STEAM ROOM FOR ANGER
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Thanks for your input. Hmm, no wonder. I also saw where they denied the Prolia claim from July saying there wasn't a pre-certification. Well, the pre cert was done in January and should be good for the year which would have included this last injection. Saw the cost went up another $2K! Not really worried about this, but annoying is a very good word to describe Aetna and CVS.
Will see what happens with my employer's decision for coverage next year. If they stay with this company, I will be certain to bring up my complaints at the election meeting.
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If a person enjoys making an appointment for a vaccine, standing in very long lines, and being told at the counter "we no longer have the staff for that," then come to my CVS! The pharmacy closes for an hour midday and at 6:00 PM weekdays, 5:00 PM weekends. CVS continues to send relentless messages to make an appointment for this-or-that vaccine. We're transferring all scripts and vaccinations to another pharmacy.
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I am going to vent right now because I am so saddened by the loss of the mother in a family that has had more grief to handle than any one family should have. She was diagnosed about a year after me (2014). She had cancer in her lymph nodes but they didn't do chemo. I was a little surprised at that. She was still grieving the sudden loss of her 19 year old daughter at the hands of a drunk driver. After her daughter died, she drank a LOT, and I can't stand in judgement of that, but it may have exacerbated the situation, I don't know. I also think that she may have stopped being monitored because she was complacent or her doctors were. She also moved about an hour south of where she was living at the time. She was diagnosed with stage 4 just over a year ago, had meds and radiation and then chemo this past Feb.
I'm overwhelmed because my son dated her daughter for over a year, and while they weren't together when she died, they were talking again. He went through years of working through it to be able to function again. He came over to let me know that her mother passed away last night. I'm just so saddened by this!
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My condolences to you and to that poor family that has such losses. The death of a child has got to be the worse experience for a parent. Your poor son may be triggered by this loss given his relationship with them. I hope both of you can find strength in supporting one another. (((Hugs)))
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Condolences. Losing a child is so hard to deal with. I remember when my uncle passed and my grandma said to me no one should out live children and have to deal with that pain. You expect to lose grandparents and parents but losing a child is the so hard. Does not matter how old they are they are our babies.
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@homemom so sorry for your loss—sucks. just so sad. Please extend that to your son.
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Having to deal with my mom who is close to 85 had to put her dog down this week. We used to care for him when she went out somewhere since she could not leave him alone and he would bother her neighbors in her old folks building. It is hard since he spent so much time here as well. We love our pets and hate to see them suffer as well. Hate dealing with something else right now since have to try to take care of my mom and it also means can't take care of myself like I need to right now.
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bcincolorado, Sorry for your loss and your mother's as well. Losing a beloved pet is difficult.
Can another family member assist with your mother? I do think there are times where we have to make ourselves the priority even though it seems selfish. It is not, because it is called self-preservation, and if you do not take care of yourself, you won't be able to care for your mother. Hope someone will step up for you.
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No I have one sibling who lives in another State and my dad is living with him who is even older and has health issues of his own. My mom moved here to be near us after she retired and my grandma had passed away from another State. She lives 2 miles from us so it is close by us and considers herself "healthy" for someone who is 85 but has had issues with not eating right and drinking enough and has fallen and hit her head a couple of times even in falls and about passed out. Too dehydrated. I have stressed food on schedule and water on schedule to keep her ok and not happening again. Now she has to go get some testing done because of issues with dizziness and they think it from those falls. Have a feeling she is going to end up with more skilled nursing care than I can give her.
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bc, I'm sorry for all the stuff you're dealing with regarding your mom. It's hard to watch our parents age.
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bcincolorado, it seems the priority for your mother is a safe environment and agree she most likely needs more supervised care than you can provide. You mentioned she is in an old folks building, does this mean it is a private apartment or an assisted living facility? My MIL was in assisted living but frequent falls meant she had to go into a more skilled facility for her safety. This may be the route you need to explore. Good luck and (hugs).
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My mom lives in an apartment in a secure bulding and it is all seniors. They used to be able to do a thing where they turned on a light in their apartment in the morning and it would light up in the office at night and turn it off in the morning. If no one responded they would check on them. Then someone said they needed other licensing for that and made them stop doing it. Now I check on my mom every day by phone and or email a few times a day and make sure she is eating and drinking ok. She still drives and is off going to the store and to church or over here. Nothing is too far.
We did take her out to go watch the grandkids play in some games over the weekend. Very tiring. They live about 30 minute drive from here. It is her great grands. They gave her some big hugs about her doggie since they knew him as well. That helped her be a little cheered seeing them.
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@bcincolarado (not hyperlinking?). sorry, for your trouble. Been there. The worry. The feelings of no control even though your trying your hardest to help. It sucks. I'll cut to chase of my thoughts from a nursing perspective.
Some doc is directing her care.
1. Ask if the following labs have been done. TSH(thyroid stimulating Hormone), B12, Folate, Mg, Vita D, Vita A (you will get very serious pushback on this request—-you push back), plus standard Metabolic profile, CBC. In researching each of these tests, some element in the symtom lists apply to many. That's why most of these tests are include in the yearly exam, and in change of condition evaluation.
2.Referrals for the following:
—-Physical Therapy Evaluation and treatment for falls. Best person for that evaluation TaDa, It's covered by insurance b/c falls are close to the top of insurance payouts. Prevention is a priority.—-Next referral, Memory Care Specialist Evaluation and Recommendation. The professionals go by many names or alphabet, but the key is specialization or extra training in the evaluation of memory. Just like every other doc specialty, they are even more specialized within their own specialty. Don't be afraid of this type of evaluation. You expressed multiple times in your post. YouR concerns of her wellbeing. The professional doing the eval can make recommendations and orders for neurolgist eval, tests like brain MRI/ Ct Scan.
The sequence of docs/ other professional evaluations may be required by different insurance systems. The key is always to rule out a physical cause first. ABSOLUTE KEY. So keep working the problem.
Next referral. Home Health Agency to Evaluate and treat. This causes a Nurse to go in an admit with the patients consent to be admitted to home care. The nurse can make all kinds of referrals based on that one sentence. Mechanism of the how isn't a need to know in the sense that the system is designed to bring all the services together to provide the highest level of in home evaluation & care. The nurse can order in an Aide that can help with baths, linen change, light housekeeping, grocery shopping; Physical Therapy E&T. Social Worker E&R. Occupational Therapy E&T.
The CENA (the Aide). May be covered by the facility. If not covered by the facility, the key here is she safe taking a shower by herself. By medicare rules a patient can be approved to six hours a week of assistance. That can be broken up many ways based on need. The time however is very defined, it must be used for direct care given. Traveling time between patients isn't approved.
An Admission to Home Care is for an eight week period. Insurance companies follow Medicare guidelines. In that time period all the specialties that would evaluate your mom would have evaluated her and how her surroundings impact her. They will work on bringing her to her highest level of function for her situation.
Ophthalmologist referral: Before this decade I'm in now, I would have never said that AND rarely if never will you find this in the algorhtim for problem solving about Falls. BUT I have Wet Macular Degeneration. Guess what you won't find in in the symptom list—Falls. Of course, it started with dry mac . The key to macular changes is that your depth perception is affected. Try walking in a world where what you see isn't exactly right. Every step is suspect. But the average person may not connect an eye problem to a balance/falls problem. Key request to ophthalmologist "Can any condition with in these eye(s), contribute to Falls".
Your job is to make the request of her doc with her permission for refferrals. Trusting that you have Health Care Surrogate papers. Once the ball starts rolling the ideal is for you to be at every in home evaluation b/c by watching the professional's put mom through the paces you will see the problems. The evaluations are designed to make them manifest as a problem.
It will seem alot. But it's this many NURSE, PT, OT, Soc WORK. FOUR thats doable. You do two things by being present at these evaluations. YOU REDUCE YOUR ANXIETY about something being done to help her. And you are helping her by getting this all going. Plus the doc referrals which I count max three—neurology, memory care, and ophthalmology
It's very busy over a couple of weeks and then your time involvement will fall into a pattern. At the pattern point, you will request updates by phone. Home Health Agencies are very used to this.
After the evaluation session you do not need to be present for any visit. Unless someone thinks it should happen. Then you do & they do. That's a very important point. The key is to reduce everyone's' stress. A plan is worked out. Reduce all visits that you have to be present at. Quality not quantity.
I'm happy that I wrote this, unhappy about sequence of referrals. It can be confusing as written. But I have had a gummy and on a roll. Perhaps, I could write out the way the request would be salient0 -
@bcincolorado
Lab request CMET(CMP), CBC, TSH.B12, Folate, HBA1c, Vita D, Vita A, Mg
Referral. Home Health Agency to eval and Treat to include PT, Social Work, Occupational therapy.
Request that Insurance agency assign nurse to follow and expedite problem care.
Referral for Neurology and or Memory Care Evaluation.
Referral to ophthalmology for evaluation of Night blindness, dry eyes, retinal changes, Cataracts, Glaucoma, Visual perception changes
All that rambling up top reduces to a few sentences0 -
@bcincolarado Again, shucks this gummie is driving me Hahahaha…
The key in getting this all rolling is that she has had an INCREASING number of FALLS without an identified reason. That warrants all the evaluations. Anyone blowing it off to old age is a moron. Yes, we deteriorate. Yes, we will die, but don't let it be because of something we can measure/treat/fix/ ameliorate and guide0 -
Okay, reread, fixed most grammar and stuff. Pretty good stuff considering I'm feeling in the Margaritaville way. :)
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LOL sash-schatzi. Thanks for the advice. I know what you are talking about medically. Mu daughter in law is am RN and know she has been adding in her two cents to us as well and they keep track of us medically as well with our issues and her folks who live not far from us. Helped when I fell and had to go in the hospital in April after my fall and she got me a great room.
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bc, it's nice to have "connections" who can get you a nicer room in the hospital. 😀
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Definitely. The one I got was huge and had a couch which helped with family coming to visit as well. I also was in a corner and away from a lot of noise in the hallway as well. My spouse could set up his computer and stream movies or shows even if we did not like what was on the tv which was pretty sad entertainment when I was stuck in bed. With a lot family visiting a big room helped as well with so many coming in as well and we did not have to worry about disturbing others while they visited the those who were out of town since my daughter and son in law came down as well.
Did hear about mom tests though and sounds like creatine was off and egfr so her kidneys are not working right I think. I know she said she had not been drinking as much as she should have after her dog died and she was in bed and sad. Told her she needs to still take care of herself no matter what.
She worries about me all the time with cancer and after my fall since she is my mom but I am more worried about her right now. I at least get a 2 week break before any more medical stuff goes on for me.
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Hope everyone is doing well.
Anxiety is up, have a mammo next week and I'm having pain on the left side, it better be nothing. I can't feel anything. Not sure why it hurts?!! I mean like a 5 hurt. I bought a few new bras in case it's a support issue? Pretty steamed right now. I guess I will never feel normal again.
At least I have a distraction going on right now, Go Phils!!!! Baseball in October is grand! Here's a pic of my house.
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Oh ctmbiskia I hope your test comes out ok. I know where I go because of my breast cancer and stuff they are watching on me they read the one I do on my non-cancer side when I am there and often though I do a 3D mamo also do an ultrasound at the same time so it takes longer of course. They at least tell me before I leave if they saw anything or not. Keep us posted.
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The Ibrance commercials are very maddening. I wish Pfizer would use their advertising budget to reduce the cost!
For seven years I have been on Ibrance. Every year I search Medicare.gov and the cost for me has been about $12000/year with the best Medicare part D coverage. I do not qualify for financial assistance. In 2024, my cost will decrease to about $3200 thanks to passage of the Inflation Reduction Act. It has been frustrating to have people tell me that they have great insurance coverage and all their drugs are paid for by their insurance. It feels like they are implying that my prescription coverage was a poor choice which is totally false. Thanks to the current administration, the cost is finally going to be reasonable and in 2025, no one on Medicare part D will pay more than $2000 for drugs.
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Ctm, wishing you peace before your mammogram. Here’s to distractions, right?
Illinois1, I agree. I have no idea what my drug costs are going to be when I switch from private insurance to Medicare.
Carol
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illinois does anyone remember when the drug companies and lawyers could not advertise on tv? Hate when they say "talk to your doctor about taking xxx". Really? Do you think your doctor is that dumb? If so you should not be seeing them to start with!!
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sunshine99, You can go to the medicare website for your state and see what the various plans for your zip code will cost before signing up. It's easier to do when you have a medicare account since you can save all your information but I used the site in advance to decide whether to buy medicare part D or retiree prescription insurance. You enter all your meds and choose pharmacies near you. It gives the total and breakdown costs of each plan and lets you see if they cover everything you take. Things change every year but it was useful for planning purposes.
I ended out going with retiree insurance but am looking forward to switching to part D in 2025 when the drug cap is $2000 (as long as my expensive meds are in a formulary.)
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For me a PPO plan was better. For DH he is on advantage plan since he also has VA and they do all his meds which is a lot cheaper in the long run for us. I am on Medicare only at this point though and the PPO plan did not need pre-auth on the tests. The drug companies are making a fortune off all who have medical issues.
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I passed the mammogram!! It did say there are benign appearing calcifications present (both sides). No prior mention of that. I did not mention the pain to the tech since it is gone now. Had it for a week. So, I'm glad that's over and very glad the pain stopped. Not going to worry about it unless it comes back.
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Way to go @ctmbsikia! ! Think go all of you as you navigate all the health insurance issues. Please reach out if we can help in any way!
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Congrats ctmbiska! I know the scans we do make us nervous. I am so glad yours are good. You need to be able to relax a little bit. 😀
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Need to vent, this time about my Multi-Ethnic Lit professor. Knowing its a short week because of Thanks giving, she decided to have us do a discussion post about 2 of 4 poems we had to read, 2 response posts to other classmates posts and start a rough draft of thr Final paper. On top of this, if we had any issues to fix with our presentations we had to do last week that lead to the Final paper, to do that too. the only thing that I am happy with so far this week is that my Shakespeare professor only had us working on the rough draft of our final paper for that class.
I mean what kind of numbskull loads a student down with that much work in a week where a holiday occurs?2
