Here we go again!

I am working through several years of medical expenses in order to clean up my files for our health care reimbursement account.  My health insurance plan is one that allows me to set aside money for medical expenses.  These are “pre-tax” dollars, which one is then allowed to withdraw for medical costs. As long as you pay for health care, you pay no tax on the money, ever.  So, this is a good deal for anyone who has the financial wherewithal to put a chunk of change away. (Of course, it’s just one more example of a public benefit program that benefits those who probably need it least – the working premise being that you have to have sufficient income to be able to set money aside for medical costs that you may not incur for years – or ever.  But that’s another post for another time!)

In any case, we’ve benefitted from this program, and I diligently save and eventually track all our medical expenses so that we can determine the amount to withdraw each year.  We don’t always take money out, and we certainly do not match our withdrawals to our expenses, line by line.  That would be an enormous data-tracking exercise.  We tend to do it when we need a couple thousand dollars.  Since our medical expenses have been high the past few years (accidents, surgeries for me, etc.) we have no trouble meeting my deductible.  That gives me an easy benchmark for the amount we can withdraw.  I don’t have to put all the documents into my spreadsheet to know that they have exceeded my deductible amount, and with our dental plan and Roger’s eyeglasses, it’s easy enough to confirm our costs are over $4,000 a year.  So if Roger asks what we can transfer from the account, it's easy to make a very good-faith estimate of a reasonable amount to take.

And what does that mean? It means that we’ve skated along like that for several years, and I am now in the process of “catching up” on many years of medical costs.  How many?  Well, the last tab in my spreadsheet was 2013!  Yikes.  Five years of medical data to input!  Ay yi yi.  I have at least taken the time in prior years to sort and order the expenses by date.  So I know roughly how much is there for 2014, 2015, and 2016. Ah, yes – 2016. That was the year of our big bicycle trip, and hence our VERY big medical file following the accident that ended it. So that year is in good shape, and since we were reimbursed by the insurance company of the guy who hit us, we won’t be able to claim any of those costs in this program, anyway.

But then there was that OTHER accident – the one that happened on December 29, 2016. That one was on us, so to speak. And so here I am, contentedly if somewhat belatedly keying in my expenses for things like prescriptions and office visits for my trigger finger surgery and other fine stuff like that in 2017 when I come across the bill for my little stay at Loma Linda University Medical Center. Sigh. It just never goes away. The specter of those events keeps coming up. When you least expect it, here it is again.  Powee! – like hitting the pavement all over again.

For me, at least – this was a “2-fer” – meaning that I was basically in the “buy one, get one free” mode by that time in the medical expenses year. The first accident, the one in Kingman, took me over my deductible. So this one was pretty much fully paid by Kaiser. I had a $100 co-pay for my ER visit, and I think that’s it.  Not bad! If there’s any silver lining to be found in all of this, I guess that is it. And when you are looking at piles of bills that total thousands of dollars, a silver lining is a nice thing to find.

This time last year . . .

Thanks to Facebook, I got a little reminder a day or so ago about where we were last year at this time. We had gone up the highway for a few days to hike and enjoy "fall" in the Sierra.  Coincidentally, it was also when I was getting checked out for my heart condition.  I wasn't quite sure I could remember when that happened, but with Facebook's nudging and a look at my phone's calendar, I was able to recreate our trip - and another portion of our journey together.

Good thing it was not summer! This is easy to hide under a sweater.

November 5th was the day - photos of that glorious hike up the mountain came back to remind me how beautiful it was.  And then there's that photo that I would not have posted on Facebook - the one with the wires from the Holter monitor zigging and zagging across my chest . . . 

Since I had been having this odd sensation when I used the bike trainer on the patio, and my deductible had been met (I hate to say it, but financial considerations do play a role in the appointments I schedule with the doctor), I had gone in to see a cardiologist and step one of that process is to wear a monitor for 24 hours. Since I had been in for a stress test years ago and nothing was found, I was determined that I would have an episode this time.  I got home, got on the trainer and rode hard until the odd sensation occurred.  Breathless, a little dizzy, heart thumping and racing - there it was!  Bingo!  Surely there would be something to review this time!

Some of the most beautiful trails in the world are in the Sierra. Roger and I love it here.

Trees here are survivors

We had planned this trip before I made the doctor appointment, and I didn't want to miss it, so I arranged to wear the monitor over the night and keep it through the weekend.  During our hike the next morning (at 10,000 feet) I jogged along the trail until I felt woozy, hoping to get another episode recorded.  Yes indeed.  There's that odd, breathless feeling again.  Wouldn't anyone feel breathless, hiking at 10,000 feet?  Probably.  But the racing in my chest was not normal, and I hoped the monitor picked it up.

It was a relief when my 24 hours was up, and I was able to peel the sticky little doo-dads off my chest.  Another day in the Sierra without being trussed up like a turkey, and then we were home.

I can't quite make out from the calendar exactly when all the follow-up appointments were, but it's clear enough that I had to go see the cardiologist in Redlands again for the results from the monitor (yes, you have Afib) and then I was scheduled to see the electrocardiologist (specialist from LA who comes as far as Fontana every now and then).  This is the guy who would perform an oblation, if that turned out to be the best course of treatment.  He is the "heart rhythm" guy, and was very helpful to our understanding of what was going on.

We discussed my options and general health, and ultimately agreed that we'd just take a "wait and see" approach since I had, by this time, also been diagnosed with sleep apnea and that condition can have an affect on the heart, leading to a high correlation with Afib.  Since I was just beginning to use the breathing machine for that, I made the case that maybe this treatment would address the Afib, and I would not need medicine or treatment at all.  Plus, I was scheduled for surgery to correct my right carpal tunnel issues.  I wasn't going to be doing anything very athletic for weeks anyway, as I recovered from that surgery.  The doctor prescribed a very low dose beta blocker for me, and said to call him if I had symptoms, and then we would fill the script and begin medication.  Otherwise, nothing. 

Thus it was I headed into the Thanksgiving holiday with thanks that I wasn't facing an imminent oblation. Even as I awaited my next surgical procedure the following week!

The heart-shaped rock seemed especially appropriate on this hike!

Two years. TWO YEARS.

Two years.

I cannot believe it has been an entire year since I last posted. Except - I can believe it. I can believe it because when you are not on an excellent adventure, life takes over. And life, it turns out, is actually a lot harder than something remarkable like riding your bicycle around the country.

That's easy. It's a long vacation doing what you want to do. Life, on the other hand, is all the little things that get in the way of what you'd like to do. So even though I have often thought about our story, and about updating this blog so that it would be complete, I have found it exceedingly difficult to get something posted. There are a lot of reasons for that, and maybe I'll get to them later. In the meantime, here's where we are now.

I could not sleep last night. I woke up about 1, and I was restless and awake until sometime after 4. I finally recognized what was going on. When I realized that the next day was Halloween, I was able to place the day, and my insomnia, in context. If you've ever had a momentous event occur in your life, perhaps you know what I mean when I say, "your body will remember even if you forget." So my body remembered that October 30th is the day we were hit. My body needed me to acknowledge that date. My mind might not have recognized it in conscious thought, but subconsciously it was screaming at me that I had to acknowledge this day.

I lay awake, composing this post in my mind and wishing that was enough to let me fall asleep again. Of course, it doesn't usually work that way! So when the alarm went off a few minutes after 7, I was tired. I've been tired all day. What I did not want to do was lie awake another night, thinking about what I ought to have written. There are many days in the last year and even before that that I have crafted a draft for this blog. But I can't seem to get around to posting it. There's always something else that I need to do. That's that real life thing coming into play. So I'm well behind in my story.

That makes me anxious, of course. Because I am hopeful that I will be able to catch up on my story before we actually finish our trip. And there's the answer to that question. No, we have not yet finished our trip. Not in two years' time. We spent six full months on the road and yet we cannot seem to find one more week to finish the trip.

I've written but not posted several additional entries about what's occurred in the last year. I'm going to do my best to complete those, add the photos that I've been cataloging, and get them posted - but if that doesn't happen at least let me say this much: the pain following the removal of my cast which I last wrote about in my post a year ago persisted and grew more intense. Inside of several weeks I was almost unable to use my right hand. I had to schedule surgery to correct the carpal tunnel injury which I probably sustained many years ago and exacerbated with the break.

Since I had met my deductible for the year, I took the opportunity to check out a couple of other things that had been bothering me. Roger had been saying for some time that he thought I ought to have my sleep checked out, because he felt it was likely that I suffered from sleep apnea. And so I did! As a result, I was diagnosed with sleep apnea.

There were also the occasional issues I had with a very rapid heart rate during exercise. As I was recovering from my wrist fracture, I used the bicycle on the trainer to stay in shape. While we managed to go nearly 10,000 miles with no episodes on our trip, my work on the trainer was causing me to have frequent episodes where my heart rate would spike, I would get a bit dizzy, and would have to stop until the heart rate returned to a more normal rhythm.  After wearing a monitor for 24 hours to capture these episodes, the exercise-induced tachycardia I had managed for 10 years was recast as atrial fibrillation. There was a week somewhere around Thanksgiving, I forget the exact time now, that I received news about all three of these issues in very rapid succession. It was, without a doubt, one of the more sobering and discouraging periods of my life. I felt like everything was falling apart.

Anyway, the upshot of all this is that a week after Thanksgiving, I had another surgery - this time to correct carpal tunnel issues on my right wrist.

I wasn't overly concerned about the A-fib. In consultation with my cardiologist, we decided to keep an eye on it and assess whether or not the treatment for sleep apnea would mitigate the A-fib (they are highly correlated). But I had an episode in February where we did a very gentle ride and I just kept having episodes of lightheadedness, dizziness, and very rapid, fluttery heart beats. It didn't stop when I got home, so I thought it made sense to get it checked out. That escalated things a bit, and I now take a very low dose of a beta blocker to keep my heart rate from spiking during exertion.

I began a new chapter in the spring, teaching several sections of a course at our University here. It's exciting to me - a challenge and gratifying to have some income. But this new activity disrupted our normal training rides. It became more difficult for Roger and me to get on the tandem.

Still, we made plans to complete our trip once the term was over. Or, as soon as possible after the term was over, considering the fact that we had again agreed to host a bicycle team for the Redlands Classic, and we couldn't leave while all that was going on! And then we decided to go up to Lake Tahoe and watch the team finish one of the races in the Amgen Tour of California. So that pushed things out another week or two. But we really were going to go to Kingman and finish the trip in May. We had even arranged transportation with some of my friends. Except - the weather forecast was for temperatures of 110 degrees in Amboy.

And . . . Roger had some conversations with a friend of ours who teaches at the pharmacy school in Loma Linda, and she did not think it would be wise for me to subject myself to those temperatures while taking a beta blocker. Because, you know - desert - and more importantly, deserted roads . . .

What are you going to do? Once again, my health interrupted our plan. As we had discussed the possibility of completing the trip in May, I was prepared to ride in the heat. I was willing to make a run for it across that long stretch, taking minimal supplies to reduce our weight and increase our speed. I was prepared to ride at night with lights so it would be cooler, resting in the middle of the day at Roy's in Amboy. I had anticipated that we might drop off water bottles along the route on our way to Kingman so we could replenish our supplies. But I was not willing to place Roger in the position of having me potentially collapse because of this issue with my heart and my medication. So when he came home with this news from Vickie, we gave it up. We would not try to do the trip until it got cooler.

And that more or less brings us to now. We've discussed whether or not we could go at Thanksgiving, but I'm teaching this term also and I really don't want to be that constrained when we complete our trip. So it looks like it will be in the Christmas break. I don't think we'll have any problem being too cold, although it will be a different set of issues to address than the heat.

Stay tuned!