The Health Of Our Care - Notes from the Un (Under) Insured

"All hope abandon, ye who enter in!" That famous line from Dante's Inferno seems terribly apt for many of us when we face a serious illness like cancer. Not only must we face a terrible disease and our own mortality, but we enter a frightening maze in navigating the healthcare system.

The Health Of Our Care will be an occasional column here on Fitness for Survivors. Once a week or so, I will feature someone's experience of dealing with cancer or some other serious illness, of getting - or not getting - the care they need. This is not meant to be a platform for my (or anyone else's) political opinions. Although I have opinions about what should be done, I will continue voicing them elsewhere, not here. 

People who have not had a health crisis have no idea how complicated and terrifying it can be. It truly is a full-time job. If you have insurance, you drown in paperwork, making sure you have all the proper forms and permissions, hoping desperately that your insurer will actually cover your medical treatments, and fighting in Kafka-esque fashion if they deny your treatments. If you don't have insurance, you have more paperwork, plus the added stress of finding doctors who will treat you, and figuring out how you will pay for it (sell your house, sell your car, another mortgage, stop paying your other bills?). And then there are the huge number of underinsured: those people who have faithfully paid their premiums for years only to discover that what they've paid for doesn't actually cover any of their necessary treatments.

So, as our fearless (or is that fearful?) leaders continue to debate the health of our care, I thought it would be interesting to tell some of the stories of how we all manage - or can't.

And I'll start with my story. I have insurance, and they have pretty much paid for everything. (In case you thought this would be an insurance company-bashing festival, it's not. That would be far too simple.) Good story, right? Well, with healthcare in America, I don't think there are too many simple, good stories.

I have an HMO with Aetna. They have covered all of my treatments/surgeries/doctors visits over the years. I have co-pays, but they're reasonable.

A decade ago, when I was beginning my healthcare adventure, I was quite worried about my insurance. Congress at that time also was debating some aspects of healthcare, specifically Medicare reform. There were scary ads about how managed care gives people no choices about their care, and news stories everyday about how people with HMOs couldn't get the care they needed. No opinions here about whether all of that was well-founded or just fear-mongering, simply that that was the atmosphere when I entered the ranks of the sick.

So I was scared: I had been paying my premiums for years, but would I actually be able to get the care I needed, with doctors I liked and trusted? Instead of simply worrying about finding the best doctors and figuring out my best medical options, I was worrying about whether I could afford to do anything to save my health.

Pleasantly, I was surprised. Aside from having to do a lot of running around and phone calls to get the proper approvals, I got great care. I found doctors I trusted completely, never had trouble getting a second opinion, was approved for all the procedures and treatments I needed. They covered my wig during chemo; they cover my compression sleeves and gloves. For a long time, though, I didn't have drug coverage. So during chemo, I would buy a couple of anti-nausea pills at a time. I'd take one or two of the good pills and then switch to the less effective but less expensive alternatives, and hope for the best. But except for the no drug coverage thing (they later added drug coverage), Aetna has covered everything else.

That's the good part of the story. But as I said, with healthcare in America, there are not too many simple, good stories.

For this very good coverage, I pay dearly, around $900 a month. Yes, that's per month, not per year. That's for one month, for one, single person. And that's close to one third of my income (gross, not net). That's right - nearly 30%! And given the economy and the financial strains for music, the fitness business, and real estate, that percentage will undoubtedly go up this year as my income continues to go down.

People who have never had to pay for their healthcare out of their own pocket, who have always had insurance through their job often are shocked; they have no idea. They don't understand that for those of us who are self-employed, as more and more Americans are, or whose jobs no longer provide health insurance, healthcare is probably our biggest expense.

Could I just change plans? Not really. As a self-employed free-lancer, I don't have access to group discounts. Other similar plans cost just as much. Could I switch to the often-touted high-deductible plan? No, because they don't really cover much. They may be fine if you never actually get sick or injured. But they offer no real provision for people who need ongoing care. I'd be paying for most of my care myself.

So I feel like I can't complain too much because Aetna has actually honored their contractual commitments, unlike some insurance companies. For more than 20 years, Aetna has had access to many, many thousands of my dollars. But when I needed care, they did what they were supposed to. It's worked out pretty well for both of us.

I'm lucky, though. Because I live with someone, my household expenses are shared. If I lived alone, I am quite sure I would not have this insurance now. I would not have been able to afford it. At some point, I would have been faced with a choice between health insurance and having a place to live. I live quite frugally; I don't spend money I don't have. It's not like I could pay for the insurance simply by cutting back on movies or shopping (I don't really do either of those things much). It would come down to a choice between basic necessities: food, shelter, or healthcare.

So, I am pleased and grateful that I have had the excellent coverage for my health care. I am pleased and grateful that Aetna has generally covered all that they should, and been fairly easy to deal with. (this is from my perspective, I have no idea how doctors or hospitals feel about the company.) And I am pleased and grateful that I have managed, somehow, to afford this coverage. But it has come with a very big pricetag, one that we cannot all afford.

Julie

Staying Fit In Nantucket (or wherever you're traveling)

Staying fit while traveling can be difficult. You don't have as much control of your diet as you do at home, and it can be tricky fitting in some exercise.

Right now I'm up in Nantucket with my quintet, the Abaca String Band. We just played a concert for the Nantucket Arts Council. (Thanks to Arlene, Natalie, Dan, and everyone else involved for all your help & good company.) It's my first trip to Nantucket, and I love it here! I've had great food (Town tonight, & a great bay scallop sandwich for lunch at Cy's!), and am staying at the lovely Hawthorn House (run by Mitch & Diane Carl).

This is just a short trip, a few days, but we have been out on tour for many weeks at a time. It's hard to stay fit when you're on the road; I know. But it's quite possible. In fact, I trained very hard a few years ago to prepare for climbing Aconcagua while I was out on tour.

A great way to keep fit is to always bring some running shoes. Run! Wherever you are, run. I got up this morning and went out for a run. I ran to the lighthouse, beach, and through neighborhoods. It was cold and windy, but it felt great!

If you're not a runner, walk! You'll get a little exercise and get to know where you are. Before I started running (I'm pretty new to running), I would go out and walk, rather than take a taxi or subway. It's a terrific way to get to know a city. I've gotten to know many neighborhoods in Paris, Hong Kong, Prague, and other cities that I never would have known without walking. You learn a great deal about a place (for instance, there are a tremendous number of real estate offices on Nantucket - can there really be enough properties for sale to support them all?).

So, pack a good pair of running or comfortable walking shoes on your next trip. They don't weigh that much; just put them in your suitcase. Get outside, get to know the place you're visiting, and get some exercise.

Julie

Oh, and special thanks to Beverly Hall for her beautiful book!

Exercise - Get It Wherever You Can

We're all busy. "I'm too busy to get to the gym" doesn't count as an excuse for not exercising. "I'm too tired" doesn't really work either. And in these very tough economic times, "I can't afford the gym anymore" is commonly heard, but, once again, doesn't really work as a reason not to work out.

I haven't been to my gym for my own workout in almost two weeks, but I've gotten plenty of exercise: I did some spinning for Cycle for Survival 2 weeks ago, I've been chopping and stacking lots of wood, shoveling, skiing, cleaning my house....

You don't need an hour at the gym; you don't even need a gym. It's great if you've got the time & access to a gym, but it's not necessary in order to be healthy.

Take advantage of what the weather or your life brings to you. Get some exercise from your daily routine. Just do what you do at a high enough intensity that you get your heart pumping & start breathing a little harder.
*rake the leaves instead of blowing them into your neighbor's yard.
*shovel the snow (or go out & help the kid you've paid to clear your walk)
*do some squats while you're on the phone or drying your hair.
*walk your dog at a little brisker pace - it will be good for both of you.
*instead of carrying everything up the stairs at once, make a few trips up & down the stairs.
*chase your kids (or your cat).
*put on some music & dance while you're dusting the living room - come on, you know you want to. It doesn't matter if it's country, swing, or some of that fine 70s funk, get down!

Just get moving!

Julie

Today's Life-Cise Workout Is Brought To You By The Letter B (for blizzard)

Snow!

No gym for me today! - not when there's skiing to be done.
Besides a lot of shoveling, my workouts the last two days have been on skis. Skiing this morning before rehearsal. Skiing yesterday afternoon during the blizzard. Skiing last night at midnight in the howling wind. (alright Mom, when I ski at night, I usually stick to trails) I always hear Sibelius in my head when skiing in the woods in a blizzard.

I know the storm caused lots of problems for lots of people, but I've enjoyed it. I can't control the weather; can't stop it, so I might as well have some fun.


Enjoy!

Julie

Exercise and Your Brain (it can help with dementia, can it help with chemo-brain?)

There is a growing body of evidence that exercise improves thinking and memory. Two recent studies published in Archives of Neurology add to that evidence.

In one study, from the University of Washington School of Medicine and the Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center, found that six months of intense aerobic exercise improved the cognitive abilities of subjects who had mild impairment. The exercisers experienced improvement in organization, planning, and multi-tasking; while the control group (who did stretching exercises but kept their heart rate low) continued to decline.

A second study found that people who exercised moderately in midlife were less likely to develop mild cognitive impairment. Moderate exercise, such as walking or swimming, in midlife was associated with a 39% lower risk, and moderate exercise in late life was associated with a 32% lower risk of mental deterioration.

Every year, 10-15% of people with mild cognitive impairment will develop dementia, compared to just 1-2% of the general population.

In addition, the BBC convened a panel of experts, chaired by the Alzheimer's Society, to evaluate the available research on dementia. Their goal was to come up with tips for reducing the risk of developing dementia. Based on strong evidence, their top recommendation was exercise! (click here to read all of their recommendations)

All of these studies are looking at age-related dementia or cognitive problems. Unfortunately, to my knowledge, there has been no major study on chemo brain and exercise. (I'm thinking this would be a great area of study for all you researchers out there....) However, there is some anecdotal evidence that exercise may somewhat improve the fuzziness of a brain on chemotherapy.

Some of my clients at Life-Cise and Stay Fit Stay Strong have reported cognitive improvements when they exercise. And many people in the cancer community say the same thing as well. I certainly experienced less "fuzzy-thinking" when I worked out during and after chemo.

I know that I don't understand enough about the workings of the brain to know if this makes sense scientifically. I don't know if the mechanisms of chemo brain are at all similar to the mechanisms of early dementia. But if there are similarities in the two conditions, it stands to reason that exercise may impart as much benefit for fuzzy-brained chemotherapy patients as older adults concerned about dementia.

Once again, I think this is a great area for study! If anyone knows of any existing studies, please let me know. I'd be very curious to read them.

And if you are currently in chemo or recently finished, try getting some exercise. It can help you feel better, and it might just improve your brain.

Julie

World Cancer Day

Today, Feb. 4, is World Cancer Day. The day is brought about by organizations such as the International Union Against Cancer and the World Health Organization.

The WHO estimates that 84 million people will die from cancer between 2005 and 2015. Remember, that's not just a statistic - those are 84 million of our mothers, uncles, friends and children. It could be you. It might be me.

This year's theme is "Cancer can be prevented". Simple measures can dramatically reduce your risk of developing cancer: don't smoke, limit alcohol use, protect against cancer-causing infections (such as HPV vaccine to prevent most cervical cancers), maintain a healthy weight, and exercise.

These are all things that are easily in our control. Do they mean that we won't get cancer? No, I'm a perfect example. I was young and healthy, ate very well, exercised a lot, and I got breast cancer in my 30s. So, it's not a guarantee, but following these measures does reduce our risk.

Life-Cise was founded with the idea of using fitness to raise the quality of life and health of people going through cancer treatment. However, increasingly, I am trying to promote the idea of fitness to prevent cancer. After all, quality of life and health are both better and easier if you never develop cancer!

The National Cancer Institute estimates that 25-30% of all colon, breast, endomitrial, kidney, and esophageal cancers are directly attributable to excess weight and lack of exercise.

So, try to get 30 minutes of moderate exercise (like walking) most days of the week. This can be split up into shorter segments; the 30 minutes doesn't have to be all at once. If that's too much for you at this time, do what you can - some exercise is better than none. Start with whatever you can manage, and build up your strength slowly. It's a process.

If you have cancer, exercise can help you feel better and manage the side effects of your treatment, as well as lower your risk of recurrence (for certain cancers). It can also lower your risk of developing certain new cancers - a good thing: we know that cancer sucks, we don't need to experience another!

And if you haven't had cancer, GREAT! KEEP IT THAT WAY!

Julie

My Great Outdoor Workout For The Day - Upper Body Strength A Plus!

I didn't go to the gym today, but I got a great workout anyway. We recently had to clear some trees around the house. The trees are down, cut up, and ready to be split. That was my workout - splitting and stacking wood for a couple of hours.

I love being outdoors and am always happy if I can get my exercise outside. This is a terrific workout for the shoulders and back.

I've offered a great deal on this great outdoor workout. I keep hoping one of my Life-Cise or Stay Fit Stay Strong clients will take me up on the offer; so far, no one has. I just don't understand why - come on people, it's a great workout!

And tomorrow we're supposed to get some snow, so there will be shoveling to do. Today was Groundhog Day, and Punxsutawney Phil did see his shadow. So there are likely to be plenty more opportunities for shoveling in our six more weeks of winter.

I realize most of you don't have cords of firewood to split, but a fair number may be shoveling (or raking leaves, digging in gardens, or any number of other activities that can stress your shoulders and back).

This is one of the reasons I always recommend upper body work for all my clients and friends. We could all use a little strength to get us through the chores we have before us. And being in decent shape makes it more likely we can accomplish our tasks without strain or injury.

This is especially important for anyone at higher risk of lymphedema. Regular strength training has been shown to be helpful, not harmful for breast cancer survivors with lymphedema. And sudden strain or injury can be a trigger for the onset of swelling.

So, do yourself a favor, work a little upper body strength training into your exercise routine. You don't have to do it every day; a couple times a week can be adequate. Start of with light weights if you haven't been working out for a while. You may want to start with no-weight exercises - just use the weight of your arm for resistance.

As you get stronger, you can increase the number of repetitions or the amount of weight, just not at the same time. When you do increase the weight, do it a little at a time. I like using water bottles when starting out. They only weigh a couple of pounds, but you can vary the weight by more or less water.

Here are three easy and effective exercises for your shoulders and upper back.

Straight arm raises: Strengthens muscles of the shoulder and upper back (deltoids, latissimus dorsi, trapezius, subscapularis, teres).
Stand straight with your shoulders back and down. Raise your arms, keeping them straight, to the front. Raise them only to shoulder height. Lower. Do this exercise also to the side, only raising arms to shoulder height. In the beginning, do this exercise using no weights; the weight of your arm will provide enough resistance. Begin adding weight slowly, for instance, using a water bottle so you can adjust the amount of weight by adding more or less water.

Rhomboid squeeze: Strengthens muscles of the upper back and shoulder (rhomboids, trapezius, serratus).
Extend your arms out to the side, at shoulder-height. Bend your elbows 90 degrees so your hands point forward. Keeping your shoulders down, pull your arms toward the back, squeezing your shoulder blades together. Add weight, if desired.

Pushup: Strengthens chest muscles (pectoralis major and minor), front of the shoulder (anterior deltoids), and back of the arm (triceps).

Do whichever version of pushup is appropriate for you: wall pushups, counter, modified, or full. Just make sure you do them in good form. Keep your torso straight, like a plank. No sagging hips or butt sticking up.

Anyone who's read this blog for a while knows I love pushups. They are a nearly perfect exercise, concentrating on your shoulders and back, but also working arms, abs, and legs. And everyone can do them; you just need to do the appropriate version for your current strength level.

But if you start adding these into your week, you'll be much better prepared for the next snowfall (or tree fall).

Julie