Tag Archives: Weight loss

Meaningful Usage

What has meaningful use done for you lately?

I first heard the term when my son was trying to share what he did at work. He’s in nursing informatics and I was curious. It’s a field I had spent maybe five minutes considering.

What he said came across as gibberish to me. I’ve been retired from nursing for almost a decade. You don’t forget what you know, but it’s a dynamic profession and things change rapidly.

Though I didn’t quite grasp what he said, I didn’t question him about it. I just let myself enjoy the moment of conversation with him. I figured it had nothing to do with me anyway.

Well, color me wrong.

This past November I had my usual rheumy work-up done prior to my visit. Other than having my arm bleed out because I lugged in groceries immediately after, nothing out of the ordinary happened and I gave it no further thought.

In January, I received a bill from the lab. My insurance had denied the claim.

Remember the chasm that Indy has to cross in Indiana Jones and the Last Crusade? There is no visible bridge, but he has to believe that there is so after steeling himself, he puts out his foot to take the first step into nothingness.

That’s exactly how I felt when I picked up the phone to speak to my insurance. When I finally got to a live person, I was told they’d denied it because they did not cover treatment for obesity.

What?

They also mentioned coding for high white blood cells, pneumonia and some other diagnoses, but by then I’d tuned them out and was patiently waiting for my turn to speak. Obviously, I’d been mistaken for another patient.

But, no. There was enough evidence pointing to me. Talk to your doctor they said.

I called the office and he himself called me back. At 8 p.m. The only time doctors ever called me back at such an hour was when I’d been on shift. I was surprised by the late callback and I was even more surprised that it was him.

I quickly explained what was going on. The man has RA as well; he needs to not work so late.

“It’s Meaningful Use,” he said. “We have to put the weight down and then they go by the BMI.”

My son’s words rang in my ear: “Now we have what’s called meaningful use.” I didn’t realize at the time that the words took capital letters.

Before I spoke with the doctor, I’d been a little mad at the nurse practitioner who, per the office, had added the “obesity coding” to the lab order. We’d never discussed my weight, or any issues related to it.

I felt that I had been diagnosed (misdiagnosed) behind my back. I’d been betrayed, judged, found lacking, or rather overabundant, and worst of all, billed for $250.

But now I understood what had happened and my options raced through my mind:

Option #1 – Refuse to be weighed.

Option #2 – Refuse to let the office add the “obesity coding” to my lab order

Option #3 – Get my BMI within normal limits.

Option #4 – Do all of the above.

At my next appointment, we discussed the problems and options we faced in dealing with this new facet of going digital. I well understand the hiccups that come with changes, the fits and starts of instituting a new way of doing the same old thing.

BMI is not the most useful way to determine weight status. Muscle weighs more than fat, so that alone skews the numbers. With a present BMI of 29, I fall into the “overweight” category.

The BMI formula takes into account your height and weight. Per last year’s bone density study, I am still 5’ 2” in height. The office has my height listed as 5’ 1” tall. That one inch is probably what threw me into the obese category. Shorter = fatter.

What would be truly meaningful is if the whole picture of the patient was taken and not just a couple of numbers. My primary, documented diagnosis is Rheumatoid Arthritis. And part of the treatment for it is the use of corticosteroids, which tends to affect weight.

Of course, that is not the only reason I am carrying around some extra baggage, but still, it seems unfair, or at least not well thought out, to devise a system that singles out one statistic and ends up penalizing a patient for their very illness.

Perhaps this quirk in the system can be revised or overwritten. At this point all it’s done in my case is cause confusion and aggravation, plus adding to the workload of all involved.

My doctor is now working his magic to retroactively code the November lab order appropriately so that the insurance will cover it. For this latest appointment, I crossed the chasm in good faith that he had indeed revised the coding for February’s labs. I suppose I will find out in a few weeks whether or not the bridge materialized.

 

 

 

 

 

Advertisements

Shoes, etc.

I did ten miles on my stationary bike today. I decided, while I was pedaling, that I would keep track of mileage as well as time. That way I could take an imaginary trip around the world while I engage in this endeavor. Though I do hope I don’t have to go all the way around the world to lose the extra pounds I have on board.

To document my origination point, I weighed myself this morning. It kind of hurt, but I’m a big girl (!) I can take it. Once the numbers stopped fluctuating on the scale readout, it settled at 149. According to my BMI, I should weigh no more than 136 for my height of 5’ 2”. But, I felt fine and looked fine, so I was told, when I was at 138. So that is where I’m headed.

And since ten miles is the distance I used to travel taking my youngest to school and that was south of me, I guess my “circumnavigation” will commence in that direction. Hopefully, I’ll hit my target weight before I “reach” the South Pole.

If I were truly headed down there, my gear would be a top concern. But since I will only be biking and walking in South Florida weather, I don’t need a parka, et al, just good shoes. After spending almost 30 years on my feet during my nursing career, I am especially conscious of good, supportive footwear.

SAS were my shoes of choice; they cushioned my feet and were worth every penny. I had my last pair for over five years, but then I began working out in earnest and wore them out within eighteen months. I meant to replace them, but then I found these.

Bought them at Macy's. They are Clarks shoes.

Bought them at Macy’s. They are Clarks shoes.

Love these shoes! They feel like I'm walking on air. Hope they hold up to the workouts I'll be putting them through. Hope I hold up!

Love these shoes! They feel like I’m walking on air. Hope they hold up to the workouts I’ll be putting them through. Hope I hold up!

And of course, my vehicle. It's a little dusty and rusty. Just like me.

And of course, my vehicle. It’s a little dusty and rusty. But then, so am I.

Plus-Sized Woman

plus2

If I can still get into my size 8 jeans that stretch up to a full size, am I still a size 8?

They are snug, but I don’t have to hold my breath to zip them up or anything. And once on, they don’t bind; I forget I have them on even.

There’s just no forgetting one fact. I’m fatter than I was when I bought them. They were loose on me back then. My husband would stick his hand in the gap that swelled at my lower back and exclaim, “You need a smaller size!” And he was right, I was constantly having to pull them up; actually I still do though not as much, or as often.

But, the mirror and the scale do not lie. This year, I have added ten pounds to my physical repertoire. And the extra weight has two favorite places to settle on my body, my tummy and my caboose. My jeans, being low-rise, are not much affected by my fuller waistline, but the other side, well; let’s just say a certain hand doesn’t fit in there anymore. Though I have to admit to not hearing any complaints.

Regardless, I have one. A complaint, that is. Or maybe I should say I have ten, one for each pound of added weight. The view might have improved from his perspective, but not from mine. As much as I dislike what I see, I have to remember that the mirror is my friend. And it’s telling me it’s time to get serious about some deletion. Would that losing weight could be as easy as hitting clear-alt-delete. I’d be hitting those keys ten times in quick succession.

Since that’s not gonna happen any time soon, I am left with only one alternative. Hit the exercise bike. It’s been sad and lonely out in my patio waiting for me. My exercise gear is stowed away somewhere in this house; I’ll have to see about digging it up while it still fits. It doesn’t come cheap. Another motivator.

And it’s not that I eat a lot or eat the wrong things. It’s that I listened too intently to my writing professor. She suggested we buy lots of chair glue. You know, to keep us in that chair, writing. I spent all summer doing that, reading about writing and writing about writing. As a result, my knowledge has improved tremendously. I just don’t want to measure my progress as a writer by the size of my ass.

Besides, I read that each extra pound of weight puts ten pounds of stress on your joints. And with my RA that is not good, not good at all. So, the amount of chair glue will have to be counterbalanced by an amount of bicycle seat glue. I will try an eight to one ratio for starters.

Don’t get me wrong. I’m not fixated on weight so much as my health. I have never been and will never be the size of those emaciated runway models. It seems the fashion industry considers anyone who isn’t a size zero, a plus-sized woman. Well, I’m proud to be on the positive end of the number line. As long those size 8 jeans fit like they use to.