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It’s a vicious circle, it is. Mmmm hmmmm.

Last week, I managed to get tv. We have long been Dish Network customers {like, over 10 years}, but, of course, didn’t bring any of the stuff with us. Several years ago, we went looking at satellite options for the RV, and basically struck out unless we wanted to go with Direct TV, which we absolutely did not.

As it turns out, about a year and a half ago, Dish Network came out with the Tailgater; a portable satellite dish designed for easy transport. Originally, I thought we’d have to pay the retail price, which I wasn’t necessarily happy with, but it’s something we would continue to use when we went camping down the road; plus, at this point, with no tv options at all and living in the rv, any bit of creature comfort has got to help.

Incredibly, the big cities here didn’t have one. Nope, they didn’t. And I was shocked. I was not of a mind to drive an hour one way to get to Raleigh to get one. Fortunately, the people Dish Network sent me to in Roanoke Rapids actually had one- as in, a single unit. AND- they got me the receiver for free. I, apparently, was eligible for an upgrade.

Little did I know, however, that getting one meant signing another 2 year contract. *sigh* Oh well. We’ve been happy with DN all these years, and we didn’t see anything changing once we got here. I figure it was worth the trade-off.

We have some more fiddling to do with it, but after climbing and putting it on the roof to grab a signal, we were still not able to, so the cable is strung across the road. I just hope no one steals it. Yikes.

5 am Saturday morning, amidst the continued downpour, Murphy came to pay us a visit.

If you’re an RVer, you know how to angle your awning so the water drains off and doesn’t collect. Well, apparently that wasn’t enough of an angle for the kind of rain we had gotten overnight. Yep. You can see where I’m going with this.

Our awning came crashing down. *sigh* It’s like, close to $1,000 to replace. *sigh*

I know this, of course, because when the spring went out on our trip to Oklahoma {the one where we lost the tires and had the blowout on the way home}, we got home and priced it out to replace the hardware. And, because the underside of the awning was stained from campfire smoke, we thought, why not check and see what it would cost to replace the whole thing.

Needless to say, the sticker shocked us right out of that thinking. Now, however, we’ve got no choice. *sigh*

So my tasks this morning are to call insurance and see if that’s covered.

I’d like to run if the rain will hold off.

And I need to get back to Wally world this afternoon. On the list also, in addition to finding shoes that we didn’t get to last week, are ear plugs. Seems oldest dd has an ear infection, which she has gotten from swimming. It’s been really only the last year or so that she’s had continued issues with her ears after swimming, so it’s time.

I also need to write down ingredients to see what I can find for treating it homeopathically {don’t laugh, but now is the time I’m wishing I had some breast milk…… you probably think it’s really gross, but I’ll tell you from experience that it DOES work, because it’s teeming with live antibodies that help all kinds of stuff- works on pink eye, too, and is used for cancer treatment…………

Breast milk used in cancer fight

http://www.sunshinecoastdaily.com.au/story/2009/01/13/breast-milk-cancer-fight/

Cancer, arthritis, diabetes, even acne – is breast milk the new wonder cure?

http://www.dailymail.co.uk/health/article-1268987/Cancer-arthritis-diabetes-acne–breast-milk-new-wonder-cure.html

Breast-feeding, HAMLET, and cancer

http://www.acsu.buffalo.edu/~andersh/research/milkcancer.asp

Substance in Breast Milk Kills Cancer Cells, Study Suggests

http://www.sciencedaily.com/releases/2010/04/100419132403.htm

but  I digress. :lol:} to help knock it. I have never gone looking for tea tree oil, but I know I can find some olive oil; maybe some garlic oil. If nothing else, I am sure we’ll be vampire-free for a while. 😀

Now’s the time I am wishing I would have had the space to pack my family herbal book. *sigh*

I will say it feels like a time warp ala Murphy. I am working on options, but honestly, I’m feeling a lot discouraged. I knew going in this was going to be difficult. I just didn’t figure on getting no respite from it. I was hoping new patterns would be established; new habits would take root. And I can say that we’re not there yet.

I can look at the situation logically and know it could be worse; we are blessed to be able to have the option of me and the kids even being here; most of the stress is material, etc etc; we are blessed to have opportunity. I can also look at this and realize the things I did to fill my tank are sorely leaving a gaping hole, and I may really need to seriously think about taking that on sooner than later.

So. We’ll see what this week has in store for us.

And, because life is a soundtrack and it’s Halloween month and I really need a good giggle this morning, I leave you with Time Warp {dance} from the Rocky Horror Picture Show

[youtube:http://www.youtube.com/watch?v=Rtkdo7bOmJc%5D

 

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I’m pretty sure that is not news y’all don’t already know.  😆 Part of what I deal with as ongoing issues are body weirdities. There is usually something strange going on, and yesterday was no exception.

Much of the time, I have skin weirdities. I seriously have not figured this one out, and really, I’ve stopped trying. When I changed to my Vibrams, there was one spot on each foot that would stay all red, on the inside of my foot. Those spots looked terrible, but they didn’t hurt and they didn’t itch.

I thought maybe it was detergent; maybe it was the seam in the shoe. Nope. Not the detergent, and not the seam, because the location of the spot changes to places where there is no seam……

Magically, one day, they totally disappeared. After that, I’d have times where that spot would splotch on one foot or the other, no matter what I did. No idea why. I’ve been splotch-free {knock on wood} for a while now, but I’m pretty sure at some point it will get weird again.

If you were around me yesterday, you probably noticed that I wasn’t all there upstairs. Yep, you guessed it. I was pretty swollen. It’s been creeping up on me, getting progressively worse as the week progressed. Today I have great plans to stay in bed as much as I can this afternoon after I get my errands done.

My biggest complaint with the swelling is that I can feel it. I can feel my hands swelling, and I can feel my toes becoming sausages. It’s a really familiar sensation, but I still don’t like it.

Another one of my weirdities is bruising. I’ve had extensive testing done for all kinds of obscure diseases, courtesy of my local cancer center’s fantastic hematologist. He’s one of my favorite doctors, and it’s good to know I can call him up and he’s willing to help.

Tuesday, after my normal run, the ball of my foot hurt for some strange reason. No idea why; didn’t hurt when I was running; I didn’t knock it into anything. But it wasn’t comfortable to walk like I normally do.

Wednesday when I got up, that part of my foot was still tender, but once shoes were on, walking was fine and there was no pain. When I got home in the afternoon, I noticed I was getting a bruise. But the bruise was not where the pain had been. Nope. This bruise was on the outside of the ball of my foot.

Thursday morning, I was feeling pretty rotten. If I hadn’t taken nearly an entire month off of running, I would have skipped my run entirely. Last month, I managed to lose 56 miles. 😯 

I know. That totally put me way behind, which means that I can’t cut myself any slack until I get caught up. By the end of this month, I’ll probably still be about 25 miles down from where I ought to be, and I’m hoping to get caught up by the end of next month.

So, when I woke up and had pitting; the bruise on my foot and I felt like crapo, I debated about whether or not I should even bother trying. I figured I would give it a shot and see how I felt. If the pain in my foot was bad, I wouldn’t push it.

 

Just in case you’re wondering- yes, that’s a dent in my ankle. You can have edema which is firm (which is what I have in my hands, arms, and legs) but when it hits my ankles, I can usually mash my finger in there and this is what it looks like. And no, it’s not “normal” to wake up in the morning and have pitting. That amount of pitting is what I consider “moderate.” It’s a bit past “slight” and “mild,” but nowhere near “severe” or “obscene.”

Obviously, it was hard to get a really good picture of the bruise, because the contrast was more evident when the light was lower, but then I couldn’t get a decent picture of it. What was bizarre about this one, as you can see, is how it wrapped from the outside ball of my foot all the way to the actual ball, all that side. It’s almost like I had my foot upturned and whacked it with something cylindrical or stepped on something and rolled my foot. I am pretty sure that I would have remembered doing something like that.

Because of the swelling, I knew it was really important to get running and get as much of it flushed out as I could. Even though I knew I’d be pitted again by the afternoon, some reduction is better than nothing. So I had to give it a shot and see how long I could go before the bruise became a problem.

Darn it anyhow, but my foot felt totally fine while running. And even though it remains very clearly bruised, that spot doesn’t hurt at all when I press on it, even though it was a little bit tender yesterday morning.

It’s a daily adventure, I’m tellin’ ya. What weirdities will I wake up with today?! What weirdities can I develop during the day?!

Meh.  I am convinced, however, that it has something to do with heat. Wednesday, we hit 102, and I have noticed that the increase of heat has brought an increase of swelling. It’s going to be a long summer……… *sigh*

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Yep.  I did, I’m ashamed to say.  I knew better, and I did it anyhow.

At first, I conned myself into thinking a little wouldn’t matter.  And you know how that goes- once you have a little, well, heck, you might as well go for broke and do what you want and have a lot, right?

And then, the really twisted part of my brain joined in and said, “It’ll be an experiment, and then I’ll know for sure one way or the other.”

Epic fail. Big time bomb.

And truly, the only one suffering is me. Go me for allowing my stupid stubbornness to get the best of me and letting myself con myself into not just falling off the wagon, but staying off the wagon. 🙄

I think this started on Thanksgiving. I “allowed” myself to have some dinner rolls, and thus, I started the fall off the gluten-free wagon.

I didn’t have any really bad effects initially. Indeed, I was flying high when my rheumatologists gave me the green light to run, and actually forbade me to stop. I started increasing my mileage and joined the Runner’s World Holiday Challenge. My mileage was good and I felt great.

I really thought, in my heart of hearts, that the worst with the diseases was behind me. How could it not be? I’d conquered the bulk of the pain; the plantar fasciitis (a kind of connective tissue) was all but resolved thanks to my Vibram Five Finger shoes, and my chronic tendinitis issues seemed to be on vacation. Systemic inflammation was down considerably, which I considered to be a major victory.

And then came Christmas week. I am pretty sure it was the combination of not napping/getting my feet up in the afternoons and the normal stress of the season that did me in. Christmas morning, I managed to crawl out of bed around 8 am and was back in by 10:30 am where I spent the rest of and entire next day.

That week, I had run 52.25 miles, and things were feeling a bit achy. In a matter of two days and a few hours, I had gained 12 lbs of fluid. Even with my continued running, I was swollen, pitting, and generally feeling like crap. This was by far the worst flare I had hit in several months. It took about a week, but the pounds dropped off.

The pain, however, remained. The first week of this month, everything was still hurting. As the pain increased, my mileage varied, as I decided to do some shorter runs to see if that would help. Stomach unease was a near constant, which meant I was doing overall a really good job staying away from the sugar cookies, knowing they would exacerbate things.

When we got the crud going around, though, the only thing I was interested in was raisin bread. And this is when the twisted part of my brain really took hold and let me fall completely off the gluten-free wagon. I mean, I was already in a lot of pain, so why bother not eating what I wanted to, right?

Shame on me. I know better.

I had nearly tricked myself into thinking I was “normal;” that I could eat “normally” and make “normal” goals and things.

Shame on me. I know better.

Part of the reason I started running eons ago was so that I *could* eat and not feel guilty. That was my reward (well, one of them) for running: the ability to eat ice cream or chocolate and not feel guilty. 🙄

As part of my research on my conditions, one theme I had run into repeatedly was the gut connection to inflammation. I’ve been tested for Celiac, and apparently there was no “intolerance.” The thing is, you don’t have to be completely intolerant, nor do you have to have an allergy to something to have it affect you and give you adverse reactions.

Yep. Sensitivities can cause all kinds of things. There is a difference between food allergies, food sensitivities, and food intolerance. I’ve undergone extensive allergy testing. By this I mean a series of over 300 injections where the “bump” is measured for allergic response (you’re going to have a bump; how high the bump is determines the level of your allergy). From what I remember, wheat was not one of my allergies.

We know that the gut/intestines – the enteric or intrinsic system- has its own nervous system, which has as many neurons as the spinal cord.

Did you get that?

Let me say it again- your digestive system has its own nervous system that has about the same number of neurons as your spinal cord. How does this work? One example would be to think of someone who is clinically brain dead (has no electrical activity in the brain) and yet survives artificially, with a feeding tube etc. Did you ever think about how that works?

How the Gut’s ‘Second Brain’ Influences Mood and Well-Being is a really good article to get you started.

I’m not going to go into a lengthy lecture about anatomy and physiology, but I WILL say that what we eat is FAR more connected to how we feel and act than most people think. Conditions like ADD/ADHD and autism often respond to dietary intervention and are often exacerbated by food with certain food colorings and additives like MSG.

There is stuff in food (like wood pulp, aka cellulose) that we don’t have the ability to digest. And then we wonder why we can’t?

There is much evidence and continuing studies that show a link between gluten and autoimmune conditions and pain. Celiac and arthritis, for example, have a link. (Celiac Disease is NOT an allergy to gluten, it is an autoimmune disease; some children with wheat allergies can outgrow the allergy.) Studies show that Sjogren’s and Raynaud’s both have links to gluten.

And gluten is in all kinds of stuff- it’s not just bread; it’s not just connected to wheat, and it’s often hidden (like whey in hot dogs, casein in tuna, or MSG being called “natural flavorings”). Gluten can be found in vitamin supplements and some medications. Most grains can have gluten, so it’s not safe to say “I’ll just eat oatmeal” because there could be (and often is) cross-contamination. Wheat free does not = gluten free.  😦

I often wonder why people are more agreeable to treating illness with artificial chemicals than they are to think about what they are eating. Is it just because processed foods are easier? (ok, I admit, this feeds into my theory of a “right now” society whereby people want things right now; easily, without having to think or work, and I believe that treating it with a pill is the route most people chose just because it’s “easy”.)

I DO think people want to take the easy route, and in some ways, I am no exception. You probably already know we don’t do a lot of processed foods and we LOVE the eggs we get from our chickens.

Gluten-free options are not abundant (nor cost-effective) where I live. And, since it’s really only me in the family that is affected, it’s hard to justify spending the $$ and having the rest of the family go gluten free. So that leaves me more or less where I started (bear with me, please, while I whine :D)– cutting out what I can on my own and hoping I see results.

Actually, that’s not entirely true. At this point, I’m nearly 100% sure that I’ll see results and my pain level will once again decrease. I’m going to miss my raisin bran.

If, in a few months, I start to complain about wanting to load up on breads and grains again, would y’all just poke me, please?

Thank GOODNESS I can still eat popcorn……………

**Disclaimer: I’m not a doctor, nor do I play one on TV. Don’t shoot me or try to sue me if some of this information isn’t spot on or is debunked in 50 years. I’m just a regular ‘ole person scouring the internet and researching what I can. If you have experience with any of this, PLEASE leave me a comment!

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What to do, what to do….

Hunny wants my docs (rheumies) to sign off on me running any kind of distance on concrete/pavement/anything without cushion. He is worried that I am going to hurt myself and that’s going to result in me going down for more than a few days. The last time he was insistent I not do something because he thought it was going to physically harm me (although it had nothing to do with running), I ended up in such bad shape that I nearly ended up in the hospital and in bed pretty solidly for two weeks.

My argument is that the mileage is fine (10k) and I’m prepared for that.  Worst case scenario, I could either walk or not finish if something happened.

He has a voice, of course, because when I’m incapacitated (as I was earlier this week), he’s the one picking up the pieces and filling in. He doesn’t mind when it’s a freak or unexpected thing, but when it’s something I’ve set out to do despite his reservations and it goes bad, he’s not a happy camper.

Tuesday I had a weird funky episode about 45 minutes after my run.  I haven’t ever had anything like that happen before, and I haven’t had anything similar since. I was really glad I wasn’t driving, to say the least. Tuesday pm was spent in bed; some of Wednesday pm was spent in bed; I spent all of yesterday pm in bed (and really crashed hard).

I cannot argue with the logic, and certainly, in light of this new thing on Tuesday, one can counter and say that there will be other races, yada yada yada.

Obviously, I’m disappointed. To not run now, when I’ve spent the last 3 weeks really focused on this, in many ways would feel like a cop-out (even though logically I know I have real health issues that I can’t ignore). I’m annoyed to feel like I’m chickening out and “using” my illnesses as an excuse to not enter something I know I’ll have an awful finish time in.  😆

Even though my time will be atrocious (as in, some of the 10k walkers will finish with better time), the whole point for me was to set a goal and go for it, even just to finish (and yes, I keep telling myself that, in hopes I will some day believe it- honestly, I have a competitive streak and I like to do well; but here again, I know where I’m at now). The next race I’d probably have better time and longer, focused training under my belt.

The next one on the schedule is in December, and I am not sure I can physically run in colder temps (because of my Raynaud’s), because I’m supposed to gear up and avoid cold as much as possible. I’d really rather not run a sustained purple/blue, and in good conscience, I cannot say that any extent of time without blood in one’s appendages is smart and worth the possible/probably outcome. I am certain that my docs will NOT be keen on a winter run.

In all reality, that run would be out, unless it was balmy and 50 degrees, which hey, might happen. Last year, that was during our cold snap, where we had a week of sub-zero temps, with highs around -11 and -14. That weather was a total oddity, though, and unlikely to ever happen again. Most likely, it’ll be 40s to 50s, which really is not very cold for normal folks.

If that thing on Tuesday hadn’t happened, I wouldn’t think twice. I would be confident with no reservations, unless my hip was still in bad shape like it was last week.

But that thing- honestly, it left me a little shaken and concerned (mostly because we haven’t ruled out a heart issue, too :roll:), and I can’t say it can/should be entirely disregarded. I’ve dealt with so many weird, one-time bizarre things it would make your head spin (like the one time I could walk for over an hour)- but that’s the point- they are one time things and then I never have another episode.

What to do…… what to do…… anybody ever dealt with this kind of situation?  Give me your two cents, please!

 

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Ya, you! You’re too fat! Clearly, you are not capable of moving your fat butt, or watching what you put in your mouth. Guess we’ll have to do that for you, too.

Yep. That’s what Denmark and Hungary have told their citizens.

On Tuesday, Hungary voted to place a tax on “junk-foods” like Big Mac, pop (soda), and sweets.

Yesterday, the fat tax in Denmark went into effect. In this case, actual food in addition to that junk-food is being taxed. Here are some of the examples:

  • High fat dairy products (what about kids under 2 years old who need the fat from whole milk for brain development??)- items like cream cheese, whipping cream, and ice cream
  • Butter (huh, seems the body can break down the fats in butter than in fake, processed margarine-y food stuffs, but what do I know?)
  • Meats
  • Pizzas
  • Pre-cooked Foods
  • Potato Chips
  • Olive Oil (nevermind that olive oil is actually healthy fat- makes me wonder if this applies to peanut butter and nuts, which also contain healthy fats)
  • Etc. (does this include eggs? I have to wonder- if everyone had their own chickens, the fat and cholesterol content would be lower)

It is no surprise that citizens were in a frenzy, cleaning off store shelves and stocking up. Who wants to pay 30% more for butter until they have to?

And it’s no wonder that the rest of Europe, particularly Great Britain, is watching with rapt attention. After all, can you blame them?

Germany wants a fat tax, too. In fact, “Recently the German Teachers’ Association recommended weighing children in class each day and reporting the seriously overweight to social services, who would have the power to remove them to clinics.”

Incidentally, homeschooling is illegal in Germany. So, if your kid is deemed too fat, off to social services you go! And YOU, stupid parent, have no recourse; no option; no choice.

Stop reading now if you don’t want my two cents on this situation. 😆

My personal opinion is that when you rely on the government to take care of you, you have given them the right to make all those decisions. Absolutely, if I was in a country where everyone got free health care, you had better bet it would be up to the government to set in place parameters and guidelines for the citizens, as a means of keeping those costs down.

And why shouldn’t they? This clearly, imo, falls into the category of taking care of the individual’s health needs, since, you know, they obviously can’t make good decisions by themselves.

If people are going to make poor eating choices that have negative consequences on their health care (that the government is paying for), it stands to reason that they should contribute more financially to help off set those costs. Alcohol is taxed more; I would be surprised if tobacco isn’t as well.

Now, that being said, (and if you haven’t stopped reading in disgust) I don’t think the government has any business mandating either of those things. I don’t think it’s the job of the government to forcibly “take care” of its citizens. I’m a fan of choice.

In the US, I don’t believe its constitutional for the federal government to mandate something like federal health care. States- sure. Go for it. But once you do (like Massachusetts), is it impossible to undo?

I know the issue of mandatory health care is loaded, and I certainly don’t have the answer. I think it’s a bad idea to give up any decision-making choices in favor of other people making decisions for you.

If you’ve been reading along, you know how I feel about the health care system as it is now. It’s definitely broken.

Case and point: out of the two hospitals we have here (the hub of anything in 200 miles in any direction) both are too small, apparently, to have their own ER doctors. Instead, they use a contracted service.

While both hospitals are in my insurance network, this contracted service, which is the same for both hospitals, is not. That means that they can charge anything they want to, and they do.

What does this mean to me?

As a person with insurance through a national insurance group on a Fortune 500 company policy, it means that my deductible is doubled because they are out of network. It means that those services (the ER doctor charge) get paid at 70% instead of 90%, after my doubled deductible. This deductible also doesn’t go towards my out-of-pocket costs because they are out of network, or to my other, in-network deductible.

If my insurance decides to pay in-network costs as a courtesy to me- which it usually does because of the rural factor, in that I have no other choice- they pay “reasonable and customary” costs.

What does that mean? That means if “reasonable and customary” is $100, they will pay the 90% of that amount. Because they are not under contract with the insurance company, this means that the provider can- and does- charge whatever they feel like. For that $100 insurance deems “reasonable and customary”? The provider can charge you $100,000.  And you, poor sucker who had to go to the ER, legally has to eat the difference.

I’m up to my eyeballs in this again right now, after having a trip a few months ago for my middle daughter’s concussion. I cannot tell you how sick I am of being Screwed. A look at 2010 should bring you up to speed.

The bill for the doctor in the ER was $800. I have no idea what amount will be considered “reasonable and customary,” but I know insurance will probably initially pay 70%. Then I’ll have to sit on the check they send me (because they don’t pay out-of-network providers; they send the check to you) and have it go for review, which can take 60 to 90 days. In the meantime, I’m going to get letters from the provider, telling me they are (and will- trust me, I’ve been down this road) going to turn you over to collections.

Nevermind the insurance you have. Nevermind that you went to an IN-FREAKING-NETWORK provider to keep your cost down. NEVERMIND that they are GOUGING you because you have insurance and being UNETHICAL because of their outrageous cost.

Ticked? Doesn’t begin to cover it.

The thing is, they aren’t all like that. Take my GI doc, for example. When I regularly go visit him, he charges *exactly* what is deemed “reasonable and customary” by my insurance. Our company changed insurance carriers since I’ve been seeing him, and his billing practices are exactly the same for each provider: they are under contract, and bill accordingly. This means when I go visit him, if my deductible is paid, I pay my 10% which comes out to less than $5.

Yep, you read that right.

LESS than $5, and the man is a specialist. And a good one. Who actually cares about his patients, even the ones (like me :lol:) who basically self-refer even though they aren’t supposed to.

So I don’t buy the mantra that all costs are high. Some providers are out to screw you, plain and simple. And when you are rural and without options or recourse, you’re the poor sucker who, again, has to take it in the shorts unless you don’t mind your credit rating getting wrecked while you duke it out.

The uninsured (particularly here, where people go to the emergency room for colds because they can’t be turned away) is a problem. Skyrocketing costs are a problem (don’t even get me going on the comparison cost of x-rays….). Something has to be done.

But giving complete control over to the federal government?

Sorry, I just don’t think that’s smart. I think once you get on that path to expecting to be taken care of, you give the right to that entity to make choices for you, like raising your taxes on butter, bread, and meats.

 

~~When you give up your rights to choice, you give up your voice.~~

 

More articles for your reading pleasure:

Germany Weighs Tax on the Obese

Bulge Battle Will Wallop Your Wallet

Denmark Levies World’s First Fat Tax

Fat Tax Lands On Denmark’s Favorite Foods

 

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Yep.  That’s me. Are you being screwed, too? 

I cannot think of another way to summarize the health care system besides using this term. When you live in a small, rural community that is isolated from the rest of the world, I really do think that the health care systems feels you are supposed to feel indebted to them while being screwed. And if you don’t?  Well, they don’t give a rip.

You may recall my earlier post about 2010 and the struggles I’ve been dealing with regarding medical billing. Yes, they continue. I spent nearly 6 hours non-stop today scanning, copying and summarizing the one situation in my complaint to my state’s Public Regulation Commission (PRC). 

Do I feel better? No. Why not? I’m expecting to be screwed yet again for reasons that are presently unknown to me.

The health care system is not just screwed up, it’s totally broken.  I have *zero* hope that it will ever get fixed.  Socialist health care won’t fix it. Goodness knows having insurance doesn’t contribute in any way past lowing the dollar amount owed by those with good insurance by which the consumer gets screwed.  It’s like having a bullseye on you when you have insurance.

Seriously.  One test now in dispute was billed at over $220.  Insurance says “reasonable and customary” for that procedure is around $40.  Insurance paid at 90% even though the PPO provider sent the labs to a non-PPO lab.  Which means…… I am “responsible” for paying the difference.  See -that’s getting screwed. 

Insurance says the contracted amount should only be around $40 and will pay over $35. My portion, if the lab had been under contract with my insurance group, would have been around $3.95.  But I, the consumer playing by the rules, is going to be billed the remainder of that $220 plus amount, and will be screwed if I don’t pay.  And, I’ll be charged tax on the whole amount because, since the provider is not in network, neither is lab testing, which means they can charge me gross receipts tax for any non-covered procedure.

I can’t tell you how darn tired I am of getting screwed. The consumer, as far as I know, has no recourse, except to file a complaint and ask for an investigation. It feels like everyone is out to take advantage of people who do have insurance, especially those in poor, rural locations where options for care are not abundant. 

In my opinion, if I go to a PPO (in-network) provider for a ser vice that is contracted and covered by my insurance, it should be the responsibility of the provider to perform and likewise send labs to other PPO providers. I was never given a warning that this would not be the case, nor the option to specifically chose who labs get sent to. Rest assured, I would have travelled 200 miles in any direction to ensure that things would go to ONLY PPO providers had I known the alternative. Traveling would mean ultimately paying more out-of-pocket, but to not have the battle afterwards would justify the expense, in my opinion.

I’ve also recently been told that no one cares about pursuing this because of the low dollar amount.  Excuse me? For me, it’s not so much the dollar amount as much as it is the principle of the thing.  I’m not one who says, “Oh, gee, because this one only costs “x” amount, I will pay it.” It doesn’t matter.  The point is that they could charge you *ANY* amount.  Dollar amount does not make something right. The could charge $2,000 for the labs or the procedure – they could only charge you $2. Some might say that the lower dollar amount isn’t worth their time to fight.

Who is going to pay me for the 6 hours I spent today to speak up? If they charged everyone $2 and no one complained, it wouldn’t take long for it to add up. They can screw up my credit rating over $2 if I don’t pay it, yet I have no recourse for unethical and fraudulent billing?

Here’s another problem with the medical community where I live.  In order to get into a doctor, it takes as a new patient nearly 3 months to be seen. Most doctors here are already overwhelmed and aren’t accepting new patients.  Until I got sick 3 years ago, the only medical person I saw in the last 15 years was my midwife. That’s right, I don’t use doctors unless I have to.

Now imagine you don’t have a family doctor and you or your child gets really sick with a respiratory something. Is it reasonable for you to wait 3 months to be seen – or even 2 weeks if someone is willing to try to squeeze you in -when you are very ill and having difficulty breathing *now*?  No, it’s not.  So, what to are your choices?  In the last year, we have finally gotten a single non-emergency after hours clinic that is open on Saturdays and until 9 pm. Before that? Nada.

It was no wonder people went to the emergency room for non-life threatening problems! Initially, my company’s health insurance plan responded by changing the deductible for emergency room visits.  At first, it was $300 out-of-pocket, which did not go towards meeting the deductible, and then it was contracted plan amounts after the deductible was paid. Then, it went up to $500 out-of-pocket etc. This extra amount was waived in the event you were admitted to the hospital. 

I don’t know what it is now, but our family motto is that unless death is imminent, we’re not using the ER (which only works unless stitches are needed). And, even though you go to an in-network/PPO provider like both of our local hospitals, the ER doctors are provided by a company/service which was not contracted with my PPO, which meant that we got charged all the excessive charges because they weren’t bound to a contract.

Both hospitals used this same service because since we are in a rural town, they weren’t able to ever get enough people on staff to cover the ER. So now you get totally screwed again. And charged tax because the doctors are providing the in-network provider with out-of-network services.

Yes, I know the world isn’t fair. Yes, I know I have no real impact over anyone doing (or not doing) the right thing. But I am TIRED OF GETTING SCREWED.  If that means I have to waste my time to complain and go public, then I will. Until you and I, the consumer, keep at it until someone gets tired enough of hearing from us to address the issue, unethical and fraudulent medical practices will continue.

But darn, I am tired of the fight. I’m tired of the hassle, the headache, the stress and chasing things down trying not to get screwed. If you have answers, please share!

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Sent to Bed


“Uh oh,” you might be wondering, “who got sent to bed, and what did they do?” I got sent to bed. And that was after a nap!  My wiser half decided I was too sick to get out of bed, so he sent me back.  I got dinner in bed and a movie plugged in, which was very nice.

Remember me saying earlier that I couldn’t sustain that crazy pace and hoped I wouldn’t get sick? Well, ya. I should have knocked on wood.

To be fair, this past week was spent being around several pretty sick people, so in some regard, it’s not surprising that I have ended up with a viral something.  I have been fighting something off and on for over a month anyhow, and it seems this was the final push. Fall and winter seem to be the worst time for my allergies, so I’ve been snorkly for a while, which was the primary reason I took so much time off running. It always surprises me, though, how fast things settle in my chest.

I did run yesterday, but I split the miles 1/2 and 1/2 because my lungs have been junky and I knew I had a lot to get done during the day and couldn’t afford to run out of energy.  I also took it easy on myself because I knew this weekend was going to be busy and full of preparation, and since I’m on a time limit, I really do need to make sure I don’t totally crash and burn.

I guess I should get to it.  I’ve been up for about an hour, and am already tired and ready for a nap.  It’s also my oldest daughter’s birthday, and that would have meant company if I wasn’t sick.  There are still cupcakes to make, but my guess is that she’ll want to make them herself. I’m hoping to get at least some laundry done before I end up back in bed.  And then I may dig back into the dwindling stack of unseen movies.  🙂

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Yes and I don’t know.   I had 9 major items on my to-do list today, most of which involved using the telephone.  I am not a phone phobe, but I admit that I *much* prefer email and other online communication. Calling is rarely something I look forward to doing.

Calling to struggle with medical insurance and billing is never something I look forward to doing. Today was no exception. I always anticipate a solid, uphill battle; rarely actually seeing the results that were supposed to come from the first round of calling.

The result today is a mixed bag. I did get the one bill issue resolved, I think.  She said she deleted the one account addressed to Hunny Me; hopefully it really IS resolved.  On the upside, two bills – both to labs with the same name but different locations – were sent for review when I called a few weeks ago, even though I hadn’t gotten the second bill.  BOTH of these bills were from last April.  Are you kidding me?  It takes 8 months to finally bill insurance?? 

 

While insurance did pay the in-network amount for “reasonable” charges on both bills, there was a substantial amount of the most recent bill that was not deemed “reasonable” by insurance.  *This* part of the billed amount is what the other providers (out-of-network providers practicing at in-network facilities from my post here: 2010) like to use to try to screw over consumers with, in my experience. 

Even though my insurance has graciously paid at the in-network price on the reasonable charge, because the provider is out-of-network, they justify charging you the whole amount because they are not bound to any kind of contract with your insurance.  See how this works?  They could charge you a million and $1 dollars for a Tylenol, and expect you pay the million dollars your insurance has deemed to be not “reasonable and customary.”

Now I get to sit and wait. When it comes to this kind of stuff, that usually means worrying, too.

Was the day a total loss?  I don’t think so.  I think it was a victory to get the one account cleared up, and hopefully that solution sticks.  I made numerous phone calls over several hours; calls that I had been dreading.  I feel better knowing those are off my mental plate.

I also got some work stuff accomplished, which is also nice to get off my mental plate.  I missed my opportunity for a nap today, and my head is pounding. I am hopeful it will not become a migraine.

I haven’t gotten anywhere with the dealing with the stuff issue, as we didn’t get the cubes (see my Stuff  post to know what these are).  We looked at the cubes, but the sale was over, so we’ll wait until they come around on sale again. That might actually give us time to sort through the stuff and get some of it sorted!  😆

I feel good about what I got done today.  It’s a tight time-line, and I need to stay on track. I am a list-maker on days when I have a lot to do.  It’s a good feeling to cross things off that list and know you won’t have to do those again today. Tomorrow, I’ll make a new list, unless I do that tonight so I don’t forget something.  😆 

For now, I am going to drink my pot of chamomile tea, and think about what to make for dinner.   🙂

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In this case, I mean that literally, and not figuratively.  I have pain. As long as I can remember, I have had pain. Right now, I am trying to untangle the pain.

Let me explain.  Being chronically ill with an autoimmune disease – which causes pain – and also being a physically active person (to combat said pain – I need those endorphins!), I am firmly in the camp of “It’s going to hurt anyway, so I might as well exercise.” Something my last batch of doctors said has given me pause. That comment was something along the lines of, “It’s time to start treating the symptoms, and see if we can rid of the pain.”

Two months and a new medication (an NSAID) later, I still have pain.  This is no surprise.  I’ve spent time on anti-inflammatories before, and the prescriptions I’ve taken haven’t ever done anything for the pain. There are pain relievers that are also NSAIDs, and for treating my pain, these kinds of over-the-counter medications seem to work better than just straight the NSAIDs.

The pain I’m thinking about today is my hip pain. December of 2009 was when I first noticed the lingering hip pain.  At first, my one hip only bothered me at night, in bed, while laying on my back.  While initially it hurt to lay on that side, after that split second or two of pain, it started to feel better, which led me to wonder if compression was helping. Another position that brought relief while laying on my back was to kick that leg out sideways from the hip, resting the foot on the inner thigh of my other leg, or somewhere in that general area (like tree pose, while laying down, without the arms over the head).

Observation: There was no pain at that time, while running.  The *only* time I had pain was when I was in bed, trying to sleep.

I should share:  I am a runner.                     

Well, I run.  I don’t know if that actually makes me a runner or not. 🙂 At my peak, between child one and child two, I was running 15 miles a day, between naps. During the morning nap, I ran the first 8 miles.  The afternoon nap gave me time to run the last 7 miles. That all changed, of course, once child two arrived and there was no going to the bathroom by myself, let alone pounding out miles on the treadmill.  😆

After child two, I got into yoga, and did several hours every day. This was something, I learned, I could do and still see, hear and interact with my children, even whilst attempting shoulder or head stands  and other inversions. I seriously considered getting certified and opening a studio, but the work that required would include separation from my kiddos and a lot more time away from home than I had in mind.

These days, I’m home four mornings a week, and I run/cross train 5 miles those days.  I do power walk portions, depending on how I’m feeling, and to give a periodic rest if I need a break from the pain. While the pain is nearly constant, striking does give a spike in the ow-factor. I’ve contemplated adding days or other exercises on the off days, but have not done so because of the hip pain.

I was diagnosed with several bulging discs in my lower back nearly 20 years ago. It took a significant amount of time, but eventually, the tingling and other pain from my posterior down the back of my legs finally went away.  This was a condition that was exacerbated by sitting, so being on my feet and active meant I could continue to function and do pretty well. Through the years, I’ve continued to have spells off and on of the tingling and pain. I’ve had days when a backache kept me curled up in a ball in bed. I’ve had days where I felt pretty good. Until I got sick 3 years ago. It’s been pretty much downhill ever since.

I know that compressed discs in your back can cause all kinds of things, particularly hip pain. Because this pain doesn’t seem to be completely disease related, I wonder: Could it be a problem with my back causing the hip pain? I know people who have been disabled for several months by hip pain that was resolved with very good results through chiropractic manipulation.

After the initial onset of pain, I continued to run. Some days I had no pain. Other days I had a little bit of pain while running at higher speeds and while laying in bed.  Some days, my other hip also had pain. While it was not the same kind of pain and was much less infrequent, it was, on occasion, much more intense.  Go figure.

Over the course of the year, the pain increased to points where it was constant pain; throbbing nearly all the time and radiating down the outside of my thigh. This is where I’m at now. Sometimes it is constant, intense pain. Sometimes it doesn’t hurt as much, or while I’m sitting.  Sometimes the pain doesn’t increase until I run at higher speeds. It always hurts when that side of my hip/leg is touched, even lightly.

Observations: Almost immediately after the onset of pain, there has been noticeable lump in that area. That area hurts <more> to brush against it in addition when being pressed. The pain radiates nearly down to my knee. I don’t have right side hip pain nearly to the same degree, and that pain seems to be focused on the front part of my hip, as opposed to the side. This stuff in my hip was palpable to the docs, who took turns feeling it and wondering what it might be.

Because of my crazy schedule this time of the year, I allowed myself to take nearly two months off.  I wanted to see if resting would help, in combination with the new medication.  My conclusion: not so much.  I don’t know that the new medication has done *anything* to help anything, but it has for sure exacerbated other symptoms. While the hip pain hasn’t been as consistently intense, I don’t feel there has been enough improvement to say either resting or new medication has helped.

“Life as usual” starts back on Monday. That means, for me, one of the first things I do in the morning, after checking email, is get on the treadmill. I warm up with some yoga (in particular, hip openers and gentle stretching) and do about 20 minutes more after running to cool down. While I am looking forward to getting back to my exercise regime, I am not looking forward to the prospect of increased pain.  Which may or may not happen.

At my one last appointment, it was suggested that I might perhaps have some bursitis in that hip. X-rays revealed no degradation of the joints, which was good. But the comment – that the doctors made about treating symptoms – has caused me to apply this thinking to causes of the pain. Is there more than one cause? Could the pain be *not* disease related?

That line of thinking logically led to running, and injuries caused by running. Could this pain be caused by running? There are a lot of hip injuries people have resulting from running. One of those is ITB Syndrome, or Snapping Hip Syndrome. Now I’m left scratching my head. The snapping hip usually causes the bursitis in the hip, as I understand it. 

I have never heard my hip snap, nor have I ever had the sensation that it was snapping. And while I am plugged in and listening to music while I run, my kids, who are always in the same room with me while I’m running, have never mentioned such a thing to me, either. This diagnosis does not seem likely to me.

As I run around in circles with research, I’m left wondering. If I look at this pain and think in terms not of being disease related, I’m left with two possible options: back/spinal related or bursitis.

I’ve seen the suggestion that doing certain Pilates exercises can help these specific pain points. I’ve taken quite a bit of time to look into these exercises for runners, but am unable to find good direction (like those with pictures) on which specific home exercises to use, and when and how many – before running, after running, how many reps, etc. without spending a bunch of money. Money is important to me.  I’ve spent several years blowing a bunch of it on doctors without getting results. I am loathe to throw more money at something without having an inkling of potential success or promise.

So what’s my plan? I’m going to add to my daily routine more yoga poses/Asanas aimed at strengthening and stretching my legs and hips. I’m going to try to add a second session of those poses before bed and see if it helps either the sleep or running situations any. If that fails to give me any relief or tangible benefit after a few months, I’ll probably end up seeing if the chiropractor can help. I wish I could find the cause and have a good, *free* and non-invasive treatment.  I’m not ruling out a shot of cortisone, but that would involve finding a doctor who could diagnose such a thing, and I am not sure I want to get back on that hamster wheel.

And, I’m hoping that if you are reading this article, that perhaps you may have some insight and/or helpful information to share.  Please feel free to comment and share with me!

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Was a pretty rotten year. While I hope 2011 will be markedly better, I am not holding my breath.  I see so many with enthusiasm for the new year; happy celebrations and looking forward to a “clean slate.”  A clean slate? How does one get such a thing?  Where do I sign up?

On the last day of the year, I woke up well past 9 am, which is a rare occurrence for me.  In a busy house, there are usually children arguing or dogs barking or any combination of noxious, sleep-prohibitive noises. But this morning, after getting up to see what the dog was barking at in the girls’ room at 4 o’clock in the morning, I actually managed to fall back asleep and stay that way, well past getting a jump-start on productivity.

“Aaaahhhhhh, ” I thought, “Maybe today I’ll write on the healing properties of restful sleep that gives one’s soul respite.”  Drinking my morning tea, I thought of any other number of topics, and came to realize that the laundry was piling up in my room, and in the room as well. And that being in such a state was counter-productive in getting a handle on the stuff (from yesterday’s post), so it would make more sense to put off the writing and get to doing something with tangible results.

I had great plans for yesterday, but alas, as typical of my life, it didn’t quite go as planned.  I didn’t get into the pile of “unseen” movies.  And the packing up of the Christmas stuff didn’t get totally done.  Today didn’t go as planned, either.  I didn’t get the stuff out to storage, although I did brave the crowds at Wal-Mart and had plenty of time to think about writing my reviews on the relatively new do-it-yourself-checkouts that were causing mayhem and terribly long lines. Tonight, though, I am going to kick back and watch the movie I was going to watch yesterday.

Unlike so many others that I know, I don’t have a lot of excitement for the new year.  We haven’t managed to stay up for the last several years to watch the ball come down, and going somewhere to drive home with all the drunks has never appealed to us.  So home we stay and to bed we go.

When I look back on 2010, it was a year of frustrations, most of which come from being chronically ill. As I look forward to 2011, I can’t help but anticipate more of the same, if today’s mail is any indication. Medical billing is broken, and is a source of deep frustration and never-ending stress for me. It still amazes me how much they can bill you for things like blood work.  They can bill to draw your blood; to send your blood somewhere else; then to test the blood at the other place; to read the results of the blood work tests, and then bill yet again to give *you* the results of those tests.

Have a surgery or procedure done that is bi-lateral?  But then they only do one side? Or only part of the <larger> procedure?  Nevermind that – don’t be thinking you get any kind of discount because you won’t.  Nope, they are going to stick it to you just the same. Here again, is another amazement at all the little pieces parts they can charge you – charge separate for the anesthesia, for the anesthesiologist services, which are not included in the thousands of dollars you already paid for the surgery; charge for materials/supplies, etc.  And then don’t forget the lab work from the surgery – this is more pathology that qualifies for the charge-for-every-step-we-can-think-of.

I have insurance.  Which I am immensely grateful for, because otherwise, I sometimes feel like a bullet in the head would make far more sense. I have learned that no matter how hard you try to play by the rules and follow your insurance’s guidelines, there is going to be someone doing something regarding your medical care that is not “in-network” which then requires you to pay more.  A LOT more.  Let me share a few examples.

Say you have a single hospital in town and for a reason, like a child requiring stitches after regular doctor hours, and that hospital is “in-network.”  Because you don’t want your child’s wound to bleed uncontrolled all night and risk infection, etc, you take the child to the emergency room, to this hospital, which is the only one available to you for 200 miles in any direction.  To this hospital, which is IN NETWORK. 

You get billed for all kinds of the things, like the privilege of walking in the doors (this from insurance, which doesn’t apply to the deductible and is only waived if you are admitted).  You pay for hospital services, which include being seen by someone on staff and medical supplies.  Then you get another bill, from the service that provides the ER doc.  Are you as confused as I am?  Didn’t I already pay for the doctor? 

Nope.  Because you are in a town that doesn’t have ER doctors on staff (except for the idiot who runs the department, but is also employed by the doctor supply agency), the agency provides the doctor services for a fee, to be paid by *you*, the unsuspecting fool who has no choice but to go to the ER. The kicker is  – THEY ARE “OUT-OF-NETWORK.” So, you play by the rules and go to an in-network hospital, who provides, as your ONLY option – doctors who work for an out-of-network service.  And the insurance, of course, pays them the out-of-network price.

How do I, as a conscientious consumer, do any better to keep costs down and follow the rules when stuff like that is going on???

Now, if that visit includes x-rays, you’ll be charged for the x-rays, of course.  Then, the x-rays will be read by another doctor there, who then tells the ER doctor the results.  That’s another bill from that doctor, too.  You hope they are in-network.

When this happens, you can usually call and talk with your insurance company, and I have never, to this point, not had them pay the in-network fee.  I have also written numerous letters of complaint to the charging doctor’s service (the one who is out-of-network but providing doctors to the in-network facility); and expressed that not joining the same networks as the facilites their doctors are working in and then expecting the unsuspecting consumer going to the emergency room to pick up the slack in cost is fraudulent and unethical.  If your doctors work at XYZ which is an in-network provider for company A, company B and company C, YOUR COMPANY should be a participating provider and also in-network with companies A, B and C. 

I mean, really.  What am I supposed to do?  Go to the only emergency room available to me and ask the ER doctor his network status while blood is running all over? Puh-leeze.  “By the way, don’t restart my heart if you aren’t in-network.  I’ll wait the 3 plus hours to get to the next nearest hospital, because those doctors should be in-network.” 🙄

I have called and written letters to the hospital, sharing the situation and sharing my perpective that *their*providing practices should not screw over the consumer making use of the only available IN-NETWORK services who then use OUT-OF-NETWORK providers!  Seems the hospital is over a barrel, because they are small and “need the doctor service.”

I had great hope that this kind of stuff would end once we got a second, physician owned hospital. It is in-network, and most of my in-network doctors use this facility for procedures and surgeries. For certain, it’s a MUCH nicer facility.  And not just because it’s new. The people are nice, in every department. They treat you like a real person with a brain, which I greatly appreciate.  In talking with my insurance company, as it turns out, they too, use the same doctor service for the ER.  You know, the out-of-network doctor service. ❓ ❓

What I have also learned, to my great annoyance, is that when you have unplanned surgery there and they send your stuff out to the lab, the lab isn’t in-network!!  Here again, I ask:

How do I, as a conscientious consumer, do any better to keep costs down and follow the rules when stuff like that is going on???

*sigh*

The first work day of the new year – the one that so many feel is a “clean slate” – is primarily going to consist of me calling insurance again. After I get done with insurance, I have the thrilling task of calling another hospital conglomerate (one that is 200 plus miles away; one direction) that has my one set of my specialists there.  I need to find out if a new charge is for the doctor calling me on the phone to give me my lab results, or if they are totally messed up, given that this bill came to my husbands first name with my first name as his last name. While I am getting used to be calling Mr. ______, this one with Hunny Me as the billed name is a new one for me.

That is another thing I find frustrating. It’s a reminder of the mess when I was there the first time, where the one part of the conglomerate -the one that took all my information initially – billed me just fine, but the other part of the conglomerate couldn’t find me listed with my insurance at all and therefore billed me the entire mutiple-thousand dollar(s) amount.

I am tired of the stress and frustration that comes from these things which are out of my control. I am tired of playing the game the right way, only to continue to have issues and trouble that ultimately would cost me mega bucks to ignore. It’s not healthy to have this kind of constant stress and the feeling of being completely overwhelmed that comes with it.

I would *love* to have a clean slate.  I would *love* to have a shred of optimism that so many others have with a new year, or a new month. I’d settle for a new week, even!

As this year come to a close, I can look back and wish to be able to close the cover, never to revisit. There are some things, though, that keep on “giving,” even when we don’t want to accept the “gift.” I know this is my struggle; one I didn’t wish or ask for; one I can’t control or really even impact much.  I don’t fall prey much to asking “why me” and having pity parties, but sometimes, I reach my breaking point where I cannot take any more. I think I am there.

I am not one who can walk away and decompress and just not think about things like this. I don’t relish the fact that I have a battle that I can’t wage for 2 more days. I’m going to have to think about this all weekend, and know that I have to deal with it on Monday. I’m a “deal with it and move on already” kind of person. I don’t generally tend to think that there is anything to be gained by sitting and waiting to address something. Do it and be done with it already!

It is hard to have “hope” for a new year, when you have left-over stuff from the last year to have to deal with.

Lest you think that I am depressed and need that shrink, this is my reality.  These are the kinds of things I deal with on a regular basis. This kind of stuff is the dirty diaper of life.

Overall, I still feel blessed. I know that in many regards, I am very lucky. I have a roof over my head. We have steady income. I have a loving family. My family is generally pretty healthy. I have insurance. Most of the time, I can function reasonably well. I recognize that many including those that I count as my friends – don’t have some of these things. My heart breaks for them, and my prayers go to them. ♥♥♥

In my effort of trying to keep on keepin’ on and staying on track, I am now going to do more laundry. And then I am seriously going to try to watch the movie I didn’t get to yesterday. My goal this year, as in years past, is to try to manage the stuff. 😀 I’ll keep you posted and let you know how that goes. 😆

May you all have a blessed new year, filled with good news, good health, and good relationships!

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