One Year On
Yesterday was the one-year anniversary of my surgery, and to celebrate I gave myself the day off. Slept in, had breakfast in bed, went for a long walk with a friend, had dinner with other friends. All is well with me.
For this (probably) last post in my cancer blog, I wanted to publish some facts & figures about the mind-boggling costs involved.
Total amount billed to my insurance company: $202,223
Total amount written-off by the insurance company (this is the discount the insurance company has negotiated with the various service providers): $75,245
Our out-of-pocket expenses: $9,011
Myriad Genetics charge for BRCA test (aka "breast cancer gene" - I was told they have a patent on this, and are the only lab in the country which can do this test): $3,340
Excerpts from Mission Hospital's bill (it was $107,550, and did not include surgeon's fees or anesthesiology costs):
Central Services/Supplies (hospital booties? cranberry juice? who knows?): $45,100
Operating Room (my surgery was about 6 hours): $41,745
Room and Board (2 nights and 2 meals): $5,500
Occupational Therapy (a woman came into my room the day after surgery, and spent about 5 minutes showing me 2 simple arm exercises): $350
My treatment didn't include chemotherapy, but as you might guess, the cost of those drugs is staggering.
None of the above figures are disclosed to a patient prior to treatment. In doing my due diligence to try to find out in advance which services and health-care providers were covered by my insurance, and at what percentages, I found that I was banging my head against the proverbial brick wall (ok, really, it was the dining room table).
Can anyone imagine a situation in which you agree to pay an unknown amount for an unknown set of services, and all you know for certain is that the amount in question could bankrupt you? At the beginning of this whole process I attempted to find out what the cost of the biopsy would be. I spent an entire day on the phone, being bounced between the hospital, the breast care center, the radiology group and my insurance company. The low point was when a representative from my insurance company said he could not tell me how much they would cover, because the contracts they have with the service providers are "confidential." At which point I screamed "Do you think I won't figure it out when I get the bill? I'm the one that has to pay for it!!!!!!!!"
Onward.
Thursday, March 15, 2012
Sunday, July 10, 2011
The New Normal
17 Weeks Post-Mastectomy
It's nearly 4 months since my mastectomy surgery, and almost 4 weeks since the implant surgery. It doesn't sound like a long time, does it? But it feels like so much more...
I was looking forward in my calendar this morning, because I needed to plan some work commitments. When I got to November, I found a note I'd written to myself to schedule my annual mammogram. I felt an odd contradiction of happy and sad that I'd never have to do that again.
The Implants
I'm still getting used to the implants - the "new normal". I wonder if there will ever come a time when I don't notice how different they feel from natural breasts. It's been an interesting anatomy lesson, because every time I use my arms, especially in ways which require a bit of strength or force (which I do frequently in my work) I am conscious of exactly which chest wall muscles contract correspondingly - I can feel them squeezing the implants (remember that the implants were placed under the muscle). Although much softer than the tissue expanders, it is still not comfortable to lie on my stomach. This is not a position I adopt regularly as I do not sleep that way, but I do it in certain yoga positions.
My Other Life
I am exhibiting at the Sawdust Art Festival in Laguna Beach (I design & make jewelry) through all of July and August, which means I currently have an insane schedule. I am not exaggerating when I say that, during the show, I work more than 90 hours a week. So... no more posts until September, unless something newsworthy happens. If you happen to visit the show, please look me up in booth #223 and say "hi". Medically, I am at the point where both my surgeons are content to leave me alone until after the show, when they want to see me again for check-ups.
It's nearly 4 months since my mastectomy surgery, and almost 4 weeks since the implant surgery. It doesn't sound like a long time, does it? But it feels like so much more...
I was looking forward in my calendar this morning, because I needed to plan some work commitments. When I got to November, I found a note I'd written to myself to schedule my annual mammogram. I felt an odd contradiction of happy and sad that I'd never have to do that again.
The Implants
I'm still getting used to the implants - the "new normal". I wonder if there will ever come a time when I don't notice how different they feel from natural breasts. It's been an interesting anatomy lesson, because every time I use my arms, especially in ways which require a bit of strength or force (which I do frequently in my work) I am conscious of exactly which chest wall muscles contract correspondingly - I can feel them squeezing the implants (remember that the implants were placed under the muscle). Although much softer than the tissue expanders, it is still not comfortable to lie on my stomach. This is not a position I adopt regularly as I do not sleep that way, but I do it in certain yoga positions.
My Other Life
I am exhibiting at the Sawdust Art Festival in Laguna Beach (I design & make jewelry) through all of July and August, which means I currently have an insane schedule. I am not exaggerating when I say that, during the show, I work more than 90 hours a week. So... no more posts until September, unless something newsworthy happens. If you happen to visit the show, please look me up in booth #223 and say "hi". Medically, I am at the point where both my surgeons are content to leave me alone until after the show, when they want to see me again for check-ups.
Thursday, June 16, 2011
Soft
94 Days Post-Mastectomy
As promised, yesterday's surgery was no big deal. I was back at Mission Hospital, where I'm guessing that 7 am is the earliest scheduled slot for out-patient surgery, because there was a line of us arriving at the same time (5:30 am). I had the same pre-op bed as when I went in for the mastectomy, which was nice because it was in a room, not just curtained off from other beds. The pre-op wait was much shorter this time, as there was nothing special required (like the nuclear dye to trace sentinal nodes which I had to have the last time). After I'd been hooked up and monitored, Dr. Doezie arrived and marked up my chest. The surgery started on time and went perfectly, so Pete was told.
I have to say that it felt that the hospital didn't so much discharge me as boot me out. As soon as the nurse in Recovery noticed my eyes were open, she asked if I wanted some water - which of course I did as my throat was sore from the anesthesia tube - and within less than a minute of delivering it was asking me if I was ready to go or did I need a little more time? Since I still couldn't really keep my eyes open, I croaked out "more time". Which I got, but not much.
So, we left the hospital around 11 am, and I basically slept the rest of the day at home.
The implants are, as everyone had told me they would be, soft and pliable and not at all like the tissue expanders. I'm still not sure exactly what the final result will look like, because there's swelling all around, and of course the incisions from the first surgery were cut open again for this one, and my chest was bound up with an ace bandage, all of which contributes to the slightly squashed look I currently have. I don't know what to expect when I look in the mirror any more, with so many changes happening to my chest over the last 3 months. I confess I was afraid to take the ace bandage off and see what I look like now, because this is it (sort of)!
As far as pain goes, there is very little. I took some percocet yesterday and early this morning, as instructed, but that was it.
Today Pete had to take me back to Dr. Doezie's for a post-op appointment. He had to learn to do some simple manipulation of the implants, which is supposed to help prevent scar tissue forming and causing capsular contraction. It hurt a little bit, but the exercise only last 10 seconds on each side. It's supposed to be done twice a day for 2 months - after a couple of weeks I should be able to do it myself.
As promised, yesterday's surgery was no big deal. I was back at Mission Hospital, where I'm guessing that 7 am is the earliest scheduled slot for out-patient surgery, because there was a line of us arriving at the same time (5:30 am). I had the same pre-op bed as when I went in for the mastectomy, which was nice because it was in a room, not just curtained off from other beds. The pre-op wait was much shorter this time, as there was nothing special required (like the nuclear dye to trace sentinal nodes which I had to have the last time). After I'd been hooked up and monitored, Dr. Doezie arrived and marked up my chest. The surgery started on time and went perfectly, so Pete was told.
I have to say that it felt that the hospital didn't so much discharge me as boot me out. As soon as the nurse in Recovery noticed my eyes were open, she asked if I wanted some water - which of course I did as my throat was sore from the anesthesia tube - and within less than a minute of delivering it was asking me if I was ready to go or did I need a little more time? Since I still couldn't really keep my eyes open, I croaked out "more time". Which I got, but not much.
So, we left the hospital around 11 am, and I basically slept the rest of the day at home.
The implants are, as everyone had told me they would be, soft and pliable and not at all like the tissue expanders. I'm still not sure exactly what the final result will look like, because there's swelling all around, and of course the incisions from the first surgery were cut open again for this one, and my chest was bound up with an ace bandage, all of which contributes to the slightly squashed look I currently have. I don't know what to expect when I look in the mirror any more, with so many changes happening to my chest over the last 3 months. I confess I was afraid to take the ace bandage off and see what I look like now, because this is it (sort of)!
As far as pain goes, there is very little. I took some percocet yesterday and early this morning, as instructed, but that was it.
Today Pete had to take me back to Dr. Doezie's for a post-op appointment. He had to learn to do some simple manipulation of the implants, which is supposed to help prevent scar tissue forming and causing capsular contraction. It hurt a little bit, but the exercise only last 10 seconds on each side. It's supposed to be done twice a day for 2 months - after a couple of weeks I should be able to do it myself.
Tuesday, June 14, 2011
New Breasts Tomorrow
92 Days Post-Op
This past week has been so exhausting that I'm thinking they won't need anesthesia to knock me out tomorrow when I have the surgery to replace my tissue expanders with implants. In addition to various work commitments, I received a call from Dr. D's office on Monday saying that I had to have new labwork done before tomorrow's surgery. So I had to find a way to squeeze in a trip to a lab to get blood drawn and pee in a cup.
I have to be at the hospital at 5:30 am for a 7:00 am surgery, but if they manage to stay on schedule, I should be home by lunchtime (it's outpatient this time). I briefly, but seriously, considered just pulling an all-nighter because I have so much STUFF to do. But I was never able to do that, even in college, so I'm off to bed next.
Thanks to Stuart and Isabelle, and of course Pete, for all the help with shows and booth preparations these past few days!
This past week has been so exhausting that I'm thinking they won't need anesthesia to knock me out tomorrow when I have the surgery to replace my tissue expanders with implants. In addition to various work commitments, I received a call from Dr. D's office on Monday saying that I had to have new labwork done before tomorrow's surgery. So I had to find a way to squeeze in a trip to a lab to get blood drawn and pee in a cup.
I have to be at the hospital at 5:30 am for a 7:00 am surgery, but if they manage to stay on schedule, I should be home by lunchtime (it's outpatient this time). I briefly, but seriously, considered just pulling an all-nighter because I have so much STUFF to do. But I was never able to do that, even in college, so I'm off to bed next.
Thanks to Stuart and Isabelle, and of course Pete, for all the help with shows and booth preparations these past few days!
Monday, June 6, 2011
Turning Into the Homestretch
12 Weeks Post-op
This past week I had my pre-op appointment with Dr. Doezie - outpatient surgery to get my silicone implants will be on June 15th.
The big (ha, ha) question is: what size? It's not as straightforward as one might think. Should I stay exactly the same as I was before? I don't think they make implants that small ;)
So here's a confession: I am going to be a bit bigger. But just a bit. My previous bra size was 36B, but I didn't fill it out (in reality I was probably a 37A). So I decided I wanted to look the same way I did when I was wearing the 36B, only without the bra. Because the implant is under muscle, not just skin, and because I'll still be a relatively small size, I won't have to wear a bra anymore (yippee).
The implants come in set sizes and are measured in milliliters. So I can have a 304 ml or 339 ml but not, for example, a 325 ml. I know of one woman whose implants are in the region of 800 ml (definitely not for me). The tissue expansion process I've been going through has helped me judge size, but it's still a guessing game because the shape of the tissue expanders is different from the shape of the implants. The expanders are designed to push straight out because their function, after all, is to stretch muscle and skin. And the implants have a little droop because their function, after all, is to mimic a breast. So 300 ml in the tissue expander sticks out a lot farther than 300 ml in a silicone implant. And then there's the fact that implants have narrow, medium and wide bases, and high, medium, and low profiles. So the same volume looks vastly different from one model to the next.
And then there's the me factor: I'm built with a broad ribcage and a wide sternum, which means that where I should have cleavage, I in fact have a valley big enough to land a jet plane.
I read a suggestion on the internet to fill a plastic bag with an equivalent amount of rice (or in my case, cous-cous) to judge your implant size. So I measured out 339 ml of cous-cous... but then what? It's comical, really, only if I choose the wrong size, it's not like I can exchange them (well, I could, but that would mean another surgery and I doubt insurance would consider "oops" a medically necessary justification).
This past week I had my pre-op appointment with Dr. Doezie - outpatient surgery to get my silicone implants will be on June 15th.
The big (ha, ha) question is: what size? It's not as straightforward as one might think. Should I stay exactly the same as I was before? I don't think they make implants that small ;)
So here's a confession: I am going to be a bit bigger. But just a bit. My previous bra size was 36B, but I didn't fill it out (in reality I was probably a 37A). So I decided I wanted to look the same way I did when I was wearing the 36B, only without the bra. Because the implant is under muscle, not just skin, and because I'll still be a relatively small size, I won't have to wear a bra anymore (yippee).
The implants come in set sizes and are measured in milliliters. So I can have a 304 ml or 339 ml but not, for example, a 325 ml. I know of one woman whose implants are in the region of 800 ml (definitely not for me). The tissue expansion process I've been going through has helped me judge size, but it's still a guessing game because the shape of the tissue expanders is different from the shape of the implants. The expanders are designed to push straight out because their function, after all, is to stretch muscle and skin. And the implants have a little droop because their function, after all, is to mimic a breast. So 300 ml in the tissue expander sticks out a lot farther than 300 ml in a silicone implant. And then there's the fact that implants have narrow, medium and wide bases, and high, medium, and low profiles. So the same volume looks vastly different from one model to the next.
And then there's the me factor: I'm built with a broad ribcage and a wide sternum, which means that where I should have cleavage, I in fact have a valley big enough to land a jet plane.
I read a suggestion on the internet to fill a plastic bag with an equivalent amount of rice (or in my case, cous-cous) to judge your implant size. So I measured out 339 ml of cous-cous... but then what? It's comical, really, only if I choose the wrong size, it's not like I can exchange them (well, I could, but that would mean another surgery and I doubt insurance would consider "oops" a medically necessary justification).
Wednesday, May 25, 2011
Not Much
10 Weeks and a Bit
Just some odds and ends to report. Last week I had what was probably my final physical therapy appointment - I'll carry on with my exercises at home. My range of motion is, I think, back to normal, with only minor discomfort when I really stretch.
I had my 4th follow-up visit with Dr. Kushner this week, and it was pretty straightforward. Everything is looking good. He'd like to check up on me again in September, but I think our relationship is coming to an end.
Next week I have my pre-op appointment with Dr. Doezie, the last one before the surgery to swap out the tissue expanders for the implants.
I've added some links and resources to the blog, just in case some other breast cancer patient stumbles upon it looking for information.
Just some odds and ends to report. Last week I had what was probably my final physical therapy appointment - I'll carry on with my exercises at home. My range of motion is, I think, back to normal, with only minor discomfort when I really stretch.
I had my 4th follow-up visit with Dr. Kushner this week, and it was pretty straightforward. Everything is looking good. He'd like to check up on me again in September, but I think our relationship is coming to an end.
Next week I have my pre-op appointment with Dr. Doezie, the last one before the surgery to swap out the tissue expanders for the implants.
I've added some links and resources to the blog, just in case some other breast cancer patient stumbles upon it looking for information.
Monday, May 16, 2011
2 Months
9 Weeks Post-op
Just over 2 months since my surgery. Just over 3 since the diagnosis. It sounds like such a short period of time, but so much has happened. I suppose any great period of change has odd time warps: slow and fast, long and short.
Today's post is just a quick update. Last week marked a milestone: my first week without doctor's appointments since January. Although today I did have a physical therapy session - probably my last one. Doing my exercises has dramatically improved my ability to use my arms, and now it's really just a question of staying with the program.
The Dust
Last week was Booth Pick for the Sawdust - an event causing me great anxiety because my lottery draw meant I might not get a booth for the summer show. And not getting a booth for the summer show would be the financial equivalent of losing my job on top of everything else. However, I did get a space. And so the madness that is being an artist in the Sawdust Art Festival begins....
Just over 2 months since my surgery. Just over 3 since the diagnosis. It sounds like such a short period of time, but so much has happened. I suppose any great period of change has odd time warps: slow and fast, long and short.
Today's post is just a quick update. Last week marked a milestone: my first week without doctor's appointments since January. Although today I did have a physical therapy session - probably my last one. Doing my exercises has dramatically improved my ability to use my arms, and now it's really just a question of staying with the program.
The Dust
Last week was Booth Pick for the Sawdust - an event causing me great anxiety because my lottery draw meant I might not get a booth for the summer show. And not getting a booth for the summer show would be the financial equivalent of losing my job on top of everything else. However, I did get a space. And so the madness that is being an artist in the Sawdust Art Festival begins....
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