Calm Waters Tonight

Finally My Head is Shrinking

The Headache is here but it is more distant and smooth, like evening ripples on a summer pond. I hurt elsewhere but The Headache is behaving tonight.

My headache diary was touchy to transmit again tonight - took three trys to get the silly thing to answer the siren call of the telephone. I almost forgot to even fill it out - I must make it a ritual to do at a certain time of day or I will forget and be non-compliant. I must be compliant in order to qualify. I do hope I have enough "headache days" to qualify. Not quite sure what the study sponsors consider a "headache day".... all of my days are headache days!

Tomorrow I will need to tackle Anthem again. I did a successful appeal of some ambulance bills from last year, and Anthem was to readjudicate these NOT using the "usual and customary" rate. The ambulance service which is non-participating with Anthem refused to accept the contractual write-off from these bills.

This is how modern medical billing works: If I had NO insurance, the ambulance service would automatically write off 20% of the bill. If I had their hospital system's insurance they sell, or another participating insurance they would have accepted the portion the insurance paid and written off the rest to contractual allowance. Since I have Anthem (with whom this hospital system has a long standing fight [pissing match] with) I was told I was responsible for 100% of the ambulance bill - worse than if I had no insurance at all! Their billers actually told me they didn't even want the partial payment, that I had to appeal. I won the appeal, and supposedly this was re-adjudicated but got paperwork from the ambulance service: apparently it is not resolved.

Anthem called me last Wednesday about the PET scan pre-certification problem. A lady named Coleen called just to make sure I knew I could appeal the pre-certification denial. I told her that I knew this, and complained again about their swellheaded contract physician who tried to advise my doctors on my care. That physician's job was to deny (and upon rare occassion approve) peer-to-peer review of service denial issues based on medical policy. He or she stepped beyond the bounds when he/she started dispensing opinions concerning my care.

Coleen wanted to make sure I understood they had a medical policy concerning PET scans. I am sure by their medical policy very few persons qualify for PET scans. I reminded her that policies are just that - guidelines to follow (generally to save the insurance company money) and that there are circumstances where policy is meant to bend, and by no means was I pleased that a physician who had never seen me, who obviously had not reviewed my medical record, and was not familiar with my case at all, was trying to dictate treatment instead of just administering a policy. Competency thy name is NOT Anthem. I am sure they have messed this up, or Coleen would not have called. I doubt it is standard procedure to call a subscriber especially to urge them to appeal a decision just made the prior day.

My personal opinion is that when the Blue Cross Blue Shields (WellPoint and Anthem aren't the only ones) starting going public and for profit their focus shifted from providing the best coverage at a reasonable cost to quarterly returns and stock price (which of course is what upper management likes to measure because they have a direct influence on their own stock options and bonuses). Too much managment focus on nest feathering and too little concern for their employees, quality, and their subscribers have changed the perception of excellence the Blues once stood for.

Ah well, this is why I am obviously not cut out for higher eschelons of management. I have no patience for greed, and most corporations seem to assume that managers will operate out of self interest instead of the good of all. The incentives and initiatives I observed when I was management all were geared to appeal to shortsightedness and personal gain. This current financial mess the world is in is because of this sort of business philosophy and everyone having his/her hand in someone else's backpocket.

I guess I'm done being gripey tonight. Tomorrow is another day! Hey, at least I'm not just droning on about how my head hurts tonight!

Bad Headache #21 2009

No Pet Scan

My day yesterday started off just fine, got to the PET scan facility, and waited and waited and waited. I had noticed the note "need pre-approval" on my paperwork I signed at the door. Apparently my doctors office forgot to get insurance pre-approval for the PET scan. Getting the pre-approval took so long the PET scan got canceled, and then found that Anthem Blue Cross Blue Sheild denied the the PET scan after going to my oncologists office. The Anthem Blue Cross Blue Shield doctor in his infinite wisdom told my onocologist that I couldn't be allergic to all contrasts and I needed to see an immunologist/allergist. Since he had not bothered to look at my extensive Anthem Blue Cross Blue Shield medical record before he refused the service, he didn't notice that I have been to an immunologist/allergist and that I have a "mast cell disorder" that became evident as I started having anaphylactic or anaphylactiod reactions to various medications and all CT, MRI, ERCP, IVP contrast materials that use mast cell reactions for contrast (pre-medicated or not) and the documented recommendation by the last radaiologist who had to deal with one of these saying "only on the threat of end of life" should I have contrast. So now I wait. I told the oncology group I didn't care if I had a PET scan or not, I needed to find out - but now they are going to appeal (another at least two weeks). They must have bought interest in the PET machine so they have to use it! :) I hate insurance company folderol, I used to be a manager for a BCBS so I know its all folderol. Anthem has a especially bad reputation for refusal of services but they bought out the local BCBS so there we are.

I then went to work, and the boss had decided to "shake things up a bit" by rearranging our decidedly unworkable work areas. Yeah for me I get a private office area!!! Boo because everyone else gets moved to communal work areas, including the guy who had my new office. I know it is because we are ramping up to a new platform, and I am supporting the old platform. Life moves on - but since I won't be here for moving day, I packed up my desk so someone else would not have to.

Maybe that's what set The Headache off. In spite of the goof with Anthem (bless their stingy hearts while they outsource American jobs to the Phillipines) I was in a pretty good mood yesterday, but I know that physical activity can set me off, and boy did it!

I left work at around 4:00 pm because The Headache was pounding, but I thought I could make it home. Nuh uh - I was halfway through town when The Headache pounced, ramping up to full glory in four quick throbs. I drove myself to the ermergency room, and I'm not quite sure how I got there. The pain was so severe, I debated pulling over and call 911 but remembering where I live I thought it would be quicker to drive to the ER, which was 30 minutes crosstown. I was at the "Oh God Oh God Oh God" level of pain and threw up all over the interior of the car just a block from the ER. I was in bad enough pain and unfortunately looked bad enough that the other ER patients waiting in line to sign up parted like the Red Sea for Moses. One sweet lady actually told the ER clerk that I needed to be seen first. At this point I was in such pain that my arms were shaking and my legs were starting to go and tears were dripping down from my bad headache eye.

Generally at this point I am at home where I am not under the observation of others. I have trouble talking and thinking when The Headache is at full pain. I have been hoping that The Headache had lightened up, but no deal. This was The Headache telling me I was a fool! Bless the emergency room people they got me back to triage and then to a room, but it was another 30 minutes (at least it seemed like it) until they got medication to me. They tried oxygen through a cannula because they thought it might help the pain, but it was too little too late. Then I had a headache cocktail of phenergan, Benedryl, torradol, and fentanyl. This allowed me to lay still, but the pain kept pounding on, just a little under the maximum. I think that is when the doctor came in and asked me what else they could do (this aggravates me somewhat - I know they don't see a lot of people with hemicrania continua - probably none - but I am in such pain when The Headache peaks out I can't think). I beleive we decided in consensus for some solu-medrol and more fentanyl. This brought The Headache down below a nine on my personal pain scale, and dropped my blood pressure a little. At least I could think! And I had some self countrol - not rolling around in pain for all to see!

My brother got a friend (thank you Bean!) to drive him to Springfield to pick me up, and drive me back home in the vomit car. I was discharged from the ER at 7:00pm and I slept off and on most of last night and have gotten up this morning early because The Headache is at the bruised brain stage. It hurts to look out of my left eye, it hurts to move my head, and it hurts to think. I have a meeting this morning at 10:00 that I need to attend and I am hoping I can make it.

I am thinking of getting a MD visit with my personal physician this afternoon and seeing if I can get a couple of extremely strong pain pills to carry with me. With the nausea issues, I'm not sure if I would be able to keep them down, but I fear being in places I can't get to medical care in (such as airplanes) when I am get in such pain so quickly.

Sigh. I think The Headache is up to its old tricks, two bad headaches in a few days, one off the scale. Guess I am glad I passed the psych eval.

Oh, and by the way, artwork that I use that is derived from someone else I generally (if The Headache is cooperating) put a link on the artwork to where I found it. So just click on the artwork if you want to see in original context.

Cleveland Clinic Appointment Confirmed

Spring has Sprung & I'm Psychologically Sound

Got voice mail today that verified I passed the psychiatric exam and my appointment for this Thursday in Cleveland is confirmed. I have mixed emotions - glad that I am eligible, but dreading the next month because until I meet the documentation and frequency guidelines I won't be eligible for the trial occipital stimulator. A month can be a long time with The Headache bopping around.

Sigh...I am facing more travel - this will be the first airplane trip I have taken since The Headache took hold. I hope it will behave on the flights. I have a fear of being in a situation where I cannot get privacy and being in terrible pain. It has happened to me several times in the last year especially prior to receiving indomethacin. I wish that The Belly liked the indomethacin, life would be so much easier.

I have my PET scan tomorrow. I'm trying to remain upbeat but today has been a shadow of yesterday - much nausea and dizziness. Hoping tomorrow will be better! And hoping The Headache behaves because my understanding is that I have to remain still while allowing the dispensation of the nuclear tinged glucose in my system, and to remain still during the scan.

My forsythia bushes are blooming, there are robins everywhere, and the neighbor's jonquils and daffodils are blooming. I believe spring has arrived!

Pet Scan Anxiety

Tests Tests yet More Tests

Had an appointment today with the gynecological oncology group (boy that's a mouthful!) as a consult from my doctor appointment last week. I am now scheduled for a PET scan next Tuesday to check to make sure my pain is not from a cancer recurrance. If it is I will be surprised, but I think anyone who has had cancer dreads each time you get rechecked or have more tests run because it can mean the undying cells have reappeared. I am considered at fairly high risk for distant metastases because of the depth of the cancer invasion (into the deeper vascular/lymphatic tissue of the uterus) and the histology of the cells. I am dreading the scan somewhat because it is one of those types where you have to lay still for at least an hour and a half, and if The Headache makes itself known that day it will be very difficult.

Other news from the gyno onco which was no surprise to me - they stated if the health issues I am having with neuropathic pain and dysfunction are because of chronic radiation damage there is nothing anyone can do, and it will just progress. I do show more signs of radiation changes in other tissues so that seems to concur with nerve damage due to radiation.

Up side if the problems are due to recurrent cancer there are probably steps to take, down side if the problems are not due to recurrent cancer there is nothing I can do. Up side if the problems are due to radiation and not cancer I will most probably be cancer free for the next five years also, then declared cured!! Down side if the problems are not due to radiation and are recurrent cancer there are very few treatment options for recurrent endometrial cancer and they have limited efficacy.

Having to take much trammadol this evening because of course poking around on me started the nerve pain to increase again. You tell a doctor it hurts somewhere and then they poke you there and of course it hurts, and then they say I'm sorry - but no, they are not. They deliberately poke you in your sore spot(s) just to see if it really hurts.

My blood pressure is still elevated due to pain. At this point I can't tell if it is from the hemicrania continua (which pitched a fit this afternoon) or the pelvic pain or both. Most probably both. There have just been a few times (after injections of major pain killers) this last year and a half where my BP has been normal. One neurologist said he could see changes starting in the vascular part of my eyes from elevated BP. Just one more broken part in the junk heap that is my body...

The Belly and The Headache are vying for my attention this evening. I had the shakes from not eating so had to feed The Belly and it was not grateful. The burning ouchiness is being helped by the trammadol I took for the pelvic pain, so a benefit there! The Headache started surging this morning with big lumps of pain, so I only worked a few hours today. I updated some records for a client so they were productive hours, but I went home early and just crashed on the couch in the living room.

I think some of the improvement I have been having with The Headache is from some advice I got from a fellow Hemicrania Continua sufferer: sleeping sitting up and sleeping on the side The Headache is on. I don't do it every night, and I don't sleep entirely sitting up, but in a semi reclining position, but I do believe it has been of benefit. Thank heavens I have a memory foam couch that is very comfortable.