After more than 8 months, Unum Insurance Company has finally agreed to make full payment pursuant to my disability insurance policy. It's an income replacement policy. The policy provides that, if due to medical reasons I am no longer able to do what I had been doing (first chair complex intellectual properly litigation), and have lost more than 20% of income as a result, Unum would pay me according to a complex formula. If my income loss is greater than 80%, then Unum would pay the full contract amount.
I agreed with my firm that, effective January 1, 2013, I would work no more than 20-25 hours per month, and would be paid about 15% of what I had been paid in 2012 and earlier years. That's basically enough to pay for my health insurance and various other professional expenses. (Law firm partners must pay 100% of the cost of their health insurance; there is no employer subsidy, so it's basically the COBRA cost). I am essentially uninsurable in the private health care market, so being able to keep on with the firm's health insurance is a good thing.
It's been a long slog with Unum. It took forever to get them the medical records (I eventually personally obtained virtually all of the records and sent them to Unum, keeping copies for myself), and went through three claims representatives and two supervisors, and multiple "tentative" rejections, misinterpretations, lost paperwork, and miscalculations -- none of which were ever in my favor. What a surprise. But I'm glad that Unum has finally ponied up. The other insurance companies that sold me similar policies (MassMutual), agreed to pay in full relatively quickly. Because I paid for these policies with post-tax dollars, the payments that I am now receiving are tax-free. The policies provide that they will continue to pay to age 65, or until I die, or, if by
some miracle I am cured, able to resume my profession, and
meet or exceed my pre-cancer earnings. Having this revenue stream gives
me great comfort and relieves the financial pressure that otherwise
would quickly become crushing.
Somewhat to my surprise, I found that I had also bought a policy from
MetLife that makes payments into a 401(k) account, since I no longer
have the earnings or ability to save for my (now theoretical)
retirement. It likewise will continue to age 65. I vaguely remember making the decisions years ago to buy disability coverage, and adding to the scope of disability coverage from time to time, but until my cancer diagnosis, I paid little attention to the details. I didn't even realize that I had purchased four different disability income replacement policies from three different companies -- it was all handled by a single agent, who I trusted to bring me and my fellow law partners the most appropriate coverage.
I must say that I'm no fan of insurance companies -- they seem to be eager to accept your money, but unreasonably resist paying out
-- but now that I am on the beneficiary side, I'm glad that I listened
to my agent over the years, bought the policies, and increased my
coverage as the opportunities were presented to me. My agent has been invaluable in prodding Unum to pay up.
I guess that this is a testament to the benefits of disability insurance. I'm told that the odds of suffering a career-altering disability are greater than a premature death, yet apparently life insurance is more widely purchased that income-replacement disability insurance. I've carried and paid for these disability policies for years, just as I have carried and continue to carry a substantial amount of life insurance. Readers who are the primary breadwinner for their families, or who would find it difficult to live on just your partner's income, consider calling your agent to review and update your insurance policies.
Thursday, May 30, 2013
Tuesday, May 28, 2013
Mets Day 411 - little changes
There is little new to report. I've been taking Imipramine (Tofranil) for about two weeks now. I have not noticed a dramatic difference. Perhaps I've been a little less wet each night, but that's hard to measure. I still wake up several times a night, and a good night's sleep is elusive. I think that I'll double my dose to 50 mg and see if that makes any difference.
I rarely go into the office. I usually scan my work emails daily, but as the chronic sleep deprivation has adversely affected my memory and limited my ability to work, my motivation likewise has slackened. Instead, I keep myself busy with various tasks at home. We are rebuilding our deck, and I've been meeting with contractors and trying to decide on how the new deck will be finished. I've also been mapping out the logistics for our family trip to Europe this summer.
For the past month I have been having physical therapy for my shoulder. I made a New Year's resolution to start going to the gym and playing racket ball, and within a month my right shoulder was complaining, It's been over 20 years since I've played, and I'm not in my 20's any more. The orthopedist diagnosed it as an inflamed bursa sac and various other angry shoulder parts. Taking an anti-inflammatory failed to settle it down, so I had two cortisone shots. I've been going to physical therapy three times a week, and am doing those goofy exercises at home in the meantime. This experience reinforces my belief that exercise is a conspiracy dreamed up by the industrial health-care complex as a way of providing them with more business.
This past weekend my son-in-law graduated from law school. It's a great accomplishment. He's now studying for the bar, and has a job with the firm that he worked for last summer. He and my daughter recently moved into our basement, and it's nice having them closer by. She's busy finishing her third year of medical school, and is showing more as her pregnancy progresses. They found out it will be a girl, and have a name picked out. It's fun watching them nest as the anticipation builds.
On Sunday, Kirsten and I came home from church and decided that we would join the annual Rolling Thunder motorcycle ride that goes from the Pentagon, across the Memorial Bridge, around the Mall, and ends near the Lincoln Memorial. We had to jump-start my Harley to get it going -- I have not ridden it this year, nor did I last summer, since I was otherwise occupied -- but we finally got the beast chugging. We rode down the GW Parkway and joined thousands of other bikers parked in the Pentagon's massive lots. The start of the ride was delayed, and we were in the third parking lot -- it took hours for the riders in the first two lots to form up and roll out into the ride. In the meantime we walked around and looked at all the other bikes and people. I quickly learned that my dusty, dirty old Sportster was the saddest bike in the group (until we saw a Vespa, but at least that was clean). After waiting a while, I tried to start my bike and found that my battery was completely dead. Fortunately, a member of the Christian Biker's Association (the ones with the cross tattoos) had jumper cables, so we coaxed my Sporty back to life. We decided that we didn't want to wait another hour or so, especially with having to keep the bike running, so we went home, never having joined the ride. But it was the thought that counts, right?
I rarely go into the office. I usually scan my work emails daily, but as the chronic sleep deprivation has adversely affected my memory and limited my ability to work, my motivation likewise has slackened. Instead, I keep myself busy with various tasks at home. We are rebuilding our deck, and I've been meeting with contractors and trying to decide on how the new deck will be finished. I've also been mapping out the logistics for our family trip to Europe this summer.
For the past month I have been having physical therapy for my shoulder. I made a New Year's resolution to start going to the gym and playing racket ball, and within a month my right shoulder was complaining, It's been over 20 years since I've played, and I'm not in my 20's any more. The orthopedist diagnosed it as an inflamed bursa sac and various other angry shoulder parts. Taking an anti-inflammatory failed to settle it down, so I had two cortisone shots. I've been going to physical therapy three times a week, and am doing those goofy exercises at home in the meantime. This experience reinforces my belief that exercise is a conspiracy dreamed up by the industrial health-care complex as a way of providing them with more business.
This past weekend my son-in-law graduated from law school. It's a great accomplishment. He's now studying for the bar, and has a job with the firm that he worked for last summer. He and my daughter recently moved into our basement, and it's nice having them closer by. She's busy finishing her third year of medical school, and is showing more as her pregnancy progresses. They found out it will be a girl, and have a name picked out. It's fun watching them nest as the anticipation builds.
On Sunday, Kirsten and I came home from church and decided that we would join the annual Rolling Thunder motorcycle ride that goes from the Pentagon, across the Memorial Bridge, around the Mall, and ends near the Lincoln Memorial. We had to jump-start my Harley to get it going -- I have not ridden it this year, nor did I last summer, since I was otherwise occupied -- but we finally got the beast chugging. We rode down the GW Parkway and joined thousands of other bikers parked in the Pentagon's massive lots. The start of the ride was delayed, and we were in the third parking lot -- it took hours for the riders in the first two lots to form up and roll out into the ride. In the meantime we walked around and looked at all the other bikes and people. I quickly learned that my dusty, dirty old Sportster was the saddest bike in the group (until we saw a Vespa, but at least that was clean). After waiting a while, I tried to start my bike and found that my battery was completely dead. Fortunately, a member of the Christian Biker's Association (the ones with the cross tattoos) had jumper cables, so we coaxed my Sporty back to life. We decided that we didn't want to wait another hour or so, especially with having to keep the bike running, so we went home, never having joined the ride. But it was the thought that counts, right?
Thursday, May 16, 2013
Mets Day 399 - Cymbalta doesn't work for incontinence
I've been taking Cymbalta (Duloxotine) for two weeks in the hope that it would help my nighttime incontinence. It has not. Each night I have continued to leak; in fact, I think that the volume of my leaking has been even greater than before I started the medicine. I have had to wear Depends consistently after having several overflow accidents wearing pads. I also have noticed that my flow is weaker after I started taking Cymbalta. Most importantly, my sleep patterns have not improved while on the drug. I've concluded that this drug is not doing the trick.
So now I'm going to switch over to Imipramine (Tofranil) and give that a shot. Dr. Phillips said I could start at 25 mg., and if I didn't notice any improvement after a week or two, double it to 50 mg. Hopefully, I can find better living through pharmaceuticals.
So now I'm going to switch over to Imipramine (Tofranil) and give that a shot. Dr. Phillips said I could start at 25 mg., and if I didn't notice any improvement after a week or two, double it to 50 mg. Hopefully, I can find better living through pharmaceuticals.
Wednesday, May 8, 2013
Mets Day 391: Another Uro's opinion on incontinenece
Today I met with Dr. Phillips, partner to Drs. Hendricks and Fraizer. Dr. Phillips specializes in solving incontinence issues. He used to do RC's and build neobladders, but stopped doing that several years ago. He was very familiar with problems with nocturnal incontinence with neobladders. He sketched out diagrams to explain why neobladders had a propensity to leak at night.
We had a long discussion about my options, which we identified as follows, in order of least to most invasive:
1. Do nothing, and hope my nocturnal incontinence gets better by itself. Not interested, thanks.
2. Try medicine. We discussed Duloxotine (Cymbalta), but he said that he believed that another medicine, Imipramine (Tofranil), had a better likelihood of helping. He said he'd prescribed Imipramine for his patients who had their prostate removed and had enuresis, but had not had a large track record of use with neobladder patients. He suggested that I try it, and that I would know in a few weeks whether it was making any difference. He candidly admitted that he had no idea if it would work, but said it was worth a shot. "It certainly won't hurt," he said, noting that he was starting me off at 25 mg, a relatively low dose.
3. Use a clamp. This was a new one for me. I had a mental image of a binder clamp on my penis (ouch!), but he said that there was a product called a C3 penile clamp that was designed to help with incontinence. I'm skeptical. It looks uncomfortable (despite the title), but Dr. Phillips said that many of his patients had found that they worked. It's going to take me little while to get used to the idea . . .
4. An Artificial Urinary Sphincter, or AUS. His discucssion was identical to Dr. Wright's: implant it, wait 6 weeks, then activate it. He was candid on the pros and cons, and recommended that I try options 2 or 3 first.
5. Remove the neobladder and switch it to an Indiana Pouch or an ileal conduit. This is major surgery. He said that changing it to an IC was straightforward, but changing it to a pouch would mean taking out the neobladder and then taking another chunk of bowel to make the pouch, which would increase the odds of bowel problems. I'm not too excited about that either.
I think I'm going to try the medicine option first. I've been taking Cymbalta for 5 days, so I'm going to continue with that for a couple of weeks and see if there is any effect (so far, I haven't noticed any difference). Then I'll give the Imipramine a try.
We had a long discussion about my options, which we identified as follows, in order of least to most invasive:
1. Do nothing, and hope my nocturnal incontinence gets better by itself. Not interested, thanks.
2. Try medicine. We discussed Duloxotine (Cymbalta), but he said that he believed that another medicine, Imipramine (Tofranil), had a better likelihood of helping. He said he'd prescribed Imipramine for his patients who had their prostate removed and had enuresis, but had not had a large track record of use with neobladder patients. He suggested that I try it, and that I would know in a few weeks whether it was making any difference. He candidly admitted that he had no idea if it would work, but said it was worth a shot. "It certainly won't hurt," he said, noting that he was starting me off at 25 mg, a relatively low dose.
3. Use a clamp. This was a new one for me. I had a mental image of a binder clamp on my penis (ouch!), but he said that there was a product called a C3 penile clamp that was designed to help with incontinence. I'm skeptical. It looks uncomfortable (despite the title), but Dr. Phillips said that many of his patients had found that they worked. It's going to take me little while to get used to the idea . . .
4. An Artificial Urinary Sphincter, or AUS. His discucssion was identical to Dr. Wright's: implant it, wait 6 weeks, then activate it. He was candid on the pros and cons, and recommended that I try options 2 or 3 first.
5. Remove the neobladder and switch it to an Indiana Pouch or an ileal conduit. This is major surgery. He said that changing it to an IC was straightforward, but changing it to a pouch would mean taking out the neobladder and then taking another chunk of bowel to make the pouch, which would increase the odds of bowel problems. I'm not too excited about that either.
I think I'm going to try the medicine option first. I've been taking Cymbalta for 5 days, so I'm going to continue with that for a couple of weeks and see if there is any effect (so far, I haven't noticed any difference). Then I'll give the Imipramine a try.
Thursday, May 2, 2013
Mets Day 385: Neobladder anniversary
My cancer-riddled bladder and prostate were removed a year ago today, and my neobladder was created at the same time. Too bad there was no warranty on the neobladder. It has always leaked, and it's not getting any better. In the past two nights, for example, I've completely voided before going to bed (in fact, I catheterized last night), and less than two hours after going to sleep, I was jolted awake not by just a slight trickle, but enough of a flow to saturate the pad, my underwear, and wet the sheets. Ick. It's not overflow or stress incontinence, since I had less than 100 ml in my bladder.
After each event, I have to wash -- sometimes I soak in the hot tub -- and change the sheets or at least put a towel over the wet spot. I find it difficult to go back to sleep -- eventually I may doze, but REM sleep is rare.
Today I met with the chief of urology at Hopkins, Dr. James Wright. He specializes in incontinence issues. he sees a lot more stress incontinence with men after prosectomies,but also sees the occasional neobladder patient. He is willing to consider adding an artificial urinary sphincter, or AUS. It's a 90 minute procedure, followed by six weeks of waiting for the body to heal and adapt to the cuff over the urethra, before it is activated. He has a 4 week wait before he could do the surgery. We talked about my planned Europe trip with the family, and he'd prefer waiting until after that trip before doing the surgery. He wouldn't want me somewhere in Europe a couple of weeks after the surgery, and have some complication.
We discussed how an AUS would work. I've blogged about this before. Essentially, an AUS has 3 parts: the cuff, a doughnut-shaped restrictor placed over the urethra; a reservoir of fluid that is placed somewhere in the abdomen, and a valve in the scrotum. The valve is squeezed a couple of times to force from the cuff into the reservoir, opening the urethra. In a couple of minutes, the cuff refills with fluid, closing the urethra. it lasts 5-10 years before it wears out, with the average being about 7 years. Parts can be replaced independently.
While I think about it, he gave me a prescription for Duloxotine. He said he's had limited success with using it to help incontinence, but he sees little downside to trying. I'll start that now and see if it makes any difference. If I decide to get an AUS, it probably won't be until August.
In the meantime, I'm going to meet next week with Dr. Michael Phillips, a local DC urologist who also specializes in incontinence, and get his views.
In other news, Unum insurance company has grudgingly agreed that I meet their definition of disability, and has started making payments pursuant to my private insurance contract. However, they are only paying about 50% of the benefits that the contract says would be paid. Half a loaf is better than nothing, but I'm trying to get all that I am due. I don't like doing battle with insurance companies, but avoiding paying money is what they do.
After each event, I have to wash -- sometimes I soak in the hot tub -- and change the sheets or at least put a towel over the wet spot. I find it difficult to go back to sleep -- eventually I may doze, but REM sleep is rare.
Today I met with the chief of urology at Hopkins, Dr. James Wright. He specializes in incontinence issues. he sees a lot more stress incontinence with men after prosectomies,but also sees the occasional neobladder patient. He is willing to consider adding an artificial urinary sphincter, or AUS. It's a 90 minute procedure, followed by six weeks of waiting for the body to heal and adapt to the cuff over the urethra, before it is activated. He has a 4 week wait before he could do the surgery. We talked about my planned Europe trip with the family, and he'd prefer waiting until after that trip before doing the surgery. He wouldn't want me somewhere in Europe a couple of weeks after the surgery, and have some complication.
We discussed how an AUS would work. I've blogged about this before. Essentially, an AUS has 3 parts: the cuff, a doughnut-shaped restrictor placed over the urethra; a reservoir of fluid that is placed somewhere in the abdomen, and a valve in the scrotum. The valve is squeezed a couple of times to force from the cuff into the reservoir, opening the urethra. In a couple of minutes, the cuff refills with fluid, closing the urethra. it lasts 5-10 years before it wears out, with the average being about 7 years. Parts can be replaced independently.
While I think about it, he gave me a prescription for Duloxotine. He said he's had limited success with using it to help incontinence, but he sees little downside to trying. I'll start that now and see if it makes any difference. If I decide to get an AUS, it probably won't be until August.
In the meantime, I'm going to meet next week with Dr. Michael Phillips, a local DC urologist who also specializes in incontinence, and get his views.
In other news, Unum insurance company has grudgingly agreed that I meet their definition of disability, and has started making payments pursuant to my private insurance contract. However, they are only paying about 50% of the benefits that the contract says would be paid. Half a loaf is better than nothing, but I'm trying to get all that I am due. I don't like doing battle with insurance companies, but avoiding paying money is what they do.
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