Going in style

We all want to go in style - none of this sitting on a nursing home porch with drool running down your chin for seven years, but to be the one sliding to a stop with a drink in one hand and a tan left from a tropical vacation - saying 'yee-haw, that was fun'. Unfortunately life doesn't always let us do that. As a second best effort, we can make out a living will that tells what we want. (What am I on a morbid kick? No. And I have no plans on going anytime soon, but I could get hit by a bus tomorrow. I call it being practical.)

A few weeks ago, when I was passing through the hospital lobby on the way to an appointment (what a novel experience, it hadn't happened for at least a couple days), there was a group of nurses sitting at a table distributing information and answering questions on living wills and health care proxies. I have been asked about these a few times by my doctors - they just want one in my medical file. (But where are they going to keep a piece of paper in their electronic records system - it sound likes it defeats the purpose.)

I did fill one out once and get it witnessed and its someplace around here. The one question I did ask the nurses is once you make out your living will, what are you supposed to do with it once you have it? The answer is - keep the original, give a copy to your doctor, and give copies to those you designate to be decision makers. That was helpful.

But I digress. I like the idea of having a living will. I like the idea of having a plan - I am a planner, ask my husband, it drives him crazy. I think I want to plan a big bash when I am going. It will be before I go because I want to be there. You can have another one after I am gone if you want, but I want one last bash.

More than that, I want to plan my going. Through my job at the cancer support center where they have an Advanced Cancer Support Group, I have learned about a program called Aging With Dignity, where you fill out a form called Five Wishes. In this you answer these five questions:

1. The person I want to make medical decisions for me when I can't.
2. The kind of medical treatment I want or don't want.
3. How comfortable I want to be.
4. How I want people to treatment.
5. What I want my loved ones to know.

Not only does it ask the questions, it helps you answer the questions as well. It includes medical, spiritual, emotional, and personal issues. And it is accepted as a living will in many states. And it tells you how to make changes at a later date, etc. Its very practical. It involves planning - I like that (even if its only to drive my husband crazy).

An ounce of prevention beats a pound of cure

We get our flu shots and other lovely injections to prevent 'bad' things. Now 'they' (as in the big mysterious them a/k/a big brother) tell us that Tamoxifen and aromatase inhibitors can help prevent breast cancer in women who are high risk. And if you take a pill for five years you get another 15 years, 20 years total, of 50% or more risk reduction. Now that is pretty good news I'll say. If I could have prevented my breast cancer, I would have. But I was basically at a normal risk level so I wasn't a candidate

But the article adds that there are risks of side effects from the medications. Tamoxifen can cause uterine cancer or blood clots. Aromatase inhibitors can cause hot flashes, bone loss, muscle cramps and other little fun things. Side effects are side effects. I do not think they are a reason to stay away from a medication. First of all not every one gets them. If they did, the drugs would be off the market. If you have to deal with hot flashes for five years but then significantly reduce your risk of cancer for another 15, I'll take hot flashes over cancer any day. If one drug does not work for you, there are often substitutes that can be made. And if you are on the medications you will be well monitored.

My take on drugs that are recommended to me is that I will try them and if I can't cope with the side effects or don't like how I feel, I go back to my doctor and ask for a dose adjustment or a substitute medication. A medication is taken for a purpose and which is the lesser of two evils - the side effects or the original ailment?

A pound of cure for breast cancer often includes chemotherapy as well as radiation and surgery. Surgery leaves scars. Radiation can leave skin and other issues. Chemotherapy can leave blood issues, and chemo brain. Now that it has been documented by Fox News, we can confirm that chemotherapy causes chemo brain. So not only do you get to be on the cancer roller coaster for life but you lose some of your marbles, a/k/a brain cells, during treatment. But my chemo brain has created an endless supply of humor for my husband as he laughs at my latest brain freezes, and I'm not even a politician.

I did the exercise, eat right, take care of myself life style, but apparently it wasn't enough. I want a magic pill that prevents everything - or are those called vitamins?

More on insurance rates

Today's paper tells me that Massachusetts no longer has the highest health insurance rates in the country. In fact it is now down to number 9 on the list. In 2009, the average health care cost for a family was $14,723 and in 2010 it was $14,606. So it actually decreased a tiny bit. Here's how the numbers stack up

2009	2010
1. MA $14,723	1. DC $15,206
2. WI $14,656	2. NH $15,204
3. VT $14,558	3. FL $15,302
4. WY $14,319	4. CT $14,888
5. DC $14,222	5. RI $14,812
6. AK $14,182	6. NY $14,730
7. CT $14,064	7. IL $14,703
8. LA $13,846	8. DE $14,671
9. MD $13,833	9. MA $14,606
10.NH $13822	10. ME $14,576

I actually find the numbers appallingly high. That's a lot of money no matter how you stack it. $15,000/year is $1250/month - a significant amount. Yes employers usually kick in a fair amount of it, but that percentage has been decreasing for many years. I know people now who's employers only kick in 50% leaving the other half to the employee. And we know co-pays are going up. Even for Medicare. There is another article in the paper that says Medicare is increasing the co-pays for some brand name drugs by up to 40%.

Also, the rate of increases are substantial. In 2003, the average family premium in MA was around $9300. "Even if Massachusetts is improving, “health care premiums are still growing at a faster rate than our economy, and they’re growing at a faster rate than our wages, and that’s a problem,’’ said Sarah Iselin, president of the Blue Cross Blue Shield of Massachusetts Foundation." 

The question is are these results indicative of the success of the MA state health care program or just a 'blip' in the radar? I hope they are showing success. I would like to note that while some states on this list increased around $1000 from 2009 to 2010, MA didn't increase at all.

Who is getting all this money anyway? They blame costly tests and expensive medical equipment so where does the money go? Are the costs high because the machines are made out of some expensive metal which means the mine owner in some corner of the globe is getting rich? But its still just too much money. We need to figure out more ways to reduce these costs.

And they still want to raise rates

I live in Massachusetts. We are not that big a state with a population of just over 6.5 million. The largest health insurers have announced their third quarter earnings. They claim they had a good quarter because of 'seasonal improvements' and fewer health claims due to a sluggish economy.
That's a lot of hogwash to me. What are seasonal improvements? I mean I understand that there is less flu in the summer but people are active and they drive more, enjoy potentially dangerous outdoor sports, etc. And fewer claims because of a sluggish economy? People don't go to the doctor when the economy sucks? I can understand delaying your nose job until after you get a job but I'm not sure its covered by insurance anyway. But cancer diagnoses still happen. I do understand that people might be reluctant to go back to the doctor for a follow up and pay another co-pay when they are tight for money but people still get sick.

I like this quote from the article: "Blue Cross said it was pressing forward with its campaign for health care affordability, both by managing its own administrative expenses and by holding down reimbursement increases for doctors and hospitals." Hmmmm.... So BCBS is getting rich but hospitals and medical professionals are barely making ends meet. I like the idea that insurance companies are working on their own administrative expenses but dislike their reimbursement reductions. Insurance companies should not be making medical decisions.

Anyway, on to the numbers. Remember the state population of 6.5 million:

Blue Cross Blue Shield of MA - earnings of $78.9 million, up from $75.8 million last year
Fallon Community Health of Worcester - earnings of $12 million, up from $7.2 million last year
Tufts Health Plan didn't do as well as the rest - earnings of $52.6 million down from $59 million last year
Harvard Pilgrim Health Care also didn't do as well - earnings of $37.9 million down from $44.5 million last year

Total for third quarter earnings this year are $181.4 million, against last year's $186.5 million. So maybe they weren't quite as good as last year but they still made money. And they want to raise rates. I am not sure the exact numbers and think they are slightly lower than previous trends but they are still substantially higher than the cost of living increases most of us see in our paychecks.

I am in the 1.3%

I found this breast cancer risk assessment tool online. I took it based on me before my diagnosis and I was considered as having a 1.3% chance of getting breast cancer, vs. a norm of 1%. I took it again, based on my current age and pretended I didn't have breast cancer, and I would also have a 1.3% chance of getting breast cancer vs. a norm of 1.3%.

I then tried taking it and answering the first question and said I previously had a breast cancer diagnosis and the tool could not compute as it is not designed for those with a cancer diagnosis. We are in a special group, we are off the charts.

Then I started plugging in the information for friends and family members to see the impact of my diagnosis on them. I was surprised how much of a difference it made. Because of my diagnosis, their risk has increased by at least 50%. Go check it out and see how you can figure out your risk and everyone you know. Its kind of interesting to see how little factors have impact.

Yes I do know there are all those other little pesky factors that must have put me in that 1.3% instead of the 98.7%. Obviously I drank too much, smoked too much, ate too much fried food, used too much plastic, played in contaminated swamp lands, didn't take vitamins, etc. that put me in the wrong group. Grr.

Promising research

A few weeks ago I went to a conference and Dr Susan Love spoke about the latest in cancer treatment and research. One area she talked about, that I didn't explain well in my other post, was that one area of research is to look at what is in a cell's neighborhood that causes it to turn cancerous. The theory is, according to my tiny, non medical brain, that there must be something about the area a tumor is in that allowed it to grow instead of just remain a bunch of normal cells.

Now there is an article on current research on the cancer cells' neighborhood. If you think about it, it is fairly logical. I mean put a person in a tough neighborhood that lives on guns, gangs and drugs, and what are the chances they will not be touched by the bad influences? Its the same theory with the cancer cells - what are the bad influences that turn the cell into a cancer cell?

This picture explains it in better detail (and its prettier than a lot more text):

Also as part of the conference one of the doctors, who is head of the radiation oncology department, spoke about how important it is to treat not just the area of the tumor but a centimeter or so around it, but not much more than that. Treatment is becoming much more targeted.

I look forward to future research that expands on this new knowledge. Cancer research has been going for a long time but this is now looking like a new direction which might be promising. But I am getting kind of sick of waiting...

Make a list

When I was first diagnosed with breast cancer, I joined a support group at the hospital for newly diagnosed women. It was our introductory support group and we met weekly for seven or eight weeks covering different topics of life with breast cancer. Of that original group, there are five of us who still get together for coffee periodically. One of the members of the group was actually on her second breast cancer diagnosis. Then she had a recurrence a couple of years ago. Then we found out she died in mid-October. We didn't know. We were appalled. We never got to say good bye. We would communicate primarily by email. She used her work email address. She retired finally this summer. We think her husband didn't know how to get hold of us.

I spoke to another member of the group about this. She said she immediately turned to her husband and said 'don't forget to tell my friends if anything happens to me'. He wanted a list of who to contact.

We used to joke about my grandmother's 'in-case-of-death' envelope. She would write notes and put them in the envelope of things she wanted done upon her death - who to notify, her services, where things were, etc. If you do this for 20 years, you need to update it periodically. But when she did finally die at 96, we knew what she wanted.

I'm not planning on going anywhere soon but I will make a list too.