasn’t.

We have not calculated LTC insurance.  We have not started siphoning money to our kids in order to let Medicaid take care of us.

Grumpy Nation, have you taken steps for end of life care planning or end of life planning more generally?

 

In which DH does not have rabies but we spend as if he does

Three weeks have passed and DH is still alive.  Hale and hearty even.  We are all grateful and relieved.

So….

Remember how DH helped break up a dog fight and had to get tetanus shots and I purposefully didn’t get the dog’s information because it was an intact pit bull and I didn’t want it to be put to death?  (Turns out that is not a thing in this state– they would have just quarantined it for 10 days.)

A month later, DH came back from a business trip feeling nauseated off and on, with a headache off and on, and chills off and on.  After reading on the internet about how the incubation period for rabies is 1-3 months but can last up to 6 years, and reading up on the symptoms of rabies, and how you die within 1-3 weeks once symptoms have started (so far only 10 people have survived after symptoms started, and 8 of them had been vaccinated prior to getting bitten), he also developed anxiety and insomnia.  Which are also symptoms of rabies.  On the fourth day he started getting muscle twitches.

Early on in this process, we’d looked for places to get first of four rabies shots.  Walgreens has rabies vaccine, but not the first shot which has human blood in it and isn’t very shelf-stable.  None of the urgent care places in town had it.  No doctor we were recommended carried it.  Everyone said it had to be gotten at the emergency room.  DH’s insurance said they do not cover the rabies shot under any circumstances.  So to the emergency room it is.  This will be a minimum cost of 10K, and I would not be surprised if it tops out at 13K including the cost of the first shot.

At the emergency room they told DH he didn’t need to get the other three shots at the emergency room and recommended a couple of urgent care places or the department of public health.  Neither of the urgent care places would give DH the second shot.  The department of public health said the emergency room was smoking crack and they never give out rabies shots.  They said their protocol was to get the first shot at the real emergency room and to get the remaining three doses at the emergency room place without actually going into the emergency room and seeing a doctor in order to save $.

So I told DH to call the emergency room to make sure that things could work that way.  He called, but did not ask about the not seeing a doctor or the money stuff.  He just basically confirmed that they had the second shot.  Then he went and saw a doctor and had more unnecessary tests done.  So… >$20K so far.

I was not annoyed about the first emergency room shot, as I figured that was an unavoidable (albeit expensive) way to decrease DH’s anxiety, but I’m not that happy about the second shot given that he didn’t actually ask about the protocol the department of public health suggested.  He did talk to the emergency room billing again after, but they basically said they couldn’t talk to him about the bill until after it had been refused by his health insurance.  So there’s some hope he might be able to negotiate it down.  But who knows.

When he got his second shot, he got all the info about the shot (and the third and fourth shots) and it turns out those are exactly the same ones they give out at Walgreens as pre-rabies vaccines, so he could have just gone to Walgreens for the second shot and been done after paying $350.  Which he did for the third and fourth (and final) shots.  So $700 paid on credit card.

I don’t know when we’re going to get our actual insurance bill for the emergency room visits.  If we do end up paying more than $20K, that puts a really big bite into my car fund in addition to cutting into the emergency fund.  Which I guess makes the choice of cars easier as the options become much more limited.

So, you ask, why didn’t you just get the information for the pet owner?  It takes at most 11 days for an unvaccinated dog to die of rabies.  If the dog is still alive, then DH didn’t get rabies.

Well, we didn’t have the contact info for either of the dogs.  We posted on nextdoor (the neighborhood social media site) and on day 3 an anonymous neighbor pointed us in the direction of the golden retriever owners.  They were very nice about everything and gave us the contact information that night for the pitbull owner, but warned us that they thought the pitbull owner’s house was for sale.  And indeed it was.  For sale and empty of furniture.  DH tracked down the facebook page of the dog owner’s son which was blank, and then to the son’s wife which had lots of oversharing posts.  The posts mentioned the grandparents moving to the closest city (~2 hours) and it sounded like they were taking a dog with them, though no guarantee it was the dog in question.  But also no mention of sad dog deaths in the previous month.  The son’s wife did not respond to a FB friends request or any of DH’s queries.

We also called the agency that handles dog licensing in our county, since your rabies vaccines have to be up to date to be licensed.  But of course the dog wasn’t licensed.  So that, too, was a dead end.

On the morning of DH’s second shot, DC2 woke us up to let us know zie had thrown up in the night, the first of several throwing of ups.  As I groggily listened to hir, I realized I too felt nausea.  The nausea came and went.  So did a headache.  And chills.  All three symptoms would come and go randomly, seemingly completely unrelated to each other.  The chills were particularly disturbing.  I can understand how DH thought something out of the ordinary was happening.  (Though it turns out this weird virus has just been going around– it doesn’t last as long for most people because most people sleep instead of googling things that cause anxiety.  DC2 was better in a day and I was completely better by day 3.)

And that is our expensive and exasperating story.  My colleagues think it’s hilarious, and indeed, it is hilarious given that DH is still alive and we’re not going to have to go into major debt, just buy a cheaper car or sell some stocks.  Most insurance companies don’t cover rabies vaccines for people because they’re expensive and usually they’re just being given as anti-anxiety shots.  (Obviously if you’re bitten by a wild animal, you should get them if they can’t autopsy the animal in question.  But for pet dogs who are behaving nicely towards humans, not as clear.)

Morals:  If you’re breaking up a dog fight, use water, or lift the back legs of each animal.  Do not mess with their mouths.  If you get bitten by a pet dog, get the name and contact info for the @#$23ing dog so you can see if it dies in 11 days or not.  If you do get the series of four shots post-bite, get the first one in an emergency room and the remaining 3 at Walgreens (using a different schedule than the one that Walgreens will want to use– talk to the emergency room doctor about the schedule for all four shots).

List of things I need to do to take care of myself

1.  Get a haircut.  It has been 2 years.  Update:  I tried to do a walk-in at the place next to DC2’s newish Saturday morning activity, but they were full-up.  When traveling dies down, if I haven’t gotten a haircut in a conference city, I will make an appointment for during DC2’s activity one of these weeks.
2.  Get an eye-exam and new glasses.  I think it has been over a decade and my driving glasses have scratches.  I am also intrigued by the idea of computer glasses.  Update:  got the eye exam while at a conference at the Lenscrafters in [conference city] (everything is aok, though I’ve gotten slightly nearsighted in addition to my astigmatism; doctor says I can still use my glasses for just driving).  Will pick the glasses up at another conference in the same place later this month.  (Oddly, I think I’ve gotten all my glasses since 200X from the lenscrafters in this mall, and a good number of my haircuts.  I have several conference buddies who refresh their wardrobes periodically from the Ann Taylor there, though I don’t because there’s never anything in my size on sale.  I get my shoes in a completely different conference city.)  I also used my prescription to order an extra pair from (not sponsored!) zennioptical, which is where my DH gets his actual glasses.  Update:  have both pairs of glasses, and both make my vision really crisp.  I definitely needed an updated prescription!
3.  Get a mammogram.  I filled out the online form for an appointment a couple weeks after my birthday but haven’t heard back.  I should call.  Update: scheduled for May 2nd.
4.  Get tested for diabetes/insulin resistance or just get a metformin prescription.  I have PCOS.  Over the holidays plus during job candidate season I overindulged and didn’t listen to my hunger and gained weight eating all sorts of refined carbs.  Since then I’ve gone back to my regular mostly diabetes-friendly diet, but my weight has stayed the same instead of dropping like it usually does when I listen to my hunger, my periods have stopped (this could be menopause in action) but I keep feeling like I’m about to have my period, I’m tired and fatigued a lot, I’ve been drinking water a lot more, and I’ve been getting headaches (but maybe my hair is just too long).  Also I occasionally wake up with tingly fingers or toes.  In response I am going completely no-refined-carb (goodbye wheat thins, the cookie in cracker form), but I really ought to also just see a doctor for testing or medication.  Update:  diet change seems to help a lot, and when I do accidentally eat something with lots of sugar I feel cruddy and brain-foggy within an hour or so.  Still no period.  My current plan is to go back to the rule from my late 20s when I was first diagnosed:  3 months no period => go see the doctor.  That puts me at the start of summer to make an appointment.  Update 2:  diet change helped with that too… so I think I’m going to need to decide if I want to continue with the diabetes diet vs. go on metformin.  It is just hard to be careful about added sugar and refined flours (and I *like* refined flours), but metformin is unpleasant and can also interfere with B12 absorption which is something I occasionally have a problem with.  So I dunno.  After doing some youtube watching, it sounds like if you’re good about your diet over a 3 week period, diabetes won’t show up in the initial blood screen because you’re not getting the bad symptoms that show up in the bloodwork.  The fasting icky drink the awful orange drink tests should still show up positive though.
5. Eat more vegetables.
6. Get my skin checked out.  The problem with this is that the dermatologist office in town has a reputation for removing all moles, not just the ones likely to be cancerous, and he has a “non-disparagement” clause thing you have to sign, so nobody is allowed to leave a negative review on Yelp.  So I would have to find a dermatologist elsewhere and get to them.
7. Get new brown dress shoes.  My current Pikolino’s half boots (3-4 years old) are getting worn down in the heel.

Ask the readers: How to get the word out about ACA enrollment?

The Trump administration is trying to kill the Affordable Care Act administratively since they’ve failed legislatively.

Open enrollment is open from Nov 1st to Dec 15th this year.  (In previous years, people had the chance to look over their plans during their winter holiday vacation.  This year that’s out.)

The website will be shut down every Sunday from Midnight until noon for “Maintenance” except for Dec 10th.  I assume that’s to keep people from getting help before or after church.

Advertising has been cut, money for people to help navigate the system has been cut.

Then there’s some bizarre stuff going on with the previously most popular “silver” plans– rates on these have skyrocketed because of government malfeasance, and it may actually cost the same (possibly less!) to get a “gold” plan than to get a silver plan.  (“Bronze” plans will cost about the same as before, but are generally high deductible.)

Forbes has an excellent article detailing these and other points as well as giving advice.  Huffington post also has a great article/video giving advice for navigating the system.

I’ve seen various twitter accounts reminding people to sign up for the Affordable Care Act.  But I wonder, what can we do to get to word out to people who don’t follow activists on Twitter?  I’ve posted a sign on my door at work and am considering mentioning it in class.  Most of my students (at least in the past when I’ve asked) are still on their parents’ plans.

Let’s brainstorm… any suggestions for how to get this information out? 

Last year, 11.4 million people signed up for ACA. Let's top that in 2018! Your RT makes a difference! pic.twitter.com/NOuCElTN8x

— Jennifer Hofmann (@inspiredjen) September 3, 2017

While you're at it, please share the same message in Spanish. Muchas gracias! pic.twitter.com/yTgeIM1Kwd

— Jennifer Hofmann (@inspiredjen) September 3, 2017