May 31, 2015: Three Good Things

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Today’s things are going to be kind of low-key, to match the day.

1. I made a plan of attack for my current healthcare situation starting tomorrow.

2. I got almost all of my checklist done today, once again skipping exercise and stretching. I need to figure out a way of getting that done with the wife at home.

3. I managed to make great progress with my newest character in the computer game that’s currently got my attention, far more progress than I expected to make today.

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Back to Square One

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I’m writing this blog post mostly for my own information to keep track of everything that’s happened and is happening now with regard to my healthcare because I realize I am essentially back to square one.

On April 21, I had an intake appointment with Austin-Travis County Integral Care (ATCIC) for psychiatric medication management. At that time I had regular Medicare but had just applied for a Medicare plan through Blue Cross Blue Shield that included Part D for prescription drug coverage. That insurance went into effect on May 1, so the result of my intake with ATCIC was that they don’t accept Blue Medicare Advantage, so I was back to square one with regard to my psychiatric care.

I called around to find another provider and found that CommUnity Care had doctors that would accept my new coverage, so I called them to make an appointment. I was told that they wouldn’t be able to schedule a psychiatric intake unless I had a primary care physician, so being in need of one of them, I asked them to set an appointment with a PCP. In the meantime, I had gotten in touch with my previous psychiatric medication manager and she had called in a month’s worth of prescriptions for me, which meant the urgency to see a psychiatrist wasn’t so urgent, and I could wait until after I saw my new PCP to see my new psychiatrist.

On May 11, I went to see my PCP, who was a nurse practitioner. She was exceptionally thorough and made two medication changes for me. First, she added low dose aspirin to my regimen. Secondly, she asked that I start to double up on my lisinopril/HCTZ. (I would go from taking one 20/12.5 mg tablet twice a day to two twice a day.) She also explained that because I had so many health problems I would need to be seen directly by a primary care physician and not a nurse practitioner, and so she left it to my new doctor to write any prescriptions that I would need.

I called the next day to make the appointment with my new PCP and was told that the earliest appointment they had was June 30 – more than six weeks away. It meant that I would run out of lisinopril/HCTZ for two weeks (since I was doubling up without a backing prescription) before I could get another refill, but I figured I’d cross that bridge when I came to it.

That same day I got a call from CommUnity Care scheduling my psychiatric intake for May 18.

The following day, I got another call from someone else at CommUnity Care saying that I was being referred to another agency for psychiatric services, so I got in touch with my case manager at CommUnity Care (the young lady that had called me in the first place scheduling the intake) to get a clarification. She told me that yes, I had been referred out, so the intake appointment never happened.

Next came the day I ran out of lisinopril/HCTZ, and I called over to CommUnity Care to get a refill called in. I verified three times that they were calling in the combined drug and not just lisinopril. I was reassured that they were calling in the correct prescription. I went to go pick it up and discovered that they had, in fact, called in the lisinopril only version of the drug. I told the pharmacy that the nurse practitioner had called in the incorrect drug and that I would get a new prescription called in the next day.

The next day, I went over to CommUnity Care with the paperwork in my hand ordering the increase to two lisinopril/HCTZ 20/12.5 mg tablets twice a day. I was told that the nurse practitioner had changed my prescription to lisinopril 40 mg once per day. I asked why the change had occurred. I wasn’t given a reason.

The next event was my ER trip when my blood pressure spiked to 205/119. We managed to get it calmed down with a dose of Clonidine and I was given a prescription for hydrochlorothiazide (the HCTZ I was missing) 12.5 mg twice a day. I figured at least I had managed to get back to what I was taking in the first place, finally.

On Friday night, I found my old paperwork from ATCIC, including the list of Medicare providers that they carry, with mine notably absent. And then it hit me: CommUnity Care had referred me back to ATCIC, who doesn’t honor my insurance. I made it a point to call Giselle, my case manager with CommUnity Care to get things straightened out come Monday.

This morning, I was refilling my med trays as I usually do on Sunday morning when I noticed something intriguing about my HCTZ prescription. They wrote it for a quantity of 30 – 15 days’ worth of medication.

So here I am on Sunday evening, realizing that I’m honestly no farther along on this path than I was when I started. I’m once again going to run out of vital blood pressure medication well before I see someone about refilling it, and I have no current leads on getting my psychiatric medications prescribed.

Which in my mind frees me up to start the process of finding a doctor and a psychiatrist over again come tomorrow.

I’m going to call Giselle tomorrow and ask what’s the story, but I’m also going to call around and see if someone can see me earlier than June 30, as my blood pressure is now becoming my primary health concern.

It’s frustrating to feel like I’ve wasted the last month jumping through hoops only to be worse off than when I started and no further along the path to rectifying the situation.

May 30, 2015: Three Good Things

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1. Today I got almost everything on my list done. The only things that I was missing were exercise and stretching. This is the first time in three days that I’ve missed a check mark, and I’m okay with it.

2. I got to spend the day with my wife, something that I started taking for granted when she wasn’t working. Now that she’s working again, the weekends are that much sweeter. We didn’t really do much together per se, but we spent the day in one another’s company.

3. As I’ve posted here and to my Facebook wall, tonight I ate a tomato without salt. The reasons why this is a good thing (and such a big deal) can be found here.

Venturing Into Unknown Territory

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Tonight I ate a tomato without salt.

There’s a lot of meaning in those seven words. For as long as I can remember, tomatoes have needed salt. One of my few fond early memories is of being at my grandmother’s house and taking a stool, a bucket of water, a rag, and a salt shaker down into her garden for lunch. I’d head about halfway down the row with the tomatoes and take a seat, looking for a good, ripe tomato. When I found one, I’d dip it into the water and wash the dirt off with the rag, then take a small bite to break the tomato’s skin. After that first bite, I’d alternate between salting and eating, just like an apple, til the whole thing was gone. It was meditative, the process of selecting a tomato, washing it, and eating it. Salt was an integral part of that process. I salted in moderation, but every bite that went into my mouth carried with it a sprinkling of salt to enhance the flavor.

As I grew older, I added steak and eggs to the “salt required” group of foods. I rarely oversalted anything, but in my early adulthood, a lot of foods were salted before I ever tasted them. I ate a lot of salty snacks, like potato chips, and I wasn’t a moderate eater of them. My waistline grew slowly over the years, and my need to salt food was aggravated by my pack-a-day habit that dulled my sense of smell and taste.

I quit smoking on September 4, 2000. I was driving to Austin from the Oklahoma City area when I got into an intense coughing fit behind the wheel, and I realized that I was going to either pass out or throw up, and regardless of which way I went I was going to wreck the car. I pulled over and switched with my wife (we were dating at the time and still lived three hours apart) so she could drive us to the next exit. We pulled into a restaurant and I got a glass of water while I continued to try and physically pull myself together. When we were ready to drive again, on the way out I tossed my half-finished pack of Marlboro Lights into the trash can.

I haven’t touched tobacco since.

In the aftermath of that momentous decision, I started packing on weight – some 40 pounds within a few months. The oral fixation I developed while smoking still had its grip on me, and my waistline suffered.

As my depression and anxiety grew worse over time, I began to comfort eat, and I was in need of comfort quite often. Gradually, over several years, I finally came to a point that I tipped the scales at three hundred pounds.

By that time, I had developed type 2 diabetes and stage 2 hypertension, and have been to the ER on multiple occasions to manage crises in both conditions. Fortunately, I’ve found a medication regimen that keeps my diabetes under control.

I cannot, however, say that about my hypertension.

Even with three medications, my systolic blood pressure is regularly over 160 and my diastolic is at least 100, and more often over 110.

It’s at this point that I acknowledge that this post has been all over the place as I spit out part of my life’s story in a stream of consciousness. But all the parts do fit together, and here’s how.

September 4, 2000 was not the first time I had tried to quit smoking. I had attempted, and failed, at least a dozen times before. But when I finally quit, it was like flipping a switch. I was done. And having made that decision, I’ve had the willpower to keep me tobacco-free all this time, without even one slip-up.

Likewise, I’ve tried several times to reduce my sodium intake and start eating healthier, only to fail every time. But figuratively speaking, I’m about to run the car off the road with regard to my high blood pressure, and it’s time to make a knee jerk decision and stick with it, just like I did with the cigarettes.

This time, it’s going to be harder, because while I can easily live without tobacco, I kind of have to eat. But I don’t have to continue to eat crappy processed foods that are going to spike my sodium intake, and I don’t have to salt everything in sight.

Tonight, I ate a tomato without salt. It was the first time in my life I ever recall doing such a thing. It’s so deeply ingrained in me that tomatoes have to have salt that my stomach was actually a little queasy for a time after eating. It felt unnatural, but I did it, even when my wife offered the salt to me with the suggestion that I could lightly salt the tomato. I stuck to my guns, and finished the tomato. And I survived.

And I’m going to survive steak and eggs and everything else without salt, too. Because that same willpower to keep me alive when I quit smoking is now focused once more on keeping me alive. And while my depression tells me often how much better it would be if I were to just end it all, I very, very much do NOT want to die.

So from here on out, nothing gets added salt. I’ll have to learn what foods actually taste like without it, and it’ll be a new experience. I’m sure steak and eggs are going to be just as weird without salt as the tomato was.

But dammit, I’m on a mission now. And I have the willpower to see it through this time, because I’ve made the decision.

And with that decision, I’ve given myself the power to live.

May 29, 2015: Three Good Things

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1. This one is going to take some explanation. My daily checklists are organized more or less in chronological order, since 80% of the items on it have to be done in a certain order or at a certain time. The 20% of items that aren’t specifically tied to a certain time of day are slotted in what I feel is the best order given how the rest of my day flows. Regardless, there’s nothing saying that I can’t get them all done in the morning or evening or in a different order than I have them listed. Today, I had all of them done by 10:00 am, leaving me the rest of the day that I wasn’t actively eating or checking vitals or taking medications free to do whatever I chose to do. It was a good feeling getting it done and knowing that the rest of the things on my checklist were basically waiting on the clock to happen.

2. One of the items on my to-do list was a project that I’m doing for the internet radio station I DJ for. I got good feedback on my part and that made me feel good about the job that I did.

3. For the second day in a row, I was under my daily caloric allotment – this time by 157. I’m not hungry, I’m not craving anything, I’m eating until I’m full. This is the best feeling of all today.

Plotting a Plot

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I’m working on a plot outline for a novel I plan to write this November during NaNoWriMo (National Novel Writing Month). The plot is intended to follow a fictional world through various points in its history while following the adventures of an inanimate MacGuffin whose secret is revealed at the end of the book. Initially, I wanted to tell many different short stories that happened around the MacGuffin through many different periods in this world’s history, but have realized that spending so little time with one set of characters will make it very difficult to engage the reader in their storylines. I’m considering telling longer stories with fewer stops in history, which will have the added benefit of showing more progress in the civilization’s development from stage to stage. It also doesn’t mean I have to be so concerned about how one thing develops into another over two or three generations.

I’ve never taken on a writing project this large in scope so I’m a little intimidated by what I’ve committed to doing. I’m not sure of the best way to approach preparation, but I know of places that I can do research and get advice, so I think I’m going to spend today doing just that.

I have a tendency to be able to finish smaller projects with little trouble, but the larger in scope the project is, the more difficult it is for me to achieve the objective. Whether it’s in the workplace, my hobby life, or whatever, I just can’t seem to bring my larger ideas to fruition. I’m working on that, though, as I have three large scope projects on my plate right now: my nonprofit, my hobby’s office, and my novel.

And yet I look at this blog and realize that I have brought something larger to life. I’ve posted over 50 times in this blog, a minor achievement for me. (The internet is littered with failed blogs that I’ve tried to start, only for me to lose interest with the focus after a few weeks. This is the first time I’ve stuck with it for as long as I have.)

Maybe I can do the bigger projects after all. Just one little piece at a time, just like this blog.

May 28, 2015: Three Good Things

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1. I found a seated cardio workout that’s 11 minutes long and fun to do. This is good for two reasons: first, I’m actually doing cardio; and second, it’s not 12 minutes long, cause I was DONE at the end of 11. Like, could barely lift my feet off the floor done. Given the weather in Austin lately, it’s a much more reliable workout than walking and I honestly feel it’s a better one, using much more of my body than walking at 21 minutes per mile. Arms went one way, legs went another, and there were times that I got so confused I had to stop and reset the motion because I’d gone past cardio into interpretive seizure, but I think my ability to keep it straight will improve with time – as well as my endurance.

2. Now for something that involves sitting on my butt for long periods of time. I’m something of a gamer, and I found the voice cast listing for the game that’s currently holding my attention. It’s amazing to see how versatile these voice actors are. There were many voices I recognize from the game that I would never have thought were performed by the same actor. I’ve always had an interest in voiceovers, so I was very happy to find this list.

3. Today was the first day with the changes to my checklist, and I made one more change mid-day, changing “walk” to “exercise” to reflect my newfound cardio program. (The program also features cooldown stretching, which took the place of yoga, so it’s killing two birds with one stone.) First impressions: today felt so much easier to manage, despite dealing with a headache for most of the day, and I got everything checked off.

Bonus! I have the medications that I need to manage my blood pressure, at least until my new primary care physician comes online June 30. My blood pressure is still very high, but it’s not quite to the point of being a hypertensive crisis, like it was last night. (I do not fancy regular visits to the ER to manage my blood pressure.) Hopefully over the next few days I can get that down even more.

Extra bonus! I started a food log that tracks what I eat and my exercise. It’s got me on track to lose a pound a week. Yesterday I was over my caloric allotment by 74 calories. Today I was under by 354!