The High Cost of NOT Having Cancer

September 8, 2011

By Karen

I’ve been waiting for the bills (11) to trickle in after my breast cancer brush in June so I could wrap my head around how totally out of control our healthcare system is, and how Obama, in fixating on insurance, completely missed the target.

If you’re just tuning in, as the result of a fishy mammogram, I ended up having a benign lump the size of a pencil eraser removed from my right breast.

I was just able to sum up the whole situation in one sentence, but thanks to the wonders of modern medicine, it actually took a month and 5 visits.

Total cost if I had no health insurance…

$23,629

(Not including the original routine mammogram, which was $345.)

But I do have insurance. After I paid my $2,250 deductible (+ $284 in monthly premium), Anthem paid exactly $2,945.

I owed an additional $513 because Anthem has me on an 80/20 split.

Here’s the kicker: Anthem “disallowed” $17,921 — 76% — of the $23,629, so the total owed was only $5,708.

But if I were uninsured, I’d be on the hook to pay the whole $23,629.

Question 1: If the medical system can continue to function collecting only 24% of their charges, WHY are they trying to rob the uninsured?

Question 2: Why must insured and uninsured alike undergo and pay for physician CYA, providing THEM defense against a malpractice suit? Did I really NEED 2 additional rounds of mammograms and 2 ultrasounds, not to mention that stereotactic outrage where they drilled in and ripped out a half-ass piece of the lump for “testing?”

As soon as they saw that white spot on my mammogram, they hustled me off to a surgeon while everybody said it was nothing. They knew where this was going — or they SHOULD have, since this is their “profession.” Why not just knock me out, do the fucking lumpectomy, and be done with it? It would have knocked $4,532 in preliminary bullshit off the bill.

Instead of playing cute with insurance companies and whistling when hospitals are trying to stick every patient with the full cost of running the place for every moment the patient is in the building, our brilliant lawmakers should be legislating that everybody involved with healthcare GET REAL about costs and stop the gouging.

In the meantime, we schmucks who need the services will continue getting screwed, if not by the insurance companies, then by the medical providers themselves.

PS: And does Bon Secours really need to send a letter before every invoice, telling patients a bill is coming? Is this not silly and wasteful on every level? To top it off, in addition to collecting only 24% of their original billing, they offered me a 10% discount for paying my portion within 30 days (which, of course, I accepted).

And yet they manage to stay in business.

Could you live on less than 24% of what you earn unless your paycheck was obscenely inflated in the first place?


ALL CLEAR!

July 5, 2011

By Karen

My surgeon called promptly at 8:30 a.m. today with the wonderful news that they found no sign of cancer ANYWHERE.

I don’t even have to get another mammogram for a year.

I’m still soaking it in. After spending almost a month in this nightmare, it’s a little hard to switch gears into, “Oh, well. Never mind.”

Last night I watched the first 4 episodes of Laura Linney’s Showtime series, The Big C, just in case I needed to be prepared for the worst.

But the worst turns out to be a boob that’sgoing from black and blue to red to yellow, and may end up with a couple of battle scars.

Sure beats the alternative.

I’m liking The Big C, by the way, although I think credulity is being stretched a bit thin by not having her tell anybody yet but strangers in a support group she spent 5 minutes in. She’s apparently got stage 4 melanoma and has opted not to have treatment.


The End is in Sight – Maybe

July 1, 2011

By Karen

I need to correct a misstatement in my last post. I called my surgery a “lumpectomy,” but I have learned my doctor calls it an “excisional biopsy.”

ANOTHER biopsy? WTF??!!

Hands down, the worse part was being forbidden to eat or drink past midnight on surgery day (June 29), since the fun didn’t start until 3:30 p.m. I got weak and woozy, but perked up like a houseplant after they hooked me to a saline drip while we killed time pre-op.

(Coincidentally, I got the same stuff I inject into Yul every day for his chronic renal failure.)

I had a pow-wow with the anesthesiologists about keeping me asleep this time, or else. They told me that having a biopsy done in a doctor’s office, as I did with the Mammotome®, means minimal sedation because if something goes wrong, there’s no Plan B. My nurse confided that many women have told her it was the most excruciating thing they’d ever been through.

I felt vindicated that I wasn’t just being a sissy.

The doctor gave me one last scare when she stopped by and mentioned the possibility of finding “little bits of cancer,” but assured me they could be easily dealt with later.

FINALLY, it was time for my happy juice. The lights went out and I woke up when it was time to go home. The doctor said I mentioned the “governor’s mansion” and “tira misu” under sedation.

In a million years, I couldn’t tell you why.

The doctor went in from another angle, so my breast looks like a truck ran over it — twice. I’ve got an ugly-looking incision about 1 ½ inches long near my nipple, held together with clear glue, surrounded by a large, angry red area.

But I haven’t had much pain and only took one of the prescribed painkillers.

Keeping the breast immobile seems key. Last night I slept in a flimsy bra and woke up sore.

Now I wait until next week to hear if this is the end of it — or not.

I’m beginning to wonder how anyone who has gone through this is ever able to say they are “cancer-free.” I feel like I’ll never get a definitive answer so I can consider myself healthy again, that my breast has been so mangled, it will never have another “normal” mammogram, and I’ll always live under the threat of breast cancer.


Lumpectomy, Here I Come

June 27, 2011

By Karen

At least, I think it’s called a lumpectomy when they remove a chunk of breast. In my case, a chunk of benign cells behaving badly.

Getting surgery scheduled ASAP was like, oh, pulling a breast out of a mammography vise. I only managed to get my slot in the OR after some kind staff member at Virginia Breast Center heard the jerking around their surgery scheduler gave me — which included the priceless line, “The system’s down and we always leave at 2 on Fridays” — and took it upon herself to get me on the books as soon as the “system” was back up so I wouldn’t have to spend the weekend in suspense and probably delay the procedure another week.

So this morning I went over to St. Francis for PAT. That’s hospital-speak for pre-admission testing: blood pressure (sky-high), temperature (normal), EKG (beating), blood work (red).

Nobody had mentioned to me heretofore that last week I should have stopped taking my vitamin D, calcium supplements, and fish oil, so whatever they were doing that will be bad for me now is done. And since my surgery is scheduled for 2:30 p.m., even if I eat dinner at 9 pm. on surgery eve, I’ll be approaching 18 hours without food or water when they roll me in, so knocking me out won’t take much effort.

I also learned I’m not having any of that minimally-invasive, less painful, faster recovery, new age voodoo stuff you see in ads.

All that gentleness is for wusses who can’t withstand a stereotactic biopsy with only a dab of local anesthesia. Not me.

My doctor is cutting into my breast with a good old-fashioned scalpel and slicing that hunk of troublesome tissue right out of there.

And if I’m not 100% unconscious when she lays into me this time, readers, you will hear my screams, no matter where you happen to be.


Breast Biopsy Results: It Wasn’t Nothing

June 23, 2011

By Karen

Last night I removed the gauze from the biopsy site and my breast didn’t look too bad. Big bruise and old blood, but no ooze. Took my first post-biopsy shower this morning and was feeling pretty good about things when the doctor called with the results.

The didn’t find cancer, but I do have atypical ductal hyperplasia, which is defined as a “premalignant lesions of the breast ducts.” The doctor described it as a suspicious proliferation of normal cells that could become cancerous.

Since I’m childless, my breast ducts have never been called upon to do a damn thing, and THIS is how they repay me. It wasn’t enough to be cursed with freakishly large breasts that prohibit me from buttoning blouses, wearing belts, and having men look me in the eye.

So the next step is to have those “cells gone wild” removed and hope to God the doctor doesn’t find anything else.

I’m waiting to hear when I’m scheduled for outpatient surgery, which I expect to be some time next week. At least the doctor’s going to let me sleep through this round and the stitches will be internal.

And on another positive note, I’m feeling less murderous toward the doctor who first evaluated my mammograms and started me down this horribly scary path. If I manage to avoid breast cancer, I just may have to thank him for saving my life.


Biopsyville: You Don’t Wanna Go There

June 22, 2011

By Karen

Yesterday was B day. After reviewing my growing mammogram portfolio, the doctor said, “I don’t think it looks like cancer, because cancer shows up dense and black, and yours is white.”

She also shared that it’s at “8 o’clock” in my right breast, and 7 mm, or about the size of a pencil eraser. She couldn’t feel it.

Doing another ultrasound, she decided it might be a harmless lymph node and gave me 2 choices:

Stereotactic biopsy on the spot.

or

Wait 6 months and be tested again.

Since this ordeal has revealed my high intolerance for cancer, I opted for the biopsy. But the only way to do it without rescheduling was to have it under local anesthesia only. The doctor acted like this was no big deal, and ran off to arrange things.

The Virginia Breast Center uses the Mammotome® torture biopsy device.

Mammotome® describes how it works very matter-of-factly and, tellingly, without video. Nor could I find a depiction for you anywhere else.

Here’s how it went down for me…

I climbed onto a very high table to lie face down with my right breast hanging through a hole, sort of like a car on the lift at Jiffy Lube. A technician sat under the table.

Lying down was almost a deal-breaker because I had trouble finding a position that didn’t feel like I’d end up with broken ribs. I was under strict orders NOT to lift my head or shoulders or pull back during the procedure.

For yet more mammography, my breast was smashed on both sides so excruciatingly hard, tears began to flow. This pressure was maintained for the duration.

Next, they administered local anesthesia. I never saw any of the needles, but last night I found a Band-Aid over my right nipple. I can only assume a needle was inserted into my nipple opening, and that’s what it felt like.

I was now audibly sobbing while someone held down my back.

Whatever numbing ensued, it wasn’t enough. As the thicker biopsy needle went into the top of my breast, I felt burning.

Now I was hyperventilating and I think I screamed once, but they warned, “Don’t pull away or we’ll have to start over,” so I had to surrender to the unspeakable pain while the Mammotome® “gently vacuumed and cut” inside my breast and left behind a little present, a “safe, tiny device” of unknown composition, to mark the spot forever.

After they removed all the needles and loosened the vise, they cleaned and bandaged me, said something about a “large hematoma,” and told me it was now time for…are you ready for this?

MORE MAMMOGRAMS!!!!

I thought they were fucking KIDDING. But no. They needed to document my new microchip, or whatever it is. From now on, I assume if I ever get lost, I can wander to the nearest vet’s office to be scanned and reunited with my cats.

The final mammographer went easy on me because I was wobbling. They had me sit down and drink a glass of water before letting me drive home.

I could have used a fifth of vodka.

Today, gauze still covers the incision, and that Band-Aid’s on my nipple. I can see some blood. I’ll be able to more fully assess the damage and take a shower tonight.

If you’ve had any trouble following this, let me put it in a nutshell:

A stereotactic biopsy under local anesthesia is like having a large man in work boots stand firmly on your breast while he shoots it point-blank with fine-gauge nails.

They said they got a good sample for the biopsy (no doubt!), and I’m supposed to hear the results on June 23. I’ll let you know how that goes, and I hope it’s the end of this.


‘Twas the Night Before Biopsy…

June 20, 2011

By Karen

Just when you think it can’t get much worse, you get that phone call…

Me: “Hello?”

Mom: “Daddy and I just read your blog.”

WHY??!! My father won’t touch computers. Just last week, I tried to give my mother my Nook (so I could get the color upgrade) and she SWORE she NEVER reads. They’ve never shown more than a passing wisp of interest in Cats Working, and I could probably count on one hand the number of times, combined, they’ve ever read it. Yet suddenly they’re curious. 

I must have been acting suspicious at their house on Father’s Day. It couldn’t have been anything I said, because I said very little. My sister was there.

My mother’s slightly confrontive tone instantly flashed me back to a day in the ‘70s when my father announced he’d been reading my diary and advised me to burn it because it wasn’t exactly brimming with praise for my mother.

Me: “Yeah, so?”

Mom: “What’s going on?”

Were my last few posts in Chinese, or did she really expect me to recite it all AGAIN for her benefit?

I gave her the Reader’s Digest version, which turned into a third-degree about what the doctors told me, what I asked the doctors, are the doctors any good, yada, yada.

The fact is, all the players in this game are total strangers. My gynecologist’s office is getting the results, which will probably go straight into my file because he doesn’t know me from Eve. The first time he’ll see them will be in those seconds he stands outside the exam room door before he does next my Pap smear some day.

Then my mother said the thing I most dreaded…

“When’s your appointment? I think I should go with you.”

NNNNNNOOOOOOOOOOO!!!!!!!!!!

Subconsciously, I’ve been on edge since the ultrasound. I wake up every morning having dry heaves, and my blood pressure yesterday was 150/90-something. Thanks to the sketchy grasp of the situation I’ve been given so far, and its leisurely timeline, I want to scream whenever I think of it. And now I should be subjected to my mother embarrassing me like a 5-year-old in front of the breast cancer specialist (who may be someone I’ll need on my side if this doesn’t go my way)?

Well, I squashed that idea like a cockroach. However, I will give my mother credit for one thing: I feel calmer. Compared to dealing with her (don’t get me wrong, I know she means well, but we don’t have a good track record), this biopsy now seems like a piece of cake.


Next Stop: Breast Biopsyville

June 15, 2011

By Karen

This morning, I showed up early at St. Francis Hospital for my second mammogram in a week, and they were still talking as if the ultrasound was optional.

(I’m naming some names now to provide customer service feedback in case they ever Google themselves.)

After my last post and testimonials from a few women who have had iffy mammograms, I felt pretty sure a biopsy was in the cards.

When I questioned the necessity of the re-mammo, I was shown last week’s x-ray compared to last year’s. As it turns out, the white spot I noticed on the screen last week was at least a year old (but had earned the “all’s well” letter previously).

It looked to me like the lower left corner of the spot had shifted a bit. You know, the way a suspicious mole might — if it’s cancerous.

So, I let them mash and zap my right breast twice more, a little harder this time, and I was told to sit and wait for the results.

But instead of getting results, I was taken to the ultrasound room with no explanation. I could only assume the mammogram hadn’t been good.

Ultrasound is painless, but when the tech was finished, she laid a dry washcloth on my breast while I was still lying on the table and told me to wait like that for the doctor, in case he wanted to “watch her” scan some more.

So that’s how I received the next news: Flat on my back in front of a strange man with a face rag partially covering my naked, slimy boob.

He had an accent like Eric Ripert. He couldn’t say for certain what the spot was — “80%” sure it’s nothing — but it needs a biopsy to be certain. A “stereotactic” biopsy, he specified.

When they start throwing words like “stereotactic” around in conversation, you really feel as if they’re stuffing you like a dumb piece of meat down the rabbit hole.

The ultrasound tech was a nice young woman and acknowledged the scariness of it all when we were alone again. She gave me contact information for the Virginia Breast Center and said she’d notify my gynecologist. First good news I’d heard all morning — my primary care doctor and his minion who kicks patients to the curb seem to be out of the loop so I can deal with that situation later.

My biopsy is June 21. I think it’s going to be plain vanilla, on the advice of the Breast Center person I spoke to, a 10-year cancer survivor who has done and seen it all. She told me a stereotactic procedure would be much worse and possibly require stitches.

Here’s hoping I land in the 80% category and it really is nothing.


Abnormal Mammogram

June 13, 2011

By Karen

It’s going to be one of those weeks. I’m preoccupied with cat-sitting a neighbor’s long-haired freak who roams the neighborhood and refuses to comprehend how a litterbox is used so I can keep him safely indoors on my watch.

And then this morning, I had a contentious conversation with my primary care physician’s assistant where she told me to find another doctor. I’ve been seeing this doctor since 2000.  My offense was that I questioned why a recent routine visit they initiated to get my cholesterol prescription refill was coded as “medical care” that my insurance wouldn’t cover, instead of as a “wellness visit” that would be covered. My out-of-pocket was slightly over $200. I’m sorry, but I consider a doctor’s summons when I’m not sick so he can bless my continued use of a medication he prescribed to keep me healthy a “wellness visit.” So shoot me.

While I was still trying to calm down, the hospital where I had a mammogram last week called. The right breast looks suspicious, so it needs to be smashed and x-rayed again — with a possible ultrasound chaser. God only knows what all this is going to cost.

I instinctively feel like I’m OK, but I’m still a little freaked out. This has never happened before.

But I’m not completely surprised. When I was getting the mammogram, the breast was up on a screen and I saw a white spot right in the middle that didn’t look like it should be there.

My follow-up is in 2 days.

OK, readers. Have you ever been through this?


Laura Bush’s Misplaced Breasts

October 23, 2007

By Adele

I almost hurled a hairball when I saw Laura Bush’s obsession du jourbreast cancer – in the United Arab Emirates.

WHERE?

I dug up that, as of 2005, the UAE was only 32.4 percent female. So the good news is that Laura’s potential to stir up more trouble in the Middle East is fairly limited.

Laura Bush

The UAE is so rich, corporations and individuals aren’t taxed, and they report no one living in poverty. It’s slightly smaller than Maine, and its seven emirates marinate like savory sardines in oil reserves.

The government throws around titles like president, prime minister, and cabinet, but the Federal Supreme Council is the highest authority, made up of the seven emirate rulers. In fact, the FSC “elects” the president and VP.

They recently decided to start an Electoral College, of all things. Their EC members are appointed by the emirate rulers, and they’re the only people allowed to run for office. The only people allowed to vote for them are the other EC members.

It all very cozy, autocratic, and male-dominated. They need one of Laura Bush’s “wishful thinking” campaigns like they need sand for litterboxes. She hopes to erase the cultural stigma of breast cancer and get Emirati women to seek early detection.

Meanwhile, back in the U.S., some woman gets the bad news every three minutes. Our problem isn’t shame, it’s getting treatment without insurance, or fighting for coverage from greedy insurers who prefer you die while they still have your premiums in the bank.

Laura Bush harping on other countries’ healthcare issues while her husband and his cronies coddle the calamitous system here at home is as ridiculous as… a cat discussing the United Arab Emirates.


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