Is this really the best we can do?

Day three of the #DDdailygratitude challenge and already, I’m inspired to share one of my posts in a longer blog form! Unfortunately, the motivation stems from all of the frustration and anger that ultimately turned into my gratitude for the day.

I’m scheduled for a resting metabolic rate test (also known as an oxygen uptake exam, or an indirect calorimetry test) next Friday, but I need to get pre-authorization because many health plans won’t cover the exam. I have been at a weight plateau since April despite working out regularly and monitoring my diet, and so my doctor wants to do this test so that we can better calibrate my nutrition. Basically, we’re checking to see the rate at which my body burns calories while I’m completely at rest, to make sure that my metabolism is behaving the way it should be. The results of this test will help me to make sure that I’m eating enough to support my energy output in my workouts, while still maintaining an appropriate calorie deficit to get my weight down.

The pre-authorization turned into a circus. Aetna couldn’t authorize the test without the appropriate CPT code. The doctor’s office didn’t know it, and billing had to transfer me four times before they could answer my question. Spoiler alert: the Google result for the code was correct and I could have saved myself a whole lot of hold time. When I called Aetna a second time, they gave me a benefit policy code to look up, but basically told me “We won’t cover this, unless your doctor says it’s medically necessary.” However, they couldn’t tell me what “medically necessary” means. Last I checked, the very act of referring me for the test could be considered my doctor deciding this was medically necessary… but I digress.

I looked up the benefit policy to better understand what was going on, and that turned out to be a very, very bad idea. You can find it here in full, if you’re interested. Basically, I would qualify for weight loss medication, no questions asked, but they won’t cover this test because it’s still considered “experimental” or “investigational” for weight loss. Mind you, the benefit goes on to acknowledge that medication works in conjunction with calorie restriction and exercise, and also that weight loss from medication is usually temporary…. but it has the studies to back it up, so it’s all good in their book. However, this test apparently isn’t considered sound science, so Aetna’s having none of it.

A quick PubMed search turned up an article titled “Indirect Calorimetry: A practical guide for clinicians,” which

“Measurement of energy expenditure is the most accurate method to assess energy needs. Indirect calorimetry remains a gold standard in measuring energy expenditure in the clinical settings… To achieve the highest quality of patient care, we should strive for patient-specific nutrition support regiments. Indirect calorimetry offers a scientifically-based approach to customize a patient’s energy needs and nutrient delivery to maximize the benefits of nutrition therapy.” [Nutr Clin Pract. 2007 Aug;22(4):377-88]

Meanwhile, a systematic review of energy expenditure studies, published in Obesity Reviews in 2012, turned up this endorsement of using indirect calorimetry to get more accurate information for patients:

“Today, many health professionals including dietitians typically use prediction equations because of ease of use, low cost and decreased participant burden, but emerging evidence is reflecting great disparities between predicted and measured energy values… The level of inaccuracies of prediction equations that are commonly used in clinical practice may potentially impact patient outcomes… As health professionals seek to improve their quality of service and provide appropriate nutrition care to prevent clinical morbidity and mortality, measuring energy requirements through IC [indirect calorimetry] may be the direction of the future.” [Obesity Reviews, 13: 753–765. doi:10.1111/j.1467-789X.2012.01000.x]

(In case you’re wondering, this is what happens when you’re someone who is naturally curious, who enjoys learning about interesting topics, who believes in doing the research on her own health, AND who also happens to work in academic publishing. Doctors either love me or hate me. There’s no in between.)

So, basically, I was in a really bad place when I called my doctor’s office for the third time today. I had a phone number from Aetna, and I needed my physician to call and make the case for medical necessity, so I’m not on the hook for $200. And that’s when today’s moment of gratitude stepped in.

daily gratitude day 3.jpg

The woman I spoke to this third and final time was so kind. She took down all of my information, and she reassured me when she let me know that she processes requests like this all the time. My doctor is at a conference through Monday, so she told me she’d share the message then, and she also promised to follow up with me herself Monday afternoon, even if she didn’t yet have an answer, just so I’d know where things stood at that point. She listened. She cared. It was so unlike every other conversation I had experienced so far today, and I was so grateful to her, I burst into tears. (What can I say? It’s been a long week.)

It’s a sad commentary on the state of our health care in this country that I had to jump through so many hoops today, and an even sadder commentary on human behavior in general that I felt so surprised and relieved to finally experience a little kindness.

We’ll see how this all plays out. I’m probably going to move forward with the test either way, just to know exactly where my metabolism stands, but I’d feel a hell of a lot better if it didn’t set me back $200. More to come!

In the meantime, it’s not too late to jump on this Daily Gratitude plan. Thanks to @thedaydesigner for pulling this together, and for making awesome planners – check out their website here. I love that they offer free printables so you can see how the layout works for you before ordering the full planner. I’ve been using their Daily Planner printable for almost a month and I love it, and I can’t wait to order my 2017 Planner!

Create your own joy

The world happens around us, every day. It happens around us and sometimes, it happens to us. There are any number of things that are totally outside of our control, and sometimes, those things are pretty terrible.

You know what’s totally within your control? The ability to create your own joy. You can give yourself permission to seek out joy. That’s allowed. It should even be encouraged.

picmonkey-collageI spent the weekend on the Cape, borrowing my cousins’ incredible home for a much-needed break. I took Friday and Monday as work-from-home days so that I could have some time to myself, to get some much-needed mental clarity and peace. For the weekend itself, friends came up from New York and drove down from Boston to spend Halloween in Provincetown. We got to be very stereotypical New England tourists for the day on Saturday, and when night fell, we dressed up in costumes, broke out the booze, and celebrated the holiday in truly ridiculous fashion. It was something of a social experiment, throwing together two separate sets of friends who had never met, but it turned out great and the weekend was a success.

Leaving the Cape yesterday for the long drive back to Boston, I found myself reflecting on how grateful I felt for the past few days – grateful to the family who let me use the house, to the friends who made the journey to the Cape, to the job that gave me the flexibility to work remotely, to the universe for giving us amazing weather. The key, though, is that I didn’t sit around and wait for these things to fall into my lap. I asked whether the house would be free at any point this fall; I asked my friends if they wanted to spend a weekend away. I created space for this weekend to happen.

If I don’t make a conscious effort to create space for joy, then yes, it’s really easy to let everything else overwhelm me. That’s the thing about stress, about exhaustion, about bad news and difficult experiences: they creep, they spread, they entangle you. You can let it happen, or you can do something about it. I’m choosing the latter; I’m choosing to invite in the light.

To that end, I’ve decided to participate in a Daily Gratitude challenge for the month of November. I’ve been using (and loving!) the Day Designer planner printables, and the company sent an email out this morning with a link to their free daily gratitude journal printable. They shared a blog about how to make gratitude a daily habit, and they’re encouraging followers to share their daily reflections on social media with the tag #DDdailygratitude.

joy-gratitude-quoteI’ll be sharing my daily gratitude posts on Instagram at @beingyourchange, and where appropriate I may expand them into a longer post. I’m hoping this will help to keep all of the dark-and-nasties at bay, while keeping me focused on the sources of joy and light in my life.