Tricks In Sickness

About once every year or two, I get a serious cold. Each cold is different from the previous one such that whatever I did to remedy the others does not work this time. It's as if I need a new trick every time I get sick. The persistent question in my mind is why the latest medical advances haven't found a cure for one of the oldest ailments known to man -- the common cold [see "Why is there no cure for the common cold?"]. This time though, a simple regiment helped me get over it in four days: 2x DayTime and 2x NiteTime, some lotion to rub on nose, plenty of rest, and VapoRub before heading to bed. I didn't have a cough or headache as in previous sicknesses. This is by far my best trick, the fastest the Rhinovirus A, B, or C (whatever this one was) has ever been defeated in my colds.

But the common cold is pocket change compared to what else I'm contending with. It is my Achilles' Heel, if you may, this annoyance that won't go away. There is a time I used to wonder why people couldn't just quit their addictions or stop  eating poorly to lose weight, why diets didn't work despite all the right actions, or why people seemed weak-willed in certain circumstances. That is, until my Achilles' Heel caught up with me. There are just some things you can't simply overcome on your own, no matter how hard you try.

At my March appointment this year, the dentist delivered some discouraging news to me: periodontal disease for life! It is still mild and can probably be stopped if aggressively treated, but will likely be a recurring problem. What I really heard her say: "did you never learn to floss and brush your teeth all these years?". The usual cleanings would no longer work; I needed continuous gum therapy, some of which would not be covered by my insurance. Of course I protested: I sought a second opinion and did my own research, but this wasn't a case of a dental office trying to sell me extra services I didn't needed. The truth was painfully here.

So I gave in. Each day involves two flossings, two brushings, and two swirls with nasty-tasting medical mouthwash. Every three months, I must visit the dentist to check my gum health (all that gum poking) and whether I have any further bone loss (via comparative x-rays). Wherever there is still some decay, direct injection of medication is done. Each of these visits can cost up to $500 out of pocket (in addition to whatever is billed to insurance). I don't even know what hurts most: the cost, the gums, or the lack of a permanent cure? Out of frustration, I thought about just getting dentures if it meant not having to visit doctors again (and curtailing the disease).

My wife wouldn't have any of that. It would be weird, a thrity-something with dentures because he hates dealing with doctors. Besides, it's only mild and manageable, with a good 15% recovery rate (mostly depending on how young you are). I can't chew hard stuff, but blending everything would be a worse option. So I'll keep the teeth, and take much better care of them. I'm wishing for a trick to make this go go away. Coconut oil maybe?

A PCOS Diagnosis

We pride ourselves in having self-diagnosed our infertility, but while FAM can point you a certain direction, it doesn't provide a diagnosis. We needed expert opinion on what kind of infertility we are facing so we visited a fertility specialist, who eventually informed us that from his initial observations it looks like Polycystic Ovarian Syndrom (PCOS). The thing with PCOS is that it is a spectrum of fertility issues that may or may not have anything to do with ovarian cysts. In fact for a lot of women, a hormonal imbalance perhaps due to a malfunctioning thyroid can be diagnosed as PCOS, as would a pre-cancerous cyst. So we needed to find the specific infertility affecting us.

From FAM, we can see the interplay of three reproductive hormones: estrogen (obviously), luteinizing hormone (LH), and progesterone. BBT charts show lower temps because estrogen rules pre-ovulation. The temps rise after ovulation because of progesterone. Ovulation tests work by detecting the presence of LH. But there is another important hormone is this interplay: Follicle-Stimulating Hormone (FSH). It is responsible for arbitrating follicle competition and nurturing an egg to maturation in ovarian follicles, and for releasing the egg during a so-called "LH surge" (what we collectively call ovulation). By a process of elimination, FSH became the culprit that was later confirmed by labs (blood panels). Ultrasounds around the time of ovulation revealed a pattern of anovulation (no mature follicles were observed 1-2 days before ovulation). So we moved from a general diagnosis of PCOS to a more specific "anovulation due to FSH deficiency". With that, two more questions arose: (1) what causes FSH deficiency? (2) How is this hormone imbalance treated?

The cause is not as easy to pin down because of the complexity of the endocrine system. We learned that a deficiency in some gland (say the thyroid or the pituitary glands) can affect the production of hormones elsewhere in the body, and this is what was likely happening in our case. The doctor thinks there is actually an estrogen imbalance that is affecting FSH. More specific blood panels and two possible causes emerge: vitamin D deficiency and insulin resistance. It is amazing how lifestyle and diet now tie into fertility, so we know treatment will not be singular.

The treatments start with Letrozole (as an alternative to Clomid) to help regulate estrogen and restore ovulation. Daily supplementation with vitamin D is recommended, and Metformin is prescribed for insulin resistance, even as diabetes is not diagnosed. We institute a low-sugar diet ("The Sugar Solution" is an excellent resource) and continue daily exercise. We also started seeing a doctor that specializes in PCOS treatment, who helped with the specification of said diet. We know the diet and exercise are working already just a couple of months in.

Even as we do infertility treatment, we are aware of the possibility that it may not work. After some heavy discussions, we decided that we would try any options (clinical or alternative) that are reasonably available, but would not do surrogacy or IUIs and beyond. At that point, we would take a break and eventually turn to adoption. But we do what we can while we still can (insurance, etc).

It is emotionally draining and stressful to deal with such a diagnosis, the medications, the doctor visits, and the numerous clinical procedures you undergo. I applaud my dear wife for the courage and strength she has shown in this journey. As long as there is visibility into the condition (we know what is going on), great chances are that there is a specific treatment plan for it. If you have been here, I encourage you to do your research and understand the condition yourself so that you can contribute to the doctor's prognosis. You know yourself better than a doctor does, and many doctors appreciate informed patients and working as a team. It is not an easy journey and it requires persistence and diligence.

I should also say that no one treatment plan works for everyone precisely because infertility is variable in different people, even under the same diagnosis. Fertility is one of the few areas where treatment must be quite specific and exact for a given degree of diagnosis.

Healthcare After Obamacare

With most health insurance companies having published their rates for 2014, we now know what will change in our plan and how Obamacare really affects us. Overall, health insurance rates will rise 4-6% across the board in our plan (so said HR) because of changes in compliance with the Affordable Care Act (ACA).

For our family however, my employer will be paying $483 every pay period to cover my spouse and I under an Anthem HRA PPO plan. That is roughly $996/month, a $146 (18%) increased cost to the employer. What we personally pay increases from $115/paycheck to $125 (about 9% increase). Since the plan retains most of its features, we can say healthcare will cost us only 9% more in 2014.

The other changes I see include an increase in our out-of-pocket deductible, from $4000 to $6000/year. So the only action we'll take is to increase our emergency fund by $2000. The employer still contributes $4000 into our Health Reimbursement Account (HRA) at the beginning of the year, and how we use the plan remains unchanged. I also notice an emphasis towards expanded preventive care at 100% coverage. There are more women's services, and oddly questionable items like coverage for sex reassignment. Why that in lieu of more important services like fertility treatments? Starting in 2015, we'll be able to unbundle services from our plans; there's plenty I'd strike off right away. I also notice that our dental plan is now capped at $2500, with coverages at 90/60/80 for basic treatment/major treatment/orthodontics. Preventive dental care is always 100% covered. The prescription plan and other benefits do not change.

So I'd say come next year, we are paying a little bit more for healthcare but getting a little less service. Not bad, considering the stories we've heard about people seeing insurance costs double or tripple on the private market (about 12% of the insured). While most have blamed Obamacare for these increases, the truth is that healthcare is expensive to begin with (around $900/month for a family), and its costs rise every year.

Rather than focus on access, I think healthcare reform should have first addressed why the costs are so high (see this PBS Newshour analysis, for example). Second, decoupling insurance from employment would squarely make it a market problem, much like automobile or renters insurance work. Then would it have been appropriate to consider how people access healthcare and how it is delivered. I wouldn't even mind reviewing so-called entitlements to care that ultimately someone else pays for. So whether it is Obamacare causing the price hikes or not, there is a chronic problem in US healthcare that will continue to haunt us regardless of regulation and taxation.

Healthcare Before Obamacare

As the healthcare exchanges open and people all over the US sign up for health insurance, we begin to review our own options so that we are in a position to evaluate what these exchanges will deliver. We start with a review of what we currently have, at least until the end of the year.

We get healthcare through my employer, covering both of us for all medical, dental, vision, mental (counseling), and prescriptions. For 2013, it costs us $115/paycheck (roughly $230/month), although my employer ultimately pays about $820/month for this benefit. Our $9840 annual cost to the employer for healthcare insurance is a little higher than the national average. Health insurance is quite expensive in this country, this before the effects of the Affordable Care Act (ACA) kick in.

Additionally, my employer pays $4000 into our Health Reimbursement Account (HRA) at the beginning of the year, leaving our out-of-pocket deductible as $4000 annually. Whatever is not used up in the HRA the previous year is rolled over into the new year, in addition to new contributions from the employer. As we use up healthcare services, we don't start paying out-of-pocket until the HRA is depleted. When this happens, we pay up to $4000 out of pocket, and thereafter insurance covers the rest 100%. So as a matter of good planning, we decided to stow away the $4000 expected deductible as part of our emergency fund.

Medical coverage is provided by Anthem BlueCross, and includes preventive care, doctor visits, emergency room, hospital and board (3 days), and prescriptions (the complete list of benefits includes over 100 items that I do not care to list here, but that have 100% coverage in-network and 60-80% out of network). Of note, the lifetime maximum amount is unlimited. Dental coverage is provided by DeltaDental up to $3000, with 100% preventive care and basic treatments, and 80% major treatments and orthodontics. The vision plan is 100% covered beyond a $20 office visit fee.

To date, we have not had to pay anything out-of-pocket towards healthcare, even after the annual physicals and dental checkups we have done, except for various prescription co-pays at about $45/month. We like our healthcare plan thus far, but will shop around if the healthcare exchanges provide something better than what our plan will offer for 2014.

Fitness For One Month

For the month of May, we are engrossed in a fitness scheme: to work out every weekday, have one juiced drink for a meal replacement, and get outdoors for physically-demanding activities on weekends. Simple plan, right? Well, not exactly.

Our workout is mostly cardio and endurance, using the Insanity workout videos (BeachBody). For my build, I am in my target weight so the workouts are mostly for maintenance. We've done well for a week thus far.  That is, until I find myself in a familiar hard place: these demanding workouts require increased servings of proteins and carbohydrates, which we did not quite plan for properly. As someone once told me, you cannot workout on salads. A nutrition adjustment is badly needed to make this work.

The meal we chose to juice is breakfast, perhaps not the best idea. As the most important meal of the day, it is now apparent that juicing does not provide the energy needed for the day. Added to the fact that I wake up at 3am and study/work, then do a full course of "Insanity", and then put in a demanding 9-hour day at work, it is no wonder I'm drained by the time I get home in the evening. We probably need to keep a full breakfast and juice some other meal. Or if we keep breakfast, it ought to provide the zing needed to carry through the day. Whenever we get our juicing book back (The Everything Juicing Book), we'll make more elaborate and targeted juices.

The weekends are for outdoor activities. Last weekend, I was out biking for 5 hours on Saturday morning. By the time I returned home, I had a great appreciation for the week-old workout we've been doing. It was exhausting but manageable because of the endurance from the workouts (at least compared with the last time I was on that trail). The upcoming weekends will see us hiking, doing the incline, and some indoor rock climbing.

Along the way, we are keeping track of the tangible benefits: how much weight we lose, how much further we can go physically, how expensive juicing is (or not), and how we can better incorporate the good ideas into our normal lifestyle beyond the life of this project. Especially remaining fit and more healthy nutrition, tailored for our particular lifestyle.

We Fit(ness) Together

I'd be hard-pressed to find anyone that never works out and yet is physically fit. So that we look and feel good, we all must work out. Some do gyms and others get personal trainers -- we just do DVD programs at home. Enter "Insanity", which we have been doing on and off for the last couple of months. My wife does another women's Beachbody product from time to time, which has served her well.

We've seen some results, even with our lackluster commitment, so we know that if we work harder at it and be more consistent, we'll see even better results. Actually, my wife has been more successful at exercise than I, working out pretty much every weekday even if I do not join her. I realize that (1) I have a bad habit of working out in 1-2 week spurts then taking a week or two off, (2) I work out better in the evenings than in the mornings, and (3) exercise can become routine and boring, creating less of an desire to commit seriously.

So I've designated October and November as the months I intend to finish the entire "Insanity" workout. To encourage my wife in her workouts, I'll workout in the mornings with her. I'll workout everyday (except Sundays) so I can be true to the workout and see if it really delivers on its promise of serious abs and better cardio response. I'll work out to my own music though, to keep things interesting, and will "test" my physical fitness every 2 weeks with a brisk hike up the Manitou Springs Incline. Yes, this all sounds like a New Year's resolution -- and it is. Simply applied really late into the year.

At the other end though, I expect good health and vanity. I mean, why else do we work out?