taking care of my body in 2009: part 5

Alternative title: "a mixed bag"

Alternative title: "doritos do not make a healthy lunch"

Alternative title: "time to bring in some support"

As my first alternative title suggests, I have had some mixed success this month, in my quest to "treat my body as well as I treat my mind" in 2009.

Let's review, shall we?

1-Walk VIGOROUSLY for an average of one hour, five times per week (300 minutes a week).

I did very well on this front, meeting my goal and exceeding it. I am especially pleased, given that I had such a terrible cold for a while. And I am very proud of the fact that I went for a long walk every day that I was at the Conference for Women Living With Advanced Breast Cancer (near Philly). I walked after checking in at the hotel, at the end of a long day on Saturday and organized a late check-out so that I could walk again before going to the airport.

2-Go to yoga once every week.

I went twice. I can definitely do better. I did have semi-valid excuses (conflicts and a head cold that made it impossible for me to bend down) but really, I can do better.

I'm going Wednesday morning, OK? I'll report back afterwards.

3. Do either 10 minutes (at least) of strength training or yoga with the Wii Fit or abdominal exercises every day (chemo recovery days excluded).

I used the Wii Fit once. I did the abdominal exercises three times (every day when I was away and then not again). Yeah, I caught a cold and then had chemo. But there were lots of days I could have worked at it and didn't.

I think I will lower the bar to 5-10 minutes and try again.

And that's the good news.

4-Cook dinner at least once a week.
5-Cut down on refined sugar.
6-Eat seven servings of fruit and veggies a day.
7- Take my vitamin D and calcium supplements daily.

When it comes to input, things have been a little out of control.

The dinners I "cooked" were as instant as possible.

I have eaten more sugar and fried stuff in the last month than I have in a very long time (Easter, Passover, travelling and my son's birthday provided the excuse). And the volume of food has vastly exceeded my needs.

The whole fruit and veggie thing has been extremely haphazard. I stopped keeping track but I'm probably averaging three servings a day (if I am incredibly generous in my calculation).

I can't remember the last time I took the lid off a supplement.

Clearly, it's time for some more drastic action.

I'm not talking about buying into the beauty myth or wanting to look like Posh Beckham. I just need to take better care of myself.

My lymphedema is worse and has started to be painful.

The bigger pants I bought are becoming tight.

I have aches and pains in my joints.

I feel sluggish and run down.

Now, I know not all of this is attributable to diet (early menopause and chemo are playing a role) but I do have control over what goes into my mouth.

I keep attending workshops on diet and nutrition, as it relates to cancer (went to another excellent one at the conference I have yet to write about) and I have years of Weight Watchers and reading obsessively about diets under my belt.

Going back to Weight Watchers might help (I tried doing the online last year and without a person to hold me to account, it was a bust) but we really can't afford it right now and the idea of dragging my ass to meetings is extremely unappealing.

So, my friend C. (who is feeling much as I have been) and I have hatched a plan. We are going to track what we eat, weigh in weekly and report in to each other. And then we'll have a little mini-meeting about what things are working for us and why other things might not be. My goals for this month aren't changing (no specific weight loss goal and I won't count points) but I will keep careful track of my promises to myself.

This kind of accountability has worked for me when it comes to my writing goals so it can only help on the health front. When I was meeting with my coach in January (without whom I would never have finished the book, started writing fiction or done so many other things that made me feel happy and purposeful in 2008), I set the following goals for the year:

I want to fit back into my pre-diagnosis pants (two sizes smaller than my current ones).

I want to have a strong core.

I want to feel fit and strong.

I think these goals are realistic and achievable. I just need to keep my eye on the prize.

Going to go throw out the empty Doritos bag and weigh myself with the Wii Fit now.

not done yet on toddler planet

"Not Done Yet is one of the good things to come out of this new approach to living publicly, to letting the light shine in on troubles and illness, and it is a very good thing indeed."

Thank you, WhyMommy. I feel the same way about everything you write.

A Side Deal on the Medicare Physician Fee Cuts? What Does That Say About the Chances for Health Care Reform?

John Reichard has dug deeper than anyone else into the Medicare physician payment problem in an important article in today's CQ HealthBeat.He reports that the Blue Dog Dems (about 50 House moderate and conservative deficit hawks) may be willing to give the docs a pass by not requiring offsets for a two-year patch for their upcoming fee cuts--including the 21% fee cut due on January 1st. They are

Would You Want To Do Business With Medicare Under These Two Scenarios?

The Disease Management Care Blog doesn't think so. It may be dating itself, but it recalls an original Star Trek episode that featured Harcourt Fenton Mudd. His shady promises proved to be part of a grand design concoted to serve Mudd's devious interests, and Mudd's interests alone.

So with that introduction, the DMCB found two other scenarios within the U.S. Senate Finance Committees' “policy options” that are under consideration as part of its healthcare reform efforts. Based on rosy interpretations of some existing science that are really tilted toward to the government’s advantage, they aren’t win-win, or even win-lose. They’re simply Mudd-like win.

‘Payment for Transitional Care Activities’ (page 10)

This would pay for ‘transitional care management’ for recently discharged beneficiaries with a chronic illness DRG, based on interventions that have ‘proven successful’ in the Medicare Coordinated Care Demonstration Program, the Medical Home and ‘other care management models.’ Physicians would be reimbursed for ‘in person’ activities performed by non-physician professionals within 30 days of discharge. Payment would be contingent on not being readmitted.

That may sound good except for one small problem: the Medicare Coordinated Care Demonstration hasn’t really proven to be successful. In addition, the reason the Medical Home has been slated for a demo is because we don’t know if that’s going to be successful either, especially when it comes to readmissions. Limiting payment to ‘in person’ activities is not only Neo-Luddite, it’s an example of there-you-go-again, here comes one-approach-fits-all Medicare. What, Medical Homes will not get credit for telephoning patients? Can they count on Medicare alerting them in a timely manner when a patient is discharged from the hospital? Since re-hospitalizations will never get to zero despite the best of care, the DMCB suspects the only winner in this payment methodology would be Harcourt Fenton Medicare.

‘Accountable Care Organizations (ACOs)’ (page 17)

Since the Physician Group Practice (PGP)Demo ‘showed promise,’ the option here would be to set up a mechanism in which groups of providers would aggregate into business units that would exist to a) meet quality thresholds and b) benefit from a 50% gainshare once savings get beyond a 2% baseline.

Recall, based this DMCB post about the PGP, that a grand total of two out of ten organizations received any money in the gainshare, though the Senate Finance policy paper says there were four. Hmmm, doing the math, that means the odds are against the average ACO provider group ever making any money on this. However, assuming that a 40% chance of payment from Medicare is an accepted business practice, keep in mind that the types of physician groups that participated in the PGP demo in the first place provide less than 1% of the entire healthcare in the U.S. But the lack of generalizability to the other 99% is not all: what is missing from this policy option is any mention of how the PGP groups relied on old-fashioned disease management. As the DMCB recalls, the groups in this demo were also stymied by the lack of data support from Medicare. Based on what the DMCB is reading, this is also very tilted toward Uncle Sam-Mudd.

(There's lots more on Accountable Care Organizations here)

what i set out to do

PJ Hamel, had the following to say about my book, in a review she wrote for MyBreastCancerNetwork.Com (Health Central):

Wry. Real. Dealing with it. That’s Laurie’s story. It’s a personally familiar one, for so many of us. Through her week-by-week, sometimes day-by-day detailing of cancer treatment laid atop everyday life (the dog, the kids, school and work), we relive with Laurie those emotions many of us have experienced. And it’s a bittersweet feeling, this “been there, done that” comparison of radiation burns, telling your small son you have cancer, and losing your hair.

This isn’t a sad book. Nor is it a sicky-sweet, “Oh, cancer has been so good to me” book. It’s just… true. A regular woman dealing with cancer as best she can. And writing about it in an utterly compelling way.

This review made me really happy. It means a lot that PJ liked the book. She also made me feel like I achieved what I set out to do.

That's a really good feeling.

CBO Proving to be an "Obstacle" to Health Care Reform--I Hope They Don't Cave!

Looks like it's "in season" for shooting the messenger up on Capitol Hill!Senate Finance Chair Max Baucus was heard to complain this week about that pesky Congressional Budget Office (CBO) saying that, "The slight challenge we have is getting numbers and estimates from CBO,“ he went on, "Otherwise, health care reform is in jeopardy. The learning curve for all of us is fairly steep."Well Senator,

book is launching

An Ottawa reminder:





And a Toronto update:

Mark your calendars! The Toronto launch of Not Done Yet set for Thursday, June 11 at the Toronto Women's Book Store. Details coming soon.