Tuesday, November 27, 2007

Resting during recovery

Winter conditioning started this week.

After being woken up by a fox early monday morning, it took everything I had to guilt myself out of bed and go. I hadn't run all weekend and was looking forward to this for a long time, which got me out of bed. I was house-sitting for a woman from the boathouse and I couldn't find her blender, so I missed out on my protein shake, but settled for scarfing down a banana and one of those salty/sweet "granola" bars. They really are addictive. A quarter of my daily calories in like 3 salty sweet tablespoons of goodness.

I had purposely fought to get into the M/W/F section since I really liked the coach. I was nervous about being able to row the whole time and justify my slot. Thankfully, the coach had us doing 5 minute build intervals with 2 minute rest sessions. With a few modifications, I was mostly able to keep up, but it was frustrating to basically have to re-learn how to erg and to have such bad output.

The workouts go like this:

You row indoors on a rowing machine (erg)

You row for one minute at 18 strokes per minute (spm), the next minute for 20 spm, then 22, etc., until you've rowed for five minutes. Then you have a two minute rest session where you can either paddle through, rowing at a super easy pace for two minutes, or completely stop rowing. Last year after a season of triathlons and running, I preferred to paddle through and log as many meters as possible. This year, I am working just to finish the five minute sets.

The next five minute set, you start one higher than the last set, so you row the first minute at 20, the next at 22, etc.

Last year, I could row comfortably at a 30 or a 32, this year, I'm struggling to hold a 26.

Pre-surgery, mybiggest problem was rushing the slide, which is basically coming back up to stroke again too quickly. On the water, you stroke to move the boat, and sort of glide, then stroke again. If you're late, it's like flooring the accelerator then slamming on the brakes. If you're early, it's like driving with the parking brake on.

This year, I'm not rushing since I need the recovery to rest to keep up.

It was good to be back, but incredibly frustrating not to be able to perform the way I want to.

And don't even get me started about the winter holiday challenge. I've had to delete all the emails about it to remove the temptation to push too hard and ruin my recovery. 100,000 meters in a month isn't hard, is it?

Our workout:


18, 20, 22, 24, 26

20, 22, 24, 26, 28

22, 24, 26, 28, 30

20, 22, 24, 26, 28

18, 20, 22, 24, 26

2 sets of 10 crunches, 2 2 sets of planks for 1', 1 set of planks for 1' on each side, 1 set of 10 crunches.

Even not being able to do the planks, my abs are sore.

Tuesday, November 20, 2007

More soapbox time

And a word to the wise ...


Why medical debts shouldn't count
For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.

By Liz Pulliam Weston

It's a good thing Greg Hilfman of Los Angeles has health insurance because an unpaid medical bill has sent his blood pressure soaring.
Hilfman's wife was in a hospital two years ago for pancreatitis, and Hilfman said she was treated by a "cadre" of doctors and specialists. All but one submitted bills to their insurer, Blue Cross of California, in time to get paid.
Six weeks ago, however, a woman from a neurologist's office contacted Hilfman, explaining that the office "didn't have the right address for Blue Cross" and thus hadn't submitted the bill within the one-year period required for reimbursement. She demanded that Hilfman cough up $540.
Hilfman was furious. He'd never heard of the doctor and insisted he'd seen no bill or any indication there was a problem with payment. Now he's worried he'll have to pay a bill that should have been covered by insurance or risk damage to the couple's credit reports.
"How is this fair?" he asked. "They can say anything they want (to the credit bureaus), and I have no recourse."

Tiny debts with huge impacts Hilfman is right to be concerned. The Your Money message board is littered with complaints from folks whose otherwise pristine credit was sabotaged by a medical collection. Sometimes their records were besmirched over absurdly small amounts that nonetheless had big impacts on credit scores.
Poster "sunny_light," for example, recently discovered a medical-collection account for just $7.
"I pulled my credit report last week and found out," sunny_light wrote. "I promptly paid the collections people. But now my credit score is down by like 80 points."
Medical collections are surprisingly common, at least according to a 2003 Federal Reserve study of consumer-credit reports. Nearly one in three consumers (31%) with a credit report had at least one collection account reported, and more than half of those were medical collections.
The amounts owed weren't substantial: 36.5% of the medical collections were for $100 or less, and 86% were for $500 or less.

Medical collections make up half of all collection accounts:

Collection type
% of collection accounts
Median amount owed
Source: Federal Reserve
*Includes large retailers, banks and finance companies
**Includes smaller retailers, law firms, individuals and educational institutions

Yet any collection account is considered a major negative to lenders and to the credit-scoring formulas they use. Though the impact of a collection on your scores fades over time, it will shave off points for as long as the negative mark remains on your report -- typically seven years.

Your chances of having your credit ruined by a medical bill are soaring for a variety of reasons:
More people are uninsured or underinsured. The U.S. Census Bureau counts nearly 45 million uninsured Americans. An additional 16 million or so are underinsured, with too little coverage to protect them from catastrophic medical expenses. Medical costs have been rising at a much higher rate than inflation, and those without insurance are often charged more than those with coverage (read "How to survive your hospital bills" for details). Thus a single accident, illness or emergency-room visit can easily result in an impossible-to-pay bill for many uninsured and underinsured families.

Medical-debt collection has become big business. An unpaid or disputed bill is more likely to wind up on your credit report because of a sea change in the way medical bills are treated.
"The reporting of medical debt (to credit bureaus) is becoming much more common," said Travis Plunkett, a spokesman for the Consumer Federation of America. "Medical-debt reporting has become more professionalized."

Get your insurance claims paid
Good records, detailed claims and persistence will help you get your money faster and avoid problems.
A decade ago, most hospitals did their own collections or assigned them to a collector who worked on contingency, collecting a portion of what was owed. Smaller providers typically handled collections in-house. Only the largest companies tended to report collections activity to the credit bureaus -- and then only after repeated collection attempts had failed.
Today, physicians groups and other small providers are more likely to outsource their collections to agencies that use negative credit-report entries as a tool to urge patients to pay.
Meanwhile, an increasing number of for-profit hospitals and even some nonprofits regularly sell their bad debts for 2 or 3 cents on the dollar rather than try to collect the money themselves. So-called debt purchasers buy huge portfolios of debt, and one of the first things they do is post the collections on the consumers' credit reports.
"Health-care-debt buying did not exist" 10 years ago, said Michael Klozotsky, an analyst for Kaulkin Ginsberg, which tracks debt-collection trends. In 2005, purchasers bought at least $3 billion of bad medical debts, and the market seems to be growing 11% to 15% a year.

Continued: Confusion abounds
Medical billing is a mess. Even when a consumer is covered by insurance, confusion abounds. Doctors and hospitals often insist the consumer is ultimately responsible for the bills, saying medical providers bill insurers only as a courtesy. Yet frequently the providers have agreements with insurers and government agencies to accept discounted reimbursement as payment in full; the providers aren't supposed to pursue patients for payment.
Meanwhile, insurers are constantly changing what's covered and by how much, and providers move in and out of covered networks. Providers also claim some insurers deliberately drag their heels on reimbursements, adding to the chaos and uncertainty.
"Insurance companies are often contributing to the false reporting of medical debt," the Consumer Federation's Plunkett said, as tussles over payment increasingly get turned over to collection agencies.

Medical debt is no predictor of risk Even when medical debts are legitimately owed and left unpaid, though, some experts question whether they belong on credit reports.
There's no question that medical bills pose huge risks for the finances of many families. Medical problems were cited as a factor in nearly half of the bankruptcies studied by Harvard University professor Elizabeth Warren (.pdf file).

Still, many mortgage lenders who specialize in serving low-income communities have discovered that discarding medical debts often gives them a better picture of a borrower's true creditworthiness, said Michael Stegman, the director of policy for the MacArthur Foundation's program on human and community development.

"If all their other credit accounts are in good shape, or they haven't established credit but they've had no delinquencies on their rent," Stegman said, "the fact you have a bad medical debt or an outstanding judgment over a medical bill is not a good predictor of default."
One such lender, Self Help of Durham, N.C., has a 1% default rate on its mortgages, which public-policy director David Beck said is comparable to mainstream lenders that use credit-scoring formulas that take medical debt into account.
"Our experience has been that medical debt isn't generally reflective of a borrower's ability or willingness to repay," Beck said.

It's not clear that these lenders' experiences with low-income borrowers can be extended to the population in general, but it's time to find out. Credit-scoring companies such as Fair Isaac, the creator of the leading FICO scoring formula, should research whether medical debt really is predictive or not.

In a bind? 4 tips Personally, I think we could solve much of the problem of unfair medical-debt reporting by excluding all collections under $100 from credit reports. I also think medical debts should be treated differently, with shorter statutes of limitation on collection and reporting (say, four years instead of the current seven), to reflect the fact that medical bills are a fundamentally different kind of debt from credit cards and auto loans.

Unless that happens, here's how to reduce the chances of your credit getting run over by medical debt:
Bird-dog your medical bills. Don't assume your health-care provider and your insurance company will eventually work it out. Follow up on every bill or claim with an unpaid balance. If a debt remains after more than a month or two, ask your provider and your insurer what the problem is and what you can do to help.
Negotiate if you're uninsured. As I discussed in "How to survive your hospital bills," you may be able to qualify for charitable assistance that could reduce or eliminate your bills. Even if you don't qualify, you should try to get the amount you're charged reduced to what an insurer or government agency would pay.
Get payment agreements in writing. If you don't have insurance and want to make payments, make sure your agreement is in writing. One Your Money message boardcontributor agreed to pay her health-care provider $50 a month to pay off a $1,600 bill. No agreement was signed, however, and the provider recently started demanding $150 a month.
Try to talk your way out. If despite your best efforts a medical bill lands on your credit report, you have a couple of options. One is to dispute the bill with the credit bureaus as "not mine"; sometimes collection agencies won't bother to verify the disputed account, and it will fall off your reports. Option two is to negotiate with the collection agency to remove the account from your credit reports in exchange for payment.

Get your insurance claims paidGood records, detailed claims and persistence will help you get your money faster and avoid problems.
Ideally, you'd get that promise in writing before you pay anything, but sunny_light managed to sweet-talk a collection agency rep into clearing a credit report after sending the $7.
"I called that collection agency woman again and talked and talked and talked to her with lots of 'please' . . . and then it was quiet for a while so I thought she hung up . . . but then she said she was looking at my file . . . and finally she said 'normally we don't do this' and then she told me to check my report in about 30-45 days," sunny_light wrote. Two weeks later, sunny_light checked, "and the $7 medical bill (paid) has been removed from all three credit reports . . . and my credit scores went back up!!"

Columns by Liz Pulliam Weston, the Web's most-read personal-finance writer and winner of the 2007 Clarion Award for online journalism, appear every Monday and Thursday, exclusively on MSN Money.
Published Nov. 19, 2007

Monday, November 19, 2007

Platoon vs. Peloton

Fellow Bella Nikki was recently featured in an article, and that's pretty damn cool so I'm posting it. I'm fixing some of the errors the reporter made.

Nikki was last in Iraq in 2004, not currently scheduled to return anytime soon. However, two of the other gals briefly mentioned are currently in Iraq.


Tales from the peloton November 17, 2007
Velo Bella - When Duty Calls

Many of the women competing at a high level in cycling have full-time careers, but in the case of a few special riders, those careers offer very unique challenges. For a few, their jobs include serving in the United States military in Iraq. Surface Warfare Officer for the US Navy and Velo Bella racer Nicole Shue spoke with Cyclingnews' Kirsten Robbins about her life on the bike while at sea.

The Velo Bella team is a diverse group of women from across the United States. With riders from beginner to world class, the team has fun while taking racing seriously. It's a perfect environment for some special athletes like Nicole Shue and Nicole Messinger, who both work in the US Navy, and with Rebecca Gross and Beth Boyer, who work for the US Air Force. Team manager Alex Burgess regards the careers of these women cyclists as nothing short of heroic.

All of them are currently serving in the US military and have been relocated to Iraq, and Burgess thinks they have courageous stories that need to be shared. "The fact that these women split their lives amongst their family and careers as officers while continuing to achieve to be elite level athletes is a statement on their ability and talent," said Burgess.

Surface Warfare Officer Nicole Shue is a just one of several Velo Bella cyclists who balances the life of an athlete with a career in the US Navy. Shue is out to sea nearly half of every month and though she finds it difficult to train full time, being attached to a ship, she noted that her chain of command is supportive of her passion as a cyclist.

Shue admitted that officers are nurtured to have type-A personalities, a competitive personality that translates well into cycling. "We are extremely organized, methodical and display a strict execution of schedules, plans and missions," explained Shue who tapped into these qualities when training for her latest half Ironman.

When long work days start in the early morning, finding training time is very precious for anyone, let alone someone living on a ship, but Shue found a way to fit training into her life at sea with limited resources. "I received a lot of strange looks when I first brought my bike and trainer aboard the ship. I would set up my bike on the flight deck of the ship during dinnertime, and ride with the sun setting behind the ocean as my scenery."

Rigorous training and strict time management skills are essential qualities of sport and military life, and more often than not, being an athlete can mean having a somewhat selfish existence. However, the responsibilities of an officer extend beyond a single person and into the many lives they are linked to. According to Shue being a Naval Officer is a higher calling. "I'm placed in charge of the sons and daughters of the United States and am expected to mold them into capable sailors, leaders, and citizens - anything less is a failure," said Shue. "There aren't too many CEO's of companies who'd be fired because an employee got a DUI or committed a crime. But Naval Officers are held responsible for the actions of those we lead. It is a direct reflection of our leadership when our people fail to succeed."

Drawing Parallels
To better understand the lifestyle to which women need to adapt as officers, Shue focused on the similarities between her life as a cyclist and applied it to her daily routine in the Navy. Not only because both careers are physically demanding but because both military and sport are traditionally considered to be male dominant activities.

"For starters, I'm definitely the minority!" said Shue. "It doesn't faze me when I show up for the weekly road ride and I'm the only woman there. I realize I'm going to have to work hard to keep up, but as long as I'm not complaining or asking for special allowances, the guys recognize that I'm doing my best and they are supportive and encouraging."

"The same goes for the Navy," added Shue. "My first ship had a crew of a thousand men and six women. That was a scary experience at twenty-three years of age. But once the men realized that I could pull my weight and was a capable officer, we were able to work together to accomplish the mission. And it's great to be part of a team, whether it be a peloton screaming down the road and working as one organism to tackle the miles, or as a ship's crew and sailing together into harm's way, ready to carry out the mission my country depends on us to accomplish."

A typical day
Shue, like many other officers, can be deployed for months along the Persian Gulf. She described a typical day as beginning at six in the morning for breakfast along with all the officers onboard the ship, followed by morning meetings and then physical training until noon. "There are more meetings after lunch and more training all the while the ship is operating in the Gulf, protecting the coast of Iraq and its oil platforms from terrorist/insurgent attack," said Shue. "The workday continues after dinner where the officers have an opportunity to catch up on the administrative work and day's events until it's my turn to go operate the ship, either in the pilot house or down in the Combat Information Center."

Officers routinely get about four hours of sleep each night during their six months deployment at sea. The captain is always close at hand and fellow officers are always in sight, so Shue admitted that though life on the ship can become cramped, but it brings "teammates" closer together and makes the camaraderie unbreakable. "I've met people in the Navy whom I wouldn't think twice to lend them my car, my house, whatever they needed in a tight spot, no questions asked," said Shue.

"The Navy is an extended family," Shue added. "They have to be because so much of my time is spent far away from my real family. But there is definitely a fun side to it too. I have been to countless countries from Australia to Pakistan to Tonga, and have had priceless experiences, seen beautiful places and met some truly amazing people. It has opened my eyes to the cultures of the world, how all of us are so different, yet at the heart of it, we all just want to lead happy, fulfilling and peaceful lives."

Thursday, November 8, 2007

Cancer to 5K

The Cancer to 5K program is the brainchild of fellow DC Tri-er and cancer survivor Holly.

Simply put, they train cancer patients and survivors to complete a 5K to help keep them healthy and happy. The program culminated with the Ulman Cancer Fund 5K at merriwether post pavillion.

I promise, I am wearing a running skirt, which is not evident in these pictures.

I was supposed to be a pace group leader, but the shoulder intervened. Luckily, I got cleared to run the Friday before race day, so I was able to be a race day sherpa for cancer patient Cheryl.

Me, Kris, Cheryl, and Sherpa #3 who's name I can never remember.

Race day conditions were less than ideal. It did warm up a bit for race day, but it was raining almost the whole time, and quite a few people were no-shows. There was supposed to be a bike race accompanying the 5K, but they ended up canceling it both for safety and because they didn't have enough volunteers to support it. A few of the bikers ran in their bike gear, which was really nice of them.

Holly gave me the heads up that Cheryl had never completed more than two miles in training and was really nervous about the possibility of either not finishing, or finishing last. I reassured them that Cheryl would not have to be last, and that there's no shame in it. Especially when you've just finished chemo.

The festivites started with Lance Armstrong giving a speech and leading the runners out. I have to say it was really cool that he showed up even though it was pouring and not a lot of people were there.

Lance crossing the finish line.

It was pretty hilly and Cheryl had something of a tough time. Kris, the other sherpa, and I tried to keep her distracted/ entertained, and on a good intensity interval schedule so she didn't get tired out before the finish. She really was a trooper, and she wasn't last. There is no way I could have done that 3 weeks after finishing chemo.

Cheryl crossing the finish line.

On a sad note, Jess, a Team Z alumnae, didn't make it to the race because she was in the hospital having surgery for breast cancer. There was a booth at the finish line handing out keychains representing the size of tumors. The smallest was the average size when found by a mammogram, the largest was the average size when found by accident. Jess's was the latter. My heart goes out to her and I hope she is with us for the spring class of the Cancer to 5K group.

For more information: http://cancerto5k.com/

Wednesday, November 7, 2007

Major Payne

Today I almost passed out again at PT. The walls got all sparkly, and then the PT made me drink some water.

The good news: I'm gaining range of motion vertically, the bad news: even with all the agony, I'm losing it in rotation. My muscles are locking. And even pulling things out of whack with the cramping.

I am living so far beyond my pain threshold. I've gotten into the pattern of coming home from PT, eating a carb heavy breakfast, and passing out under a hypoglycemic daze. No, this isn't smart or remotely healthy, but it does let me escape from the pain for a few hours. It's gotten to the point where I can't eat before PT since the pain makes me so nauseous. Today, I wasn't sure I was going to be able to drive home. Sitting in traffic with the seat belt over my shoulder going to work was out of the question. I feel really guilty for working from home so much, I really love my job and my co-workers. I'm trying to remind myself that this is necessary to be whole and healthy again and the pain is temporary.

Friday, November 2, 2007

Putting the PT in PITA

Physical Therapy. I need it, yet hate it. My quest to find the person responsible for me being able to row winter conditioning was complicated and had repercussions I wouldn't realize until today. Originally, I was going to see the PT who trains with my tri club. I wanted someone who was sports oriented, not someone who spent their days rehabilitating hip replacements. Someone who understood the demands of the sports I was trying to get back to, and who could tailor my treatment to facillitate that. Problem was, her office was so deep in trafficland it was unreachable except by helicopter. The second problem would become evident later.

Names witheld to protect the guilty:
Since I was clearly not going to be able to get to her office, and certainly not in a timely manner for the next 8 weeks, she recommended I see another PT with her practice at a location closer to my office and easier to reach. When I was supposed to have the appointment with her, I was a little more than 3 weeks out of surgery. Time to start therapy. The new PT was not able to get me in until almost a week from that date and only scheduled me for my initial consultation. First clue. The PT took some basic measurements using a huge protractor, then after a little bit passed me off to a PT Assistant for the second half of my appointment. Second clue. I also was uncomfortable with the fact that PT was carried out entirely in a common space. How they were managing to skirt around HIPAA, I have no idea. Then, I go to make the rest of my appointments and was told they couldn't get me in to see my PT again for ten days. Third clue, and I can solve the puzzle: Q_U_A_C_K_S

It was fairly obvious they were a body shop, they didn't care about their patients, which was evidenced by the fact that this was a critical time in my recovery to regain range of motion and they had no concerns about my not being seen for a long time, or concerned about keeping me with one PT.

Progress is measured in range of motion gained over each session. measuring it is a little soft, and everyone has quirks. Seeing one PT over time minimizes confounds in the measurements. Not to mention, there is a degree of trust involved.

So back to the doctor I went:

Doctor: Where are you looking for an office?
Me: Either X or Y.
Doctor: Why Y?
Me: My boyfriend lives there.
Doctor: Do I need to tell your parents?
Me: Is this a trick question?

Then the admission of guilt:

Doctor: Why do you go see a PT at Quacks are us?
Me: I knew someone there.
Doctor: Was it on the list of recommended therapists?
Me: Is this a trick question?

So the good Dr. gave me a contact for a legitimate PT. They were polite, made my whole bank of appointments at once, tried to keep me with the same therapist, and spent a lot of time talking about my injury, the surgery, what my goals were, and generally getting to know my health history. They are great.

The caveat is that since I got started with a competent therapist so late, my shoulder had already started freezing. We have only been able to make marginal progress in regaining range of motion. Which led to to today. 8 weeks after surgery. Signaling while driving, getting dressed, washing my hair, are all difficult if not impossible. The membrane holding my shoulder in place has overachieved and fused itself to places it shouldn't have, causing frozen shoulder. The first step to thawing it is to stretch and heat or ice. That was the last three weeks. Now, we come to the fun part, forcing it to move until literally it rips free. It makes a sound like a pair of pants splitting up the back, and is excruciatingly painful.

All in all I wouldn't recommend it. Friday, I almost threw up from the pain, today I almost passed out.