Friday, June 06, 2014

Fighting the Wrong Fight

I've been following musician Zoe Keating's struggles with their insurance company after her husband's recent diagnosis of stage IV lung cancer with mets to the brain, and it occurred to me how many people in my lung cancer family have fought that same battle. When diagnosed with advanced lung cancer - one of the deadliest cancers out there - we should be focusing on fighting for our lives, and enjoying time with loved ones. Instead, so many of us have to expend our energy fighting with insurance companies.

  • Example #1: Zoe Keating's (@zoecello) husband
Zoe has been wonderfully public about this fight, posting images of their bills and transcripts of phone conversations with their insurance company. Thanks to the power of social media, Anthem Blue Cross had agreed to cover his initial hospital stay. Here's hoping they continue to cooperate throughout his treatment.
To Read More:
"Read the fine print"- tumbler post that includes photos of the actual bill with denied charges
"As if this isn't hard enough" - tumbler post with initial denial of the claim, along with media's response

Choice quote: 
"Coverage for the requested service is denied because the service does not meet the criteria for “medical necessity” under your description of benefits."
Not medically necessary to hospitalize someone who cannot breathe? 

Status: Resolved (for now)

In her post, "Insuring the Terminal Patient" Janet explains how her insurance company denied her biopsy when her cancer spread to a new location, and the doctors needed confirmation that it was malignant before they determined the best course of treatment. Thanks to her blog post going viral on twitter, the company decided to pay the claim.

Choice quote:
"… in this case the member is already known to have progressive Stage IV Bronchogenic carcinoma even after therapy. Specifically identifying the histopathology of this right upper lobe lesion is not going to affect long-term health outcomes."
Anyone who has been following current lung cancer research (heck, anyone who has been following my blog) knows that taking a biopsy and examining the tumor can have an enormous impact on the course of treatment and life of the patient.

Status: Resolved
Stage IV NSCLC Survivor: 3 years and counting, taking targeted med Xalkori for her ROS1 mutation, currently NED (No Evidence of Disease).

Blog post "Breaking up with Blue Cross Blue Shield" tells Samantha's infuriating tale of denial by Blue Cross Blue Shield of Atlanta. She was responding remarkably well to the targeted med Tarceva, and had only a portion of her primary tumor left, so her oncologist thought it would be best to radiate that area (with SBRT) to reduce the risk of it spreading. She continues to file appeals, but currently is stuck with a $116,000 bill, despite, as she said in her appeal to BCBS, "Your radiation oncologist AGREED with mine during the peer to peer review.  He agreed the SBRT was the right course of action to save my life."

Choice quote:
“We understand an appeal was requested because your doctor feels this treatment is medically necessary for you. Based on the information we have, the previous coverage decision can’t be changed. The services are considered not medically necessary….”
So the insurance company understands her medical needs better than her oncologist?

Status: Not Resolved
Stage IV NSCLC Survivor: 18 months and counting, taking targeted med Tarceva for her EGFR mutation, currently has no active cancer (thanks to the radiation that BCBS refuses to pay for).

Kim had been on Xalkori for her ALK mutation for over two years when suddenly her insurance company said she owed $7,000 for her refill. In "Boiling Point" she recounts a day of phone calls that finally got them to reverse this and give her the medicine for the normal price.

Status: Resolved
Stage IV NSCLC Survivor: 3 years and counting, currently on a clinical trial of alectinib for her ALK mutation. Her brain mets are shrinking and her lung tumor is stable.

  • Example #5: Me!
You may recall that when I first started on Xalkori, my insurance denied it (I told the story in "Stage IV is No Time to be Timid"). Thanks to blogging and the twitterverse, BCBS called me to let me know they would pay for the medicine. 

Status: Resolved
Stage IV NSCLC Survivor: 1 year and counting, taking Xalkori for ROS1 mutation. 

As you can see, insurance company battles are far from rare. Yes, medical treatment is expensive, but as Zoe points out, 
"Anthem is owned by WellPoint. Did you know Wellpoint CEO Joseph Swedish earned almost $17 million during his first year on the job? Now you know how they can afford to pay him."
$17 million could buy a lot of Xalkori.

Sunday, May 18, 2014

That Time of Year

I love summer in Ann Arbor. The weather finally turns warm, I plan the garden, festival season kicks off, and all my favorite annual events roll around again.

This time of year is now also a minefield of poignant memories.

I remember counting down the days last year until the end of my semester, willing myself to make it through that last final, that last presentation, and that last tour performance. I was not overwhelmed by the workload - it was a lot, but I thrived in that environment - for some reason, though, I was totally and utterly exhausted. I had been fighting off recurring chest colds for months, and I just couldn't get ahead of them. I remember giving my research project presentation and having to stop and catch my breath. Just standing and talking had me winded. I slept for a week after exams, and somehow it didn't feel any better....

Today we drove past Picnic Pops, an annual outdoor festival of local high school and junior high bands, and I said to Jason, "Oh! We went to that last year!" And then the memories flooded back. Getting out of breath walking around, struggling to carry the girls, ordering a big cup of coffee despite the heat because my "asthma" was terrible and I though a big jolt of caffeine might help.

I remember talking to my mom on her birthday and discussing how my doctor might try a course of steroids to try to get this asthma under control.

The awesome neighborhood bash Burgers on Bellwood is coming up soon, and I remember that Jason took the kids by himself last year, because by then I had been diagnosed and I was so short of breath that doing much beyond sitting on the couch was a huge effort. (The lovely hosts sent him home with a plate of food for me.) We both thought about but didn't talk about how he better get used to taking the little ones everywhere by himself.

I remember missing Zander's preschool end-of-year assembly because I was having a brain scan.

And I remember leaving the garden completely untouched, to be covered by the fall leaves, then the winter snow. When it started to melt this year, we stood there staring at it, an image frozen in time that was such an accurate representation of how we felt frozen in those early days. We were in a holding pattern, in crisis mode, just trying to make it through the day, make it through the night without having to go back to the ER.

And now thankfully, amazingly, we are dreaming about the future. Still cautiously and with contingency plans, but dreaming nonetheless.

Every day I breathe, everyday I think, I am alive! And that is something wonderful.

Tuesday, May 06, 2014

Xalkori, a Love Affair

Scan results today, and the verdict is...

...drumroll, please...

More shrinkage! All that is left is a tiny spot in my left lung, 7x13 mm. Amazing!

Thank you Xalkori, thank you Pfizer, thank you researchers for this miracle medicine! I understand why another Xalkori patient made a music video about her love of this drug.

Thank you to all the wonderful people sending their love and support our way. I am truly one lucky gal.

Also, this blog was named one of the best lung cancer blogs of 2014! As I said to my fellow bloggers in the list, let's do it again in 2015.  

Thursday, May 01, 2014

What Are The Odds

I've been reading a book as research for a wonderfully terrifying endeavor Jason and I are working on* and I came across a section that talks about the poor odds of a small business succeeding.
*More on this soon, I promise! There is lots of good stuff a-brewing.

I couldn't help but chuckle.

That's supposed to scare me? You wanna talk to me about long odds? So I did some digging. (Okay, googling.)

For every 10,000 kids in the US, 1 or 2 will be diagnosed with cancer each year.
That's a 0.01-0.02% chance.

Let's narrow it down to osteosarcoma, my childhood cancer. In the US, there are about 5.6 diagnoses per million people each year.
That's a 0.00056% chance.

About 2 out of 10,000 people will be diagnosed with lung cancer before the age of 40.
That's a 0.02% chance.

Now recall that I have a rare driving mutation, ROS1, that occurs in about 1-2% of non-small cell lung cancer.

Then there are the gulp-worthy stats about lung cancer survival times, and I have already (THANKFULLY, CONTINUING TO KNOCK ON WOOD) made it to the good side of the median.

For something more fun, let's consider the odds of having identical twins: 3 in 1,000, or about 0.3% chance.

The odds of all of these things happening to the same person?!?

All of this is to say that when I read that 80% of small businesses fail within a year, I see that 20% are still around a year later! Those are some of the best odds I've dealt with in a while.

I don't mean to be cocky, it's just that odds have continually proven to be meaningless to me. Also, tomorrow is my 3-month scan, so I think the nerves are making me punchy. Fingers crossed for good results on Tuesday! Let's keep beating the odds.

Sunday, April 06, 2014

The Other C Word

This weekend I saw an excellent production of To Kill a Mockingbird (seriously, if you live in the greater Ypsilanti/Ann Arbor area, run, don't walk to get tickets).
It was full of beautiful, powerful moments, but Atticus' lines about courage really jumped out to me and have been bouncing around in my mind ever since he spoke them. He explains that courage is

"knowing you're licked before you begin but you begin anyway and you see it through no matter what. You rarely win, but sometimes you do."

I've often been told how brave I am in this cancer journey (and in my first). That has never made much sense to me, as I'm not doing any of this by choice. I would much rather NOT have cancer, and NOT put my family through all of this. Sure, great life lessons, live in the moment, blah blah blah, but I would really prefer not to have cancer at all. Really. REALLY. Really really for real.

I am, however, surrounded by some very courageous people. Perhaps the most astounding and least acknowledged are the caregivers, the partners, the spouses. They voluntarily attend countless appointments, put up with scanxiety, hold the patient's hand while awaiting daunting test results, and take care of rambunctious munchkins when the patient needs to sleep. (That last one might be specific to me.) None of this is required; it is not their bodies that are resentful hosts to this beast, yet they do it willingly. That is courage.

The other group who knowingly walk into this fray are the doctors and scientists. Sadly, I need to qualify this since I have come across too many that have the - usually unspoken, but not always - belief that people with stage IV cancer are not really worth the trouble and should be sent home to die. Thankfully, there exist some doctors and researchers that dare to dream. I'm talking about the handful who choose not to give up on us, even when the odds of living a long life with metastatic cancer are, well, pretty close to nonexistent. These are the rockstar docs (I've become a bit of a fan girl for some of them). They face hopeless situations with the crazy belief that these people are worth fighting for. They believe that with enough work, seemingly impossible things just might come true. And even if they don't, they will continue to try their damdedest to find a solution.
As Atticus said, 
"You rarely win...

...but sometimes you do."

Sunday, March 30, 2014

Tangled Thoughts from a Restless Mind

"Enjoy yourself, it's later than you think."
I'm tired of being reminded of the fleeting nature of our time on Earth. 
I'm tired of being aware that this can all end so quickly. 
I'm tired of knowing how important it is to stop and smell the roses, that the frost is coming soon. 
I'm tired of happy moments carrying the pang of realization that this can be gone in the blink of an eye. 

Understanding the importance of living for today is a terribly heavy weight to carry.

"when Time and Life shook hands and said goodbye."

I'm so tired of people in my community dying.

Wednesday, March 19, 2014

What a Joy

It's my birthday!!! I am very excited to say that I turned 38 today. I wasn't sure if I would see this day, but it is here, and it is great.

I've never been one to be ashamed of growing older, but especially now I see each day as a success. I'm still here! I'm still enjoying happy times with my family, soaking up the tiny bit of sun that is starting to warm up our seemingly-never-ending winter, and even dreaming about planting a garden.

Tomorrow is not promised to anyone. Don't dread growing old; it is a privilege that not everyone gets to enjoy.

What a joy it would be to grow old
To watch my hair turn gray
To see my face crease and wrinkle
With the fingerprint of time.

What a privilege it would be 
To trade my near-sighted specs for those with a line or two
To shout, "eh, sonny?"
And debate the virtues of denture creams.

How wondrous to watch my skin sag
To be called "Over the Hill"
Or "past my prime"
Or Granny.

What a joy it would be to grow old.

May we all celebrate many more days and years on this earth.