Looking backwards and Forwards at the Same Time.

Every New Years Eve I try to sit, look back over the year, and write. Sometimes it gets committed to paper but often it remains as disintegrating memories in my head. Today, on the cusp of a new decade I thought it really important to take a moment and look back and forward simultaneous. Is this what being in the moment is all about?

First I start with a brief synopsis (if that is remotely possible). Ten years ago today I was in Monterey with my partner Guido. We had just finished laying 2 tons of stone pavers in preparation for a New Years eve party. My friends Julia and Morgan were up from LA. Ironically and very accidentally I am now down in LA at my friends Julia and Morgan's house preparing for a New Years eve party. They now have two of the most adorable kids and I am so happy that I get to be part of their lives.

Heading into the year 2000 I was staring down the barrel of unveiling the extent of my rare bone disease and unfurling the methods available to me to address the collapse of my joints. In 2000, I had the first of many experimental surgeries and hard roads to recovery. The first was a vascularized fibular graft. They took my fibula out of my leg and stuffed it into my hip. That was trick. I returned to a company that had undergone a near transformation (meaning I knew few people who worked there). Then in 2001, I found out I had the bone disease in my knees on a trip to Yosemite, started a new career in intellectual property rights. I got laid off and rehired into a new publishing organization-- Thomson Learning. I met Dr Steadman and Dr Philippon in Vail Colorado. That was the beginning of quite a journey. I traveled back and forth to Vail Colorado more times than I can even count to repair and halt the destruction of my joints and bones. I managed a career that blossomed into something wonderful. So many terrific talented people...Carline Haga, Netty Hoglaund, Andrew Clowes, Larry Molmud, and all the other creative smart people at Thomson Learning. In the midst of things my relationship with the man that I thought was the man I would spend the rest of my life with imploded and a new relationship developed. Since then, I own my house, have a loving relationship with Larry and his 3 kids -- we got married last October, I left my job in 2007 to take care of my body.....because it wouldn't let me do it otherwise, and at the end of a series of difficult surgeries -- 14 to be exact -- on hips, knees, shoulder, elbow I am hoping that staring into 2010 that I will reinvent myself and see myself looking forward to a new career in Healthcare using what I learned in 10 years at Thomson Learning and what I have become passionate about -- healthcare and the use of technology to better enable the healthcare transaction between doctors and patients.

So, the month of January is going to be about laying the groundwork and goals to start getting my body stronger, since I am finally seeing hope. And use this blog as a tool to help form my thoughts around the direction I plan on shifting my career in. (I actually can say those words for the first time in a long time). When you are so focused on pain management and recovering from invasive surgeries there is very little else that you can focus on. I am really excited that for the first time in 10years I am not facing imminent surgery. I see hope and possibility. Granted that might change anytime. But, I will take what I can get.

MoveOn.org Political Action: Stop the gift to Big Insurance

MoveOn.org Political Action: Stop the gift to Big Insurance

I have been a bit hunkered down, but am resurfacing to take on the "good" fight....and add my support to making a difference. And, one of those steps is healthcare reform. I never felt moved to be politically active. But, after my experiences in the current healthcare environment, I have been moved. And, the system needs to change. So, if have called my Congressman and Senators to add my support to retaining the public option. We need to create a competitive environment. Currently insurance is run by a few major organizations and they are primarily in it for the profit. So, we need to change that. Right now, the public option looks as good as any....

Tips for Understanding your Medical Insurance

Dealing with and understanding any medical insurance requires some talent, patience, and mostly perseverance. What happens when you have to change policies? That can be a stressful experience. 

Recently, I had to change from my fabulous traditional indemnity policy (straight 80/20 split) with no distinction between in- and out-of-network benefits) to what is considered by modern day standards pretty darn good insurance a PPO - Plus (boo hoo). The "Plus" only means you have additional out of network benefits.

After I whined and moaned for a while about my fate, I decided to bootstrap it and understand the new animal I was dealing with. And, boy, can it be complicated. Pay special attention to the language; it can be very obfuscating.

Here are some basic questions for the insurance company

1. How do copays work? Do they apply to deductible? Most don't.  That is simply what you pay out of pocket. Your deductible is the "co-insurance" part of the deal

2. What is the definition of in-network and out-of-network benefits? It is important to understand what they mean by whatever breakdown figure they use (for this example I am going to use a  70/30 split).

   What you will ultimately pay is not necesssarily based on what the doctor bills you. It is dependent on what the insurance company deems as "allowable". (And, all use different fee schedules there are no federal or state guidelines, although all insurance companies go off certain standard metrics).

   So, let's say you get a bill for $150 for an out-of-network doctor. Your insurance company may say that $100 is allowable by their schedule. They base their reimbursement on the allowable fee of $100. So, that means they pay $70 and you pay $30. The other shoe that will drop for you is the $50 that insurance did not allow. The docts office will "balance bill" you that amount + your coinsurance. So, your total out-of-pocket costs will be $80. (Sometimes, you can get a doctor to write off that $50, but you have to be proactive and ask.). This is not the same as a co-pay.
   

The other part of the equation is to understand how you provider works with the insurance company. Usually, doctors offices know who they contract with and who they don't. Remember it is your job to ask, so you know what your cost could be. 

There are many flavors of the same insurance company. Just saying Anthem won't get you very far. For instance, Anthem in California is only run by Blue Cross (not both Blue Shield and Blue Cross). You need the specific insurance info, which is determined by ID and Group numbers on your ID card. Those numbers do more than simply identify you and will let you know what the score will be. Think of it as your medical credit card with your personal rate information.

1. If you are not sure how your new insurance will treat a provider (this is usually only significant in the out-of-network scenario(s)) You can always ask for the diagnosis code(s) (ICD9) and procedure code(s) (CPT) the docts office will use for your treatment/visit.

   Then go back to the insurance company and ask to run a test claim. That should give you a good guideline on how insurance will pay. When you do this, make sure to ask if the call has been recorded, and always take good notes that summarize the discussion and outcomes (include name of person, date, and summary). Insurance companies always say that no claim quote is valid until it is completely processed. Good data is key. In the event that something goes wrong, you can point to the conversation you had. It is always more difficult to recreate your memory.

2. If you go to a hospital in your area, make sure you find out if both the facility fees and doctors fees are covered. Ask this of the billing department. The receptionist checking you in is often not a reliable source of information. I have come across cases where the facility is covered but not the doctor (i.e. radiologist, pathologist, emergency). It is a serious drag to not know this in advance. You think you are all covered, but then you get a $450 or more doctor's bill.  

   The hospital is generally not proactive in telling you this (unless you get someone who is on the ball, which in my experience is not very often.) Tell me, how many times have you asked the same question from multiple representatives of a facility or insurance company and gotten as many answers? Please note: Most say, that they do a courtesy billing. That does not mean that they are preferred providers of your insurance company. 

These are some simple techniques to help you better manage your costs. Until our medical system changes and patients have better consumer control over their costs, these simple techniques have been the only way I have some measure of understanding and controlling costs.

I highly recommend doing these basic steps before you need to use services. An emergency can happen at any time, as I have found out the hard way. Once you get a handle on what the expenses are (especially your out-of-pocket ones) before you have any treatments, procedures, etc... you will be much better in control of your outcomes.

Never assume, always ask questions, because it is in your best interest to manage the nuances of your healthcare and be a better CEO of your healthcare and body.

The second guessing yourself game and the Havoc it creates

Finally, I am going to get a lightweight wheelchair. I cannot believe that I am so excited. But I am. Mostly because of the satisfaction that comes along with it.

I started battling for use of a wheelchair during my recovery over 3 weeks ago. That was when I was told, at the hospital by the discharge planner, that was a durable medical good that was not covered by insurance, along with the shower chair, raised toilet seat, and wheelchair cushion. This was after I spent a great deal of effort to determine what my policy covers. I even, in the hospital, spent hours highlighting the insurance document to show the discharge planners what was covered. Something that they never looked at. Something they pushed me back on. And, a discussion I crumbled on, and nearly gave up the fight, mostly, I just didn't push for what I really needed (a light weight wheelchair). I accepted the 2nd best option – any old wheelchair. And, that was not very good for any of us. So, since we got it I re-geared myself up to getting a light weight one. And, I have. And, it is covered.

So, what is the takeaway. Don't second guess yourself. Don't doubt yourself, especially when you know what your rights are (as I knew by my insurance company's medical policy bulletin covering durable medical goods). It is easier to doubt yourself when you are not feeling well, especially in the face of pressure and a system that seems to run on denial. I know I buckled. 

The good thing is that I regrouped, but it took 3 weeks longer to get what I should have gotten. Had I stood my ground I wouldn't have wasted the additional time (at least 8 hours in total) – day's wage – to get the right goods. So, next time I will stand my ground. 

I wonder if other people do this?  Maybe I am the only one, but I doubt that. HA!

Share if you have similar stories.

When you don't look the part

During my last several hospital stays I have taken to wearing a camisole (helps hold up the chest) and loose yoga capris after the initial surgery etc .... instead of a hospital gown. And, boy has that caused a stir to the point of eliciting comments from caregivers.  "Wow, you look like you are ready to leave." (on day 2 post surgery, while I am shuffling around with my walker). Or, you don't like you have anything wrong with you (What about all the IVs that are sticking out of me?). 

I don't think people say these things to be provocative. I guess I get provoked.  Sometimes I take it as minimizing my suffering or what I am going through. And, I do the same thing. I try to look like and act like there is nothing wrong with me so that I can pretend that there is nothing wrong. 

It does raise the question/issue of how linked people's perception are to being sick, including my own. You have to look sick to be sick. It's weird. It is almost as if, the legitimacy of struggle/illness gets reduced when one does not look the part. That happens to me on a regular basis. When people see me in person, check out picts, especially when I do not have an aid in hand (crutches, wheelchair, walker, cane) then I must obviously be OK.  "Oh, you must be doing better." When in fact, I often don't use a cane, because it hurts other joints, or I am too lazy, or whatever reason. I am in constant pain in so many places. But, because I am athletic looking, thin, long legged, I must be ok. When I went to the hip replacement class, prior to my surgery, two separate nurses checked to make sure I was in the right class. I insisted that I was. It depressed me, or should I say enraged me. It even makes me second guess myself. ..." Maybe I really am OK, and have no problems, or have lesser problems than I pretend I do ". When I allow those sentiments to grasp hold of me it can be deadly to the psyche and hurtful.

Its a conundrum. One of the many that I have had the pleasure, so to speak, of tackling in the experience of being a patient.  Mostly I have come to accept the frustrations of my condition, there are times, especially when I am fragile that I react. But overall I have gotten to accept the humor in it all and so try to find the comical. 

If I find myself needing to react. I slyly ask people, "Didn't your mother teach you not to judge a book by it's cover?"

If I didn't I would be in a very unproductive place.

Hospitalization Recap and Analysis: How you survive a hospital stay

One would not think that lying around and recovery could yield so many different unique experiences including the good, bad, and ugly. But, it is true. I have had one of the wildest health and life adventures starting when I came out of traditional hip replacement surgery ten days ago, at Stanford hospital.

Veinipuncture: Each day a new vein supply had to be found since I kept reacting to the needless IV.  They had to bring in the vein specialist, which took over 4 hours, who put my IV right in the bend of my wrist which really was unpleasant. At the end of it all I was left with marks and bruises all over my hands and arms. The first days my blood pressure was so low that I couldn't lift my head off the pillow without spinning out. That was fine, where was I going. Not far.

Rounds and Sleep deprivation: There was the usual routing of being woken up every 4 hours throughout the night to check vitals, and then of course as soon as you do fall asleep the docts start the rounds at a god awful 4 AM. I desperately kept the sheets over my head with the hope of sleepy some  Thank goodness I brought lavender essence, an eye pillow, headphones, and my Ipod to play spacey music. (these were the essentials to maintain sanity and get some sleep). 

Neighbors: Unfortunately I had a pain in the ass neighbor, who, decided because she was up at 5 AM, so should everyone else. She had no sense of others. Asking for coffee, talking loudly with the nurse at all hours of the night, and tweaking out when her friends didn't show up when she expected them to. She is the only neighbor in all my years of hospital visits that I wanted to throttle.  I know I should be compassionate, but she really lacked it.

Pain Management: There was a young resident from the Stanford Pain Management Clinic, Carlos assigned to my case, who despite countless conversations with me still had it stuck in his head that I was on Methadone for pain management since last year. I kept reiterating that was not the case, but he clearly did not get it as evidenced on my discharge summary, that I needed to quit methadone. Clearly they are so immersed in their own process/bureaucracy that they believe their own bullshit. The pragmatics of that experience evade me. I guess because they wrote something down it must be true.  Isn't that a logical fallacy? A couple of times the whole team of 5, including head honcho, would come in and talk to me for whatever reason. I will be curious what that bill will be like. 

The EHR system, EPIC: Stanford now has a "sophisticated" and probably expensive electronic health record system. To provide meds, they have to scan your wrist band. However, when they record vitals, they only confirm your name. As a result I noticed last one evening that despite a nurse checking my name, was entering data into another patient record. WOOPS. She asked my name, but the name on the screen was somebody else's. Although in my situation it was not life threatening, it could have been. That definitely raised my blood pressure. It seems more foolproof to use the same protocol as they use with medications.

Nurses: Nurses come in all forms, good, compassionate, old school, those that go through the motions, and those that are somewhere in between. The last night I was there I had one unbelievable experience. It was the first night without a catheter and the first day I started ambulating with my little walker. I needed to go to the restroom and requested help due to the mobility restrictions and lack of stability. The nurse said, "Oh, just go to the bathroom on your own, and drag the IV rack with you using the walker." I didn't respond because I did not know what to respond with. Are you fucking kidding me? is what I thought and wanted to say. Finally, I got an nurses aid to help me. She left me on the toilet for over 20 minutes. Finally, I got fed up and tried to drag myself back to the bed with the IV rack in tow. Despite my gingerness, the IV rack got stuck in the wall mounted television's cords. I was so pissed. I tried tugging at my IV to no avail. I was stranded between my bed inches away and the TV. I wanted to teach them a lesson and was seriously thinking of ripping it out and having them find me on the floor. That would learn them, but maybe not.

Discharge Planner: Discharge planners come in many shapes and sizes.  They are supposed to help you with the transition home and arrange for essential equipment to be brought to your home. They are very sweet, smiling, reiterating how they are here to help you, saying, "Please ask me any questions and let me know if I can do anything for you." When I asked for a wheelchair and shower chair (due to my restrictions and concern for preserving my other joints) the conversation went south. They said, "Oh no, insurance won't pay for that, you will responsible for the charges, it will be cheaper to get that on your own." I even spent several hours in the wee morning the evening before discharge highlighting the relevant sections, criteria, and codes of my insurance's clinical policy bulletin governing durable medical goods (DME) to  show them what my benefits were. And, all I was met was with resistance. They wouldn't even look at the document. All they kept saying was that we want to help all our patients but you realize you will be financially responsible. I kept saying, "... fine, but please if the criteria are met, can you please use the codes and terminology that my insurance requires to get things covered." I believe, if I have insurance, I should get it to work for me as much as possible. For Christ sake, for a shower chair, the requirement is that I cannot stand, which I cannot. Finally, I asked, through a torrent of tears, what is the worst case out-of-pocket scenario for these items. For the shower chair it was $27.00 and the wheelchair it was $56.00 a month.  That is far cheaper than purchasing on my own. The cheapest shower chair is around $45.00. At the end, I got what I wanted, but it was a horrid experience. Thankfully, I was right, insurance covered all the DMEs I requested. (I found out later through the case manager that my insurance company assigned to my case that the situation should not have happened. She never was asked what my benefits covered.)

So, that is a not so summary of the highlights of my 3 night stay at the great Stanford Hospital. An acme of California's medical systems. I remembered from my last experience how much I hate that system, and this time it was even worse. It is shocking. Everything is so specialized and no one seems to know what the others are doing. The continuity of care and follow through are fragmented. Dr Maloney's team, was at least on top of the things they needed to be on top of. This experience reminded me and reinforced the reasons why I have stuck with the Colorado team and Vail Valley Medical Center for so long. Increasingly I am thinking smaller is better. People are less disassociated from the larger picture and service is overall better. For instance, I prefer Ace Hardware store to Home Despot (oh, that is Home Depot). The prices may be higher, but you get good customer service and knowledgeable staff. 

The lesson in this tale is multi-fold:

1. Don't blindly trust the system including the people in the system. It could have dire consequences.
2. Be educated about your insurance policy.
3. Make sure you know what is happening around you. 
4. Be your own advocate or have someone else be your advocate.
5. Have notes written summarizing highlights of important conversations including names and dates.
6. Bring personal small comfort objects, whatever that is for you. 
7. Bring earplugs and try to get the bed farthest from the door (very helpful for sleep).
8. Bring a good dose of humor. 

Struggling

I am 6 days post op total hip replacement. Although this should be a relatively easy surgery I am seriously struggling -- mostly emotionally. I feel like I am free falling and cannot get any firm hold on anything. The rest of my struggling joints are being hit hard by my weakened state. I am struggling with being overmedicated by the Stanford pain management team. Who I now personally hate.  Since I came home, Friday, I have not been able to stay awake. It is a horrible type of drowsiness. Saturday, I woke up at 11am, then despite my efforts fell asleep during my uncle's visit, at 1 PM and slept through 6 PM. I desperately needed to wash up, but I couldn't be bothered, nor had the equilibrium to stay alert and upright.  Basically the same thing happened Sunday and Monday. Yesterday I woke up for 1 hour and then slept until 6pm. This is so unlike me. I have never had such an extreme reaction to meds. Also, it brought along a serious desperate depression of not being loved, forsaken, raging jealousy across a wide spectrum of  "things" -- not having children, no one sending me flowers, none of my friends calling (although my neighbors have been so terrific, and Larry too), why is my life so difficult?,why do my friends have such fine lives. you name it I am feeling it. It has been a very long time since I have plummeted so far and deep. I have lashed out at Larry and succumbed to my most immature reactions. So much anger and hate. To top it off, my brain is not functioning at all. I feel like there is a hole in it. I am clearly not firing on all cylinders. My negative experience in the hospital set the stage for a lot of these issues. Larry keeps telling me to let go, let it ride, but I am not succeeding very well. Every little thing is getting under my skin. This PM I have somewhat stabilized trying to hold it together. I yearn for so much and need so much. There is no filling the hole inside. So, I keep looking at the picture of Genesha that I have here in my room, the God who removes obstacles. I am looking forward to a little peace and hopefully happiness. I have struggled for so long.

OT: Support your Local Dump

I have been needing to get some outdoor working cabinets. So, today I decided to take a trip to the Last Chance Mercantile shop at our local community dump. Instead I found a sea of 1970's vinyl and wood office furniture that could endure outdoor conditions. So, Larry and I purchased, for the sum of $20.00 a couch and two chairs. They are not the ultimate choice in furniture or style, but certainly worthwhile for the price and establishing an outdoor environment in our backyard. They are certainly weather proof.

It is amazing what people throw away. Every time I go there, I realize what a throw away society we are. I am fortunate that I do not find it objectionable to get some used item for a tenth or more of market value, that is not entirely perfect but can do the job, and requires elbow grease. Frankly, I find something very comfortable and charming about these finds. I have made many happy purchases at the dump including desks, countertops, lamp fixtures, vases, firewood, end tables, coffetables, decorative items etc....

So, here is a salute to community dumps. May they be all supported and fruitful as the one I am lucky enough to contribute to and gain from. It is humbling, exciting, and fun, but you can never expect exactly what you came for.

How much is my Time Worth in this land of Mediocrity

Yesterday, I spent over 3 hours on the phone for one medical bill worth 270.00, that I am not exactly keen to pay because it doesn't seem fair to be dinged for a bill I recieved over 1 year post the procedure.

Increasingly we seem to becoming a land of abject mediocrity. Nothing is clear, followed through on properly, and then it seems to be spewed back at the consumer. This particular case is for a bill, from a provider of durable medical goods, that I frequently use following my multiple orthopaedic surgeries. Over the years I have seen nearly 5+ bills from this company that has an agreement with my insurance company. I have never needed to pay out of pocket, since usually, by the time I have surgery, I have reached my out of pocket max.

This time, something went really wrong. I received a bill over a year post surgery, stating that I owed $759.00, because I did not have insurance coverage at the time.  When this came to light, I contacted them directly, providing them with the correct ID (you see my company went through a transition and our insurance cards changed numbers). I thought that should make this go away. Well....Not!

I generally take the stance if I do not receive a bill then I should be ok with said provider. After not hearing from them for months, I received a collections letter for the amount due. I immediately called, requested to speak to a manager, who immediately said I was responsible, I signed an agreement with them for the insurance ID I provided and therefore, if something was wrong I was responsible for the amount. This immediately sent my hackles up. First, they make you sign papers as you are coming out of surgery and full of anesthesia, with blurry eyes, and doped to the max.  I typically do not remember what happened post surgery, so, how do I remember a specific number? It is like asking a drunk person to drive you home.  Anyway, I didn't know the insurance ID changed (everything else from that surgery was completely covered). Someone got the correct ID. I told the manager that I had called previously with the corrected info, but apparently the info did not get reprocessed with insurance. He said there was no documentation of the call. (Now this is where a on top of it patient can go back and look at notes of calls and name a person that they spoke to and the date. Unfortunately I could not find any record of this conversation, so shame on me). the discussion spiraled into an I said he said conversation. At the end, I said this can be solved easily by getting it reprocessed with corrected info. He then started squawking about a penalty for late filing, etc.... Patients typically have a longer timeframe to have claims processed (usually 18 months) than providers (I think 6 months). He seemed to agree to let me do that and hold the account. I called insurance, explained the situation, and they reprocessed it on their end. I expected that they would cover the charges in full (as they have typically done for the same charges). In fact, I just received and EOB for same equipment for my 08 surgeries, leaving a zero balance.

Insurance did not pay things in full. Frankly, after looking at the math over the series of multiple reprocessed EOBs I cannot ferret out exactly what insurance paid. The $ don't add up. According to the company insurance left a balance of 271.59. I received a call from the collector last week to pay the amount due. I told them since insurance paid I would like to work something out with the provider (Orhto Rehab).  They gave me a week to sort it out.

Part of me was thinking, shit, just pay it, and get this off your plate of things. I sat on that, but, the niggling feeling of injustice and that this just wasn't right sat with me.  So, I rolled up my sleeves and started calling all the numbers for Ortho Rehab. I was thinking of finding a VP to complain to. I called a different number for Ortho Rehab for my current bill to see if they could help. The original call center, in Arizona, was not helpful. The Denver call center did not know about Arizona, so I was again stuck. My brain and irritation was driving me to distraction.

Then I had a bright idea, why not contact the sales rep who provided me with the "goods" for my latest surgery. She was nice. I did get her number.  I called her, and she provided with a name of a person at the Arizona call center who may be able to help me out, or at least point me in the right direction. I contacted Mr Forrester. He picked up the phone. I explained my situation, he said he would look into it and try to help me figure out how to make this work to an amicable resolution. He was able to pull up my payment history, see how many times I have used their services, and wanted to assure me that they were about customer service. I said, wow, this is the first time anyone within the billing department took a big picture view, and that I was appreciative. We parted on good terms promising to resolve this in the near term.

And, so that is where things stand. I am not sure if the bill will be written off, but most importantly I found someone, who seemed to appreciate my situation, had initiative to look at my history, and was willing to do the right thing and figure out what happened, especially, given my history.

The lessons for me and others here should be:

1. Stay on top of complex billing situations.
2. Write down notes from any conversation you have with anyone about a bill or any complex situation.
3. Trust your instincts. If something doesn't seem right, it probably isn't.
4. Be creative about how you approach a problem. Or, sometimes doing the same thing over and over, you will get a different response.
5. Leverage your payment history (if it is good) or customer history.
6. Leverage insurance payment patterns if something seems different.

Now, I have to deal with several more of these types of bills, the next one is for $17K that insurance keeps telling me they did not receive the records they needed to process it. Although I have a note stating they had them in Dec. No rest for the wicked it seems. 

So, how do we keep moving on.....

Recently I have been regularly lauded by people I know and meet, including medical professionals about my endurance and great attitude. It is awkward to be told about my positive attitude these days. This got me to wondering and thinking about my attitude. I certainly know that when I started this journey, in 1994, when I was orignally diagnoses with MS, that I did not have a great outlook on the world. I did a lot of flaying, crying, and self destructive acts in the face of being really sick. And, boy, that MS episode was a real nightmare. I got really sick from the steroid drip, which unknowingly at the time, caused the future long term nightmare I am "happily" living.

When I found out I had this crazy bone disease in 1997, I did plenty of flaying, crying, and more self destruction. 

Frankly, I have only gotten this far, in the end, because I seem to be quite stubborn, I had to take my life into my own hands, and I have a great support network of friends, family, and some key medical folks that have helped me along. I truly couldn't do it without that. Also, I have been fortunate to play certain cards rigth (certainly no easy task) to get the help I needed. That was in large part in the face of what most people thought was reasonable. How many people are willing to invest in their healthcare to the point of traveling back and forth to a remote destination (Vail Colorado) to seek treatment, especially without deep pockets? Thank you Mom and Dad! 

After 9 surgeries there I have lost tract how much time I have spent/lived there. The last two years I have spent over 8 months in the Rockies? And, made some many great friends in the process.