A Love Letter

This was a letter I wrote on the behalf of a patient to her medical insurance company. Now, maybe I'm naive enough to think that HMOs and insurance companies, while they do make a monetary profit, is genuinely there to help patients. But sometimes, as when this patient called me up crying because she was told her medication wasn't as necessity, I do wonder. The 'medical reviewer' who looked at her file said there were 'other' options. That she didn't need these pills and so they weren't going to pay for them.

This was my response.

Re: Denial of Calcitriol for PATIENT X

I am writing to appeal your denial of coverage for this patient’s Calcitriol. I disagree with the reason for denial, that this is excluded by this member’s plan.

This patient has post-surgical hypoparathyroidism. As any basic physiology textbook will show, parathyroid hormone is necessary to hydroxylate or activate 25-hydroxy Vitamin D to 1,25-dihydroxy Vitamin D, which is ultimately responsible for gut absorption of calcium. While most patients do not need Calcitriol as a form of vitamin D, in the absence of parathyroid hormone, patients with hypoparathyroidism cannot physiologically do this, even if taking massive amounts of over-the-counter Vit D. Therefore, the ONLY possible option, is Calcitriol. As you should be well-aware, there is no clinically available means of replacing PTH in these patients (the only recombinant PTH available is Teriparitide which is NOT used for hypoparathyroidism).

Not having access to this will lead to hypocalcemia which can be life-threatening. If your company wishes to be responsible any potential hypocalcemic seizures or worse for Patient X, please let us know and we will attach this in our medical records for her. If you wish for a refresher in basic calcium homeostatic mechanisms I would be happy to recommend a medical textbook. 

Yours truly,

Dr. Vagus 

I must say, I thoroughly enjoyed writing this letter. I had had some other frustrating insurance-related issues, and I happened to have some free time at work, so I vented my frustrations in a creative way. Sometimes I love screwing with these people.

We'll see if things get approved now. Damned greedy insurance companies. Sangchaimosifatt!

Happy Thanksgiving

Happy Thanksgiving, folks! As we celebrate this holiday, let's take a moment to reflect on all the things we can be thankful for. Things we take for granted. For me, it's my family, and our health. My parents are here with us for this this year which is a bonus. And yes, if you're wondering, that's a turkey sitting in a pail. Will pop her into the oven for the traditional turkey dinner. If you're into roasting turkeys, you'll find that it's all in the brine. Given the amount of time the bird stays in the oven, there is a tendency for the breastmeat to dry out. So, putting the turkey in a salt solution keeps the meat moist. For my recipe, I use a cup of salt, half a cup of brown sugar, ground peppercorn, aniseed and cloves. You can also use apple cider/juice in place of the cold water. Let it soak for a day before the big roast. Give it a try!

Happy Holidays, everyone!

I just had to share this. No, I did not take this picture, but we saw it on FB somewhere. And with Thanksgiving and Christmas round the corner and some neighbors are already putting up lights, this was the perfect time!

LOL.

Yawn

I'll admit it.

I've had on numerous occasions been tempting to stop blogging.

Not that I don't enjoy it anymore (I do). Just that, looking back at my posts 5-8 years ago, I realize that now, things are just so.... mundane. Boring. Yawn.

Maybe life as a resident in an academic center was more interesting.

Stories about cardiac code-blues.

Or my culinary experiments.

Or attempts to find me a mate and seeing how desperate I was.

Now that I'm 35, married (happily, of course) and a father, and am out in the boring world of practice, my posts just seem so uninteresting.

Yes, admit it, I know you think so too.

The posts about work. My daughter's diaper colors. My dogs. My bowel habits.

Maybe someday life will get more exciting (not that I'm complaining).

Maybe someday a busty redhead Russian spy is going to drive up my driveway in a Ferrari 458 Italia, wanting to seek my help in trying to prevent the domination of the world by the evil organization SPECTRE.

Maybe someday at work there will be a medical crisis, and in swoops the heroic endocrinologist with a syringe of insulin in his holster, and some Levothyroxine pills in his hands, to save hundreds of the critically ill.

Maybe.

Until then, you're stuck with this.

In a Heartbeat

We are lucky.

We have our health and each other. It's one of those things, simple no doubt, but we can so easily take for granted.

The last month has  been somewhat of a challenge because of a healthscare. Without going into details, you realize though how things can change in a heartbeat.

How things may be good one moment, and then the very next, because of a simple phrase from your doctor like "I'm worried it's cancer..." time suddenly stands still.

I recall this clearly too when my buddy first told me of his diagnosis of esophageal cancer. And with this recent development, it put us almost in a state of dejavu. And I couldn't help but re-live many of those emotions we went through 4 years earlier.

It's like you suddenly stop breathing. And life stops moving. It's a shock, and you're left reeling from the news.

And then, when life resumes, when you finally find the courage to start breathing again, you're breathing a different breath of air.

In my buddy's case, it was as if a virtual clock had started ticking. Him, the oncologist, was most familiar with this. You're talking about 5-year survival rates and median life expentancy.

And so, with every heartbeat then onwards, you are reminded that life has an expiration date. Except this time, as parents we have other thoughts going through our heads in addition. How will our children be provided for? Will we see them grow up? How will life continue?

In this recent healthscare we underwent, I'm glad the news was good, unlike our previous chapter. And so, life is getting back to normalcy. Perhaps it is serendipitous that Thanksgiving is next week. But we are again humbled and reminded, to not take life for granted. And that things may change in a heartbeat.

We're Off

Woo Hoo!
Looks like perfect snowboarding weather in Breckenridge, Colorado!



Yes, after a long lapse, we're hitting the slopes. Yea, I know, kinda hard to ski or snowboard living in the amazing flatlands of the midwest.

I took up snowboarding when I was in medical school. It was inevitable:

- Growing up in Malaysia and not having seen snow before

- Having your medical school only 60 minutes away from the Canadian Rockies

- Having a cute Japanese classmate who was into snowboarding (in retrospect, it was stupid to do something just to impress a chick. Learn well, kids)

The wife and I are leaving on a couples' trip to Colorado. The last time we skied/snowboarded was 4 years ago. Thanks to her parents who will be flying in to babysit Alli, this will be our first trip anywhere without our daughter. And, after a harrowing few months at work and some other challenges we've had to face in the last month, plus a stupidly busy call well, this will be a much-needed getaway.

I miss the feeling of the snowboard gliding on the soft, fresh white powdery snow. The contrast between the colors of the winter gear against the whiteness. The laughs and shrieks of people, against the deafening silence of the mountains.

We rented a ski-in-ski-out condo by the slopes, with an outdoor hot tub. We can't wait (ask me again next week if I end up breaking a leg!)

Crossed Lines

I realized the other day how crossed some lines can be.

I was rounding on some patients on the renal floor, and was talking to a couple of nurses about their patients, getting status updates, things like that. And then I realized that for Mrs. C, the cortisol test I ordered was still pending. It's a test that usually takes no more than a couple of hours, but the nurse wasn't sure why the results weren't back yet. I was in somewhat of a hurry to get to Hospital B where I had another 12 patients to see. And so I said to her nurse, a pretty young nurse in her mid-20s:

"Can I give you my cellphone number?"

At which she gave a half-giggle, and gave me a weird look.

"Errm. I guess so", and proceeds to take out a piece of paper and her pen somewhat hesitantly.

I thought it was the strangest response. Until her colleague asks:

"Is there something you want us to call you with?"

I told them I wanted the test results called in once it came back on the computer. And only after the both of them burst out laughing did I realize that they thought I was trying to pick her up. Bwahaha. 

At least my wife thinks I still got 'it' since she was willing to take my phone number!

Happy Birthday, bud.

Wherever you may be.

Going to the Dark Side

Ok, after years of fighting it, I relented. I finally walked into the 21st Century, and got myself the iPhone 4 (no, not the 4S). Grudgingly so. Call me a creature of habit, but I don't like change. For that reason, I keep going back to the same restaurants. Keep ordering the same damn dish on the menu. For the longest time I stuck with the same cable TV companies even though they were ripping me off, just to 'keep things the same'. Refused to try out Macs because I was so used to PCs despite all their problems. And so, for the longest time, I stayed away from the iPhones, instead using Nokias (because I was REALLY familiar with them) and then the Palm Treo and the Palm Pre plus. And I love(d) my Pre.

It's a great little device, small enough you could fit it comfortably in your PALM (sorry, bad pun). It's a very ergonomic, attractive little device, with a pull-out keypad for those of us who type like we have bananas for fingers. And WebOS is such a wonderfully intuitive operating system, with simple and very effective user interface. I loved it so much that we even got the HP/Palm Touchpad, knowing that it was no longer produced.

And so, like the many faithful Palm userrs out there, I was saddened to read about HP killing off these products, and the WebOS. Naturally, this is accompanied by ever decreasing Apps for the WebOS, including the loss of my beloved Epocrates (as a sidenote, I was somewhat pleased to read that HP fired their CEO for making all these about-turn decisions). Nonetheless I thought my Palm was in good enough shape that it should last me awhile. I babied my phone. Even to the point of powering down the unit every night to conserve battery life (from those days of using the NiCad battery phones). I kept it in my breast pocket, away from the coins and keys in my pants that might scratch the screen. I thought it would endure.

Until, as destiny would have it, there was a convergence point between a toddler, the handset and solid oak hardwood floors. In a split second, the touchscreen was cracked. And with it, all pressure-sensitive functions of the phone. It became a sleek (cracked) paperweight.

Being oncall in 3 days meant I had to replace the phone with something. Repairs were not an option anymore. At the cellular store, I held out hope that they might still carry some old unused Palms; they did not. I could order one online, except I'd be paying more for a 2 year old model that is no longer in production, compared to a relatively newer iPhone.

Truth be told, I did actually consider it. And the salesgirl actually said she's never seen anyone so attached to a Palm before (you could tell from the look on her face she thought I was an idiot for even considering it). And so, here we are.

I got an iPhone 4. Grudgingly. Sulkingly. I'm probably the only person in the world who's not thrilled to be upgrading to an iPhone. And more so out of objection than stinginess, I chose to not get the 4s.

After all, I already feel like I've lost my (2nd) wife. I'm not going to get Siri to replace her!

Sigh.