Happy Easter and where I won't be on 5/11

Happy Easter!

We actually made it out to NJ to relax/celebrate with my family, which was great.  Maya coughed through the night but never had any struggling-to-breathe attacks, so we packed the nebulizer and medications and headed out.  When her breathing started to act up and we realized that we would have to cut our visit short my mom rushed to get lunch/dinner out early so that we could eat with the family before we left, my dad broke out their air conditioner and fired it up so that we could cool & dehumidify a room to ease her breathing, and my sister & brother-in-law cut up their big cake early so that we could take a chunk to-go.  My family is pretty great :)

A few pictures (we packed meds, but not a camera, so these are from my cell phone):

Easter egg hunting with a Christmas gift bag (small and easy to carry without tripping over, of course)

After we got home I opened some mail.  It turns out that one of Maya's upcoming appointments has been rescheduled, and the office mailed me a new appointment card and this note:

In case you can't read that, it says:

"The doctor will be out on 5/11. 

I have to cancel your appointment on 5/11. 

Here is your new date. 

Don't come on 5/11. 

Thanks."

So . . . wait. 

Does that mean that we're still on for 5/11?

I guess that this proves that the patient/receptionist relationship is a tricky 2 way street.  I go out of my way to be courteous and pleasant when interacting with doctor's office personnel, but there are definitely times when I get off the phone and mumble, roll my eyes, and think "Honestly, people!  This shouldn't be so hard!"   Clearly, the office folks deal with their fair share of seemingly incompentent people.  I almost feel bad for the woman who sent me this note---I can almost hear her internal dialogue as she wrote my note:

The doctor will be out on 5/11.                               

Wait.  Is that unclear?  Would she know that if the doctor's not here, she shouldn't come?

I have to cancel your appointment on 5/11.
Ok, that's clear.  And the underlining is a nice touch.

Here is your new date.
So, I cancelled, I gave her the new date . . . anything else?  What if she still thinks she should come . . .  (sigh)

Don't come on 5/11.
She'll get the point now.  Hold on, that's clear, but not so friendly.  Need something nicer to end with . . .

Thanks.
Perfect.

Perspective

7:45am.  We're awake, looking out the windows at the pouring rain and bummed that we won't be going to Sesame Place.  It just doesn't seem worth the drive when most of the stuff to do is outside.  Also, I've been miserably sick (allergies?  I'm not sure) for a few days, and hanging out outside doesn't seem like the best option.   At 7:45, my biggest problem is that our big Sesame Place adventure was cancelled.

10:00am.  We decide to go to the mall.  The mall is indoors, they have a carousel (it's as close to a Sesame ride as we're going to get) and Maya can walk around.  Maya seemed pleased with the plan:



Good times for everyone :)

Maya & Daddy

Maya & Mommy

The mall also brought one of the high points of my day, a new zebra-y cheap plastic cell phone cover!

:)

At the mall, my biggest problem was that I felt pretty winded and run-down. 

1:00pm.  Naptime.  Maya is sleeping, coughing occasionally.  I'm trying to upload some pictures, but my laptop screen is periodically crackling (like an old rabbit-eared TV) and then going black.  Uh oh.  This isn't a good sign for the future of my computer (or the blog).  My biggest problem is the apparent start of my computer's swan song.

2:25pm.  Still naptime.  Why is she coughing so much? 

3:00pm.  Weird sounds on the monitor make me jump up and rush into Maya's room, where it's clear that she's having trouble breathing.  Dave holds her, I set up the nebulizer, she is in semi-shock from being woken up so quickly, and the stridor noises and gaspy breaths are scary scary.  From 3pm on, my biggest problem is Maya's breathing.  It makes all of the other "problems" of the day seem ridiculous.  

A missed trip weeks in the making?  The death of my computer?  Small potatoes when asthma/croupy/she-can't-breathe stuff makes an appearance.  Talk about perspective.

We've talked to the doctor, done 2 breathing treatments, started oral meds, and at one point debated a trip to the ER (which, thankfully, wasn't necessary) .  On this yucky, humid day the biggest trick for us was running the air conditioner in her room and letting it get cold and dry in there---some people do well with warm and moist, others with cool and dry, and she seems to be the latter.  Times like this make me grateful for my own asthma, and for the fact that I remember getting croup as a kid (I had it a bunch of times).  With Maya unable to talk, I'm glad that I can understand what she's feeling, and predict what might help based on what would feel better to me.

Breathing stuff is scary.

I guess the silver lining is that I'm really glad we didn't try to tough it out and go to Sesame---I think her breathing would have worsened faster if we were out in the rainy air, and I would have been panicked at being far from home and without our nebulizer. 

And poor Parker . . . we barely got to celebrate his Gotcha Day :)  It was 1 year ago today that we went and picked him up in CT  (he's a new big brother, by the way, as his lovely breeder just welcomed 7 new puppies 2 days ago!).   He's been Maya's faithful sidekick ever since.  After she was tucked into her crib, Dave & I sang "Happy Anniversary":

*PS-Did you see Maya's new big girl haircut?  She got it yesterday and I put a picture up on the FB page.  I haven't had time to upload them all yet, I was going to do a post today, but other stuff got in the way.

Shake a tail feather* (literally)

Spring was in the air at the Bronx Zoo today, and all of the boy birds were trying their best to impress the girl birds. 

Like this turkey, all puffed up:

"Look at how big and impressive I am!"

"Maya, go stand by the turkey" 

 "Um, I don't think so, Mommy"

"Daddy, save me!"

But the coolest by far was a male peacock, displaying his full plumage to a very bored looking female:

Ta-DAAA!!!

 Hey.  Hey you.  Look at me.

I know you can see me.  How'd ya like this angle?

PAY ATTENTION TO ME!!!  (This was when he shrieked and charged her.)

Right after that, I started taking some video (on the cell phone, but still pretty good quality): 

(you've got to watch at least until 0:56 to see the bird tushie shake.  It's the undisputed highlight.)

:)

An itchy science nerd = Photo play-by-play of allergy testing

This post has nothing to do with Maya.  It's all about letting my science nerdiness shine through :)   So if you don't see the suspense and intrigue in medical tests, you might want to sit this one out.

This week I've been to the pulmonologist twice.  If that seems excessive, consider the fact that prior to this, my last appointment was 4 years ago.  Oops.  He walked into the room on Monday and said "Hi!  Wow, I feel like it's been a long time, no?"  (I went off all of my medications before I decided to try to conceive, and my breathing problems got substantially better during pregnancy.  By the time I needed to go back, we were right in the middle of the first round of EI assesssments, and the rest is history.)

So my breathing hasn't been feeling right, allergies are starting, and Dave is home on break to watch Maya---the perfect storm for getting in for my pulmonary function test (PFT) and check-up.  On Monday I did the PFT (which is kind of interesting---a lot of breating exercises into a computerized tube thing that makes charts and graphs).  The results came back "good".  I was suspicious, because I don't feel "good".  The doctor was checking out my information and told me to come back today (Weds) to have 2 additional tests done. 

So the first test that I did today was an asthma challenge test.  (Dave thought this one sounds like a game show segment . . . "Step this way, folks, for the Aaaaasthma Challlllllengggggge . . . " )  It involves doing a segment of the PFT and then inhaling a medicine that "irritates the lungs".  Then you redo the PFT segment, then take a stronger dose of the medicine, etc.  If you can last through 5 rounds of battle, you're asthma free.   (I am not asthma free----after 4 rounds I could barely stagger over to the machine, and when I tried to breathe in the tube the computer beeped and the tech brightly (and quickly) said "Ok!  That's it for you!  Here, take 2 puffs of this inhaler now!")

The second test was an allergy panel.  It was awesome!  I've always been "allergic" but I've never really had any sort of scientific confirmation of my allergies (or asthma, for that matter).   My pediatrician was old school (and also, just plain old) . . . his diagnostic process went like this:

My mom:  I think she might be allergic to cats
Doctor:  Hmm.  (turning to me)  How do you feel when you're around cats?
Me:  My eyes itch.
Doctor:  (writes in chart "allergic to cats")

So I was (nerdily) excited to find out what I'm really allergic too.  The test consisted of 40 tiny skin punctures (really, puncture is a silly word for it, it's like when you poke your skin with a safety pin enough so that the safety pin dangles there, but you can't really feel it.  Not that I've done that or anything.) to test for 40 different things.

I decided to photodocument my arms through the 20 minute test with my cell phone camera.  The other folks in the waiting room must have thought I was crazy, but if I didn't find a way to entertain myself I would have scratched my arms off.

Arm 1 at the start (the markings say "A" and "B")

3 minutes in

 20 minutes in

In the bathroom mirror, as I was about to leave the appointment.  The swollen welts that remain were the things that I was allergic to on this arm.

Arm 2 at the start (C, D & E).  On the left you can see the rows of puncture squares.

3 minutes in.  See that big scary welt thing happening on the left?  It was so, so itchy.

In the mirror, about to leave.  Still itchy.

I'm allergic to a bunch of fairly mundane stuff:  cats, some grasses, some molds, ragweed, some dust mites, etc.  Nothing crazy.  The funniest allergy was that big, angry, spreading welt----that was for timothy hay.  You know who loves timothy hay?

The rabbits!

We are probably the only people in the Bronx who order timothy hay by the bale---we have half a bale on our terrace right now (the rabbits eat it and it lines their hutch & run).  I laughed out loud when the doctor told me that my strongest reaction was to the timothy hay----it figures.

I think the nerdiest part of the appoitnment was when the pulmonologist was setting up for the allergy panels---he had little trays of the liquid allergens, and was taking out the 8-pronged scratcher things, and marking my arms, and I kind of giggled and said "I feel like we're doing a chemistry experiment!"  On the outside, he kind of smiled and said something polie to me, but I think on the inside he was probably rolling his eyes and thinking "Yes, that's what I do.  'Chemistry experiments'.  Not 'medical testing',  like say, a doctor would do . . . but experiments, like you do when you're in high school. You go to the waiting room now."

You think I'd crumble? You think I'd lay down and die? Oh no, not I . . .*

A full week of no updates . . . and what do I have to show for it?

This:

Those are the supporting documents that were included in my insurance appeal.  (No, I didn't include 6 packets of blank paper---those ones are just flipped face down due to identifying information).  While I've often alluded to the misery of fighting with insurance, I don't think that I've ever taken the time to really lay the battle out.  Now that our appeal has been finished and sent, I have the presence of mind for some explanation.

I have regular fights debates clarifying conversations with the kind customer service folks over at our insurance company.   Just this week, we had 2 chats:

Monday: I receive 3 denials of claims for pediatrician visits (I tend to save up receipts and then send a bunch at once).  Upon calling and talking to the rep, I explain that I don't think it's possible that we haven't met our deductible for Maya.  He says "well, remember, the amount is not based on how much the doctor bills, it's based on how much we pay out."  I fumble with receipts, sigh, and ask why her vaccinations weren't covered, since the form says "Vaccinations are only included until the patient's 19th birthday."  At this point we realize that all of the claims were processed under my name instead of Maya's, and we have the exact same exchange that I have at some point during Every Single Call to the company:

Him:  Well, ma'am, the doctors office must have made an error in filling out the forms.
Me: Actually, I fill out the forms.  And at this point, I could do them in my sleep.  Are you able to pull up an electronic copy on your computer and verify that there's not a mistake on the forms?
Him: Hold on one second (click clack clickety clack).  Hmmmm.  (click clack clickety clack) Well, ma'am it seems like everything is in order here.  I'm going to just go ahead and reprocess them for you.
Me:  Ok, great.  (eyes rolling until they nearly touch my brain)  Thanks so much for your help.

Tuesday:  While cleaning off my desk (sorting through papers for the appeal) I find an older denial for 2 pediatrician visits.  This time the reason for the denial is "The treatment was given in an inappropriate or invalid place of service"  (yes, that's a direct quote).  And the call went like this:

Me: I'm calling because I think these claims may have been processed incorrectly.
Insurance: Well, ma'am, I'm seeing that they were denied because the service was provided in an "incorrect or inappropriate location".
Me: Well, they were pediatrician appointments. In the pediatrician's office. I'm not sure where else we could have met with him.
(then we looped directly into the conversation quoted above)

Anyway, this appeal was not about these smaller denials---it's about 79 (so far) denials for Maya's feeding therapy.  Maya gets private feeding therapy twice a week, which is invaluable to the development of her muscles and coordination, and is a large part of the reason that she's not still eating jars of baby food (which she was still on until after her 2nd birthday).   To make a 3-month-long-story short, after manymanymany phone calls and re-submissions, we found out that the therapy was being denied because it was being provided by a speech-language pathologist (SLP) . . . to the company, appropriate providers of feeding therapy included pediatricians, GI surgeons, and family practicioners. 

(If I hadn't been in frustrated tears at this point of this particular phone call, I would have burst out laughing.)  For those of you not in-the-know, this is the equivalent of saying "We cover root canals, except if they're done by an oral surgeon.  If you have a root canal done by a manicurist, janitor, or high school principal, we'll totally hook you up."

So my appeal was two fold---providing ample evidence that this treatment is medically necessary and highly beneficial for Maya, and attempting to convince them that an SLP is the most highly qualified provider of this service***.  It was a 45 page appeal, including:  a letter of medical necessity from our pediatrician, a letter of medical necessity from our developmental pediatrician, a letter of medical necessity from our feeding therapist, Maya's first feeding evaluation (at 9 months), Maya's most recent feeding evaluation (at 31 months), a phone call log of all of the discussions that I've had regarding these claims, an Excel spreadsheet of the claims and their pertinent information, 2 documents from 2 different insurance companies that show that they only pay feeding therapy claims to SLPs, 2 research articles that explain why SLPs are the most qualified providers for feeding therapy and explain that their knowledge base is unique and nontransferrable to other types of providers.

Whew.

It's taken me a few months to gather the appropriate paperwork (we couldn't get a letter from the developmental ped until we had our check-up, which takes a few weeks to schedule, etc).  I didn't realize how much having this thing hanging over me was really affecting me (subconsciously) until it was gone. 

It all goes right back to that learned helplessness stuff that I've talked about before.  It's such a downer to have something that you need to do, when you're powerless to get it done.  My to-do list felt insurmountable when I had this deeply subconscious inner dialogue of "Why bother calling that doctor to schedule an appointment?  You haven't even made a dent with the insurance yet."  or "How can you take the time to respond to emails when you should start typing a call log for the appeal?"

So either I would do smaller things on my list and feel guilty about not making appeal progress, or work on the appeal and watch my apartment get messy, take-out get ordered, and a million little things amass on my daily list and fester.

It's so hard to feel powerless.

And I'm so glad that the appeal is done :)

So now the ball is in their court. 

Be sure to stay tuned for a ridiculous update about how it was denied because they are only able to process appeals that are typed in Times New Roman, or postmarked on a Saturday, or whatever.

 ***As an aside, I'm not fully convinced that it actually is their policy that SLPs are not payable---I feel like they may have just been using that as a deterrent in the system to get me to throw up my hands and give up.  They refused to provide me with the policy in writing, telling me that then I could "just commit insurance fraud."  (How?  I'm not sure.)

I realize this makes me sound like a conspiracy theorist, but these people have pushed me right to the edge.  During one call, at 12:27pm the person I had been speaking with said "Ma'am, I'm sorry, I suddenly can't hear you at all---you're breaking up---let me just put you on hold for a minute and then reconnect to see if that helps."  She hung up on me.  When I called back at 12:29 I got a recording: "Thank you for calling.  It is currently our lunch hour.  Please call back after 1:30pm EST.  Thank you." 

Seriously?  It's enough to make anyone go postal.

Winners, a loser, and Twitter

Winners:  Dave, Maya & I had a great weekend :)

1.  Lots of playground time, some dog park time, general happiness and soaking-in-the-sunshine:

I love to climb so high . . . and Daddy's a great spotter. 

 I made it to the top!

Blowin' kisses to Mommy on the ground

We've taken to sitting anywhere.  Right in the middle of the action for a milk break?  No problem.  It's kind of strangely liberating to just sit right down wherever you please.

2.  We went to a birthday party today and Maya got to wear a dress!  Of course, this is not her first time ever wearing a dress, but it kind of was the first time that she really got to wear a dress.  Before, she wore dresses to events that either a) would have her in our arms/in a highchair the whole time (like out to dinner at a restaurant)  or b) would be in a safe enough place that we could tuck the dress into her diaper cover and let her crawl around like that.  But now she's walking!  And she can wear a dress to a party and walk around in it.  Pretty amazing (and pretty adorable, too).

It doesn't get any sweeter than this, does it?

Loser:  Parker did not have the best weekend.

A totally accidental dog park incident left him cut up.  And now until the skin heals he remains banished from the dog park (since I don't want any dirt to get in the wound).  Good news is that it's healing very quickly.  Poor dude.

Ouch.  Parker, by the way, is still obviously crazy about the ramp.

Twitter?

Since the whole Kristi Yamaguchi twitter thing, I've been wondering what the deal is with twitter.  Then someone asked me last week if I'm on twitter.  Truth be told, I'm not even sure if I should be capitalizing Twitter . . . I'm not twitterliterate (twitterate?).  But it got me curious about who reads here and is into Twitter----please take a moment and cast a vote in the new poll (upper left corner).  Thanks!

PS.  If you didn't see the Helen Keller video that I posted on the blog's Facebook page, you have to go check it out.  It's totally amazing and inspiring!

We said we'd walk together, baby, come what may . . . *

This morning I did something crazy  . . . I looked at my wedding pictures.

Why?  Because it's our 5 year anniversary  :)

Oh, you mean why is that crazy?  Because I've never looked at them before.

Although I think it's a typical newlywed thing to excitedly check out the pictures(or at least newly-married-woman thing), we just never got around to looking at our wedding pictures.  Not for any sort of weird reason, it just kind of happened.  Our wedding was a put-together-quickly affair, and between us we had 3 cousins who are professional photographers and took fantastic pictures.  They each gave us cds of their shots, and we didn't have a chance to look at them right away (and we had, after all, just been at the wedding---it was fresh in our minds and we didn't really need reminding of what it looked like).  Then time slipped away and it started to seem funny that we weren't very attached to the pictures, and we would say "maybe on our x anniversary we'll take a look at those pictures."

So 5 years it is :)

And in honor of our 5th anniversary, I invite you to our wedding . . .

The background: 
Dave and I have been together since the tail end of 2004.  At the very end of January 2006 we thought "Hey, the spring is a good time to get married.  Wanna do it this spring?"  and got engaged.  We are low muss, low fuss folks and tried to figure out how to put together a wedding that was us- that would mean not too big, not too fancy, and with as little stress as possible . . . but still a nice party.  And we wanted a quick engagement, so we picked April 8th as our wedding day---less than 3 months away. (I had to spend some time convincing people that no, I was not pregnant, we just didn't see the need for a big engagement.)

The big day:
After my hair appointment, Dave and I got ready at home together.  I had found my wedding dress at Ann Taylor (right off the rack, nice and easy) and his shirt had a hole in it, which he didn't notice until the day of (luckily, it was on the tucked-in part).  We caught a cab downtown and I remember not wanting to have to "make an entrance"  (which is kind of unavoidable if you're the bride and groom) and thinking "Thank goodness I don't have to walk down an aisle."   All-eyes-on-me is not my fave.

We found a great restaurant on the lower west side that I found in a list of "ideal rehearsal dinner spots in Manhattan".  They had a private enclosed terrace area, where we had a cocktail hour prior to the ceremony.  We had a playlist on the ipod in some corner, and hung out with our nearest and dearest . . .

After the cocktail hour, we headed inside to the restaurant's attached, private side room . . .

 . . . which had been given a slight personal (and amusing) touch with blown up black and white pictures.  Over the main table were two of our favorite pictures of us together, and on the side wall were childhood pictures:

Everyone took their seats . . .

(There was a copy of the readings and vows at each seat  . . . you can never hear at these things, and I'm a read-along type of girl)

And looked at the pretty flowers . . .

(I love flowers)

After everyone sat, we stood in the corner of the room with a lovely minister and had a little ceremony . . .

Our readings (done by our siblings) were fantastic.  A Bruce Springsteen song (If I Should Fall Behind), a Bob Dylan song (All I Really Want to Do) and a children's book (Consider Love by Sandra Boynton).   We said our vows  . . .

  . . . and then it was done  :)

Then we got to sit, talk, hug people, mingle,and relax . . .

and celebrate!

Oh, and the cake!  A few weeks before the wedding we walked by an adorable bakery that had fun cakes.  Really fun.  They made us think of Dr. Seuss, and we wanted one :)  We later found out that our cake person had been on those Food Network cake competition shows---it's a lucky thing that we happened to walk down her street, because our cake was adorable (and delicious). . .

So here we are, 5 years later.  A great 5 years, and a great team.  We've walked together, and we've helped each other stay in stride, despite some unexpected turns in our path (this line makes more sense if you listened to the Springsteen song).  Thanks for being a great partner, Dave :)  Happy Anniversary!

PS.  The hands down, absolute best picture on all of the cds was . . .  (drumroll please) . . .

The Elmo was my nephew's . . . the face?  I have no idea.  But this is spectacular.  We should have a caption contest or something.

Who doesn't love naptime?

This week is giving me a smack down.  It's laughing at me . . . "What's that?  Preschool is settled and you think you're on top of the world?  Well, how about a terrible hearing evaluation (smack!)?  And an impossible decision to make about another medical test (smack-smack)?  And a dermatological issue, and an allergist appointment (smackitysmacksmack!)?"

I cried on the phone with a doctor today.  The good news is, I don't think he could tell.  The bad news is, I'm clearly a little overstressed if I'm in tears just talking about decisions that we'll have to make a few weeks from now. 

(Pull it together, woman)

Maya helped me destress by finding the perfect book to read this morning:

Nothing to see here, Mommy.  I'm just pickin' a book.

 I know it's in here somewhere . . .

  

Victory!

And when naptime rolled around, she was as ready as I was . . .



Funny, that's exactly how happy I am when I get to take a nap.

A doozy of a day, and memory lane

Today stunk.  Coming off the high of the weekend's celebration, it was a big letdown.  The hearing test didn't go well, so we may have to do a bigger test.  On an unrelated note, one of her ear tubes is clogged, so I'm waiting to hear back from the ENT about drops or something.  Had to schedule a dermatologist appointment because she's scratched herself up and is now in a vicious scratching cycle, and an allergist appointment later this week means that we're at 3 doctors' appointments, so far anyway.  Plus therapies.  Yikes.

You know what made me smile tonight after my lousy day?  Pizza and beer. Old videos.  Ok, old videos and pizza and beer.  Have a look at a few old favorites . . .

This was the first video that I took on my own . . . Dave was working, it was a Monday so I was off from work and thought I would record how happy she was waking up  . . . (ignore my sugary voice).  She was close to 4 months old here:



This was her first laugh, and second and third and fourth . . . literally.  Dave was taping, and she laughed---like a little magical song!  And then we were so excited that we were laughing, and then she was laughing more, etc etc.  She was 4.5 months old here:



Her second trip to the dog park. (If you can handle super grainy old cell phone video, her first trip to the dog park, in which she laughed so hard that she was sick, is here.)  She LOVED dogs.  She still loves them now, but back then she LOVED them.  This is why getting Parker was so perfect.  You can't watch this video and not smile.  I double dog dare you to try.  She was almost 1 here.



:) 

Celebrate good times, c'mon!*

A very quick update . . .  I got a few emails/ims this weekend asking "How did the preschool meeting go?!" and I replied "You didn't check the Facebook page, did you?" (Reminder: The Facebook page is public, so you don't have to be a member of FB to see it.)  It's just the easiest way for me to put up a mini-update, such as:  The preschool stuff is done, and went well!

There were a few moments of tension during a conference call with the school director in which we were debating whether she really needs a one-on-one aide, but it was resolved when I brought up my safety concerns (she falls, hard, and will take out other kids as she goes down.  And she has potential choking issues and can't self-feed).  So she's in the school we want, in a nice small class, with a one-on-one, and she'll be bussed, leaving me free to lounge on the couch, paint my nails and nap all day. 

We had a lovely weekend of celebrations, starting with brunch after the meeting, and including 2 evenings with babysitters.  And on Saturday I went shopping, while Maya & Dave had some quality one-on-one time, including a trip to the zoo:

Hey you polar bear!  Look, I have a polar bear too!

Today we had to cancel our morning therapies to head to the hospital for a hearing test.  (It's not under sedation or anything, that's just where they do it.)  I'm not a fan of this test--we have to battle morning traffic to get down there, and the test involves sitting perfectly still and silently while she's on my lap and has to respond to sounds.  Last time the room she got scared by how quiet the room is when the doors shut, and if she loses focus the whole thing becomes kind of pointless.  And I think her hearing is fine, but we have to go every 6 months or so anyway.  Sigh.