I talked to our benefits department and they found an 85-page plan detail document from 2017 that clearly states if I qualified for Medicare because of ESRD, our insurance plan would be primary and Medicare would be secondary. This is contrary to the last claim details I received. Our benefits coordinator requested a callback from a supervisor from our insurance and he verified that our plan should be primary. He also said he would ask his team to reprocess my claims again to make sure they were paid out correctly. Yay! I was afraid I had to mediate between insurance plans if both thought they were secondary insurance.
Pretty clear, no?
Like my sister, our benefits coordinator said this coordination of benefits when you have multiple insurance coverage is the most complicated topic in health insurance. No one wants to be the primary coverage insurance since they usually paid 80%-85% of the claim. I avoided getting Medicare because of this coordination mess, and only got it because my work insurance will stop paying for dialysis soon.
During dialysis today, a young boy along with two volunteers, came by to give me a gift for Valentine’s Day. I think he is a patient in the pediatric dialysis ward in the same building. The gift was a pencil with a note attached. It was a nice gesture; there’s not a lot of happiness at the dialysis clinic.
Last year, they handed out a Valentine’s Day gift too. It was a mini-donut with a note attached. The patient that came around was even younger, probably 4-5 years old, and he was in a wheelchair. I still have the note. <sad face>
I finally finished the third and last solo virtual trail in Fitbit. Pohono Trail is another hiking trail at Yosemite and it had 62,500 steps. This seems to be a fairly difficult trail covering ~13 miles one way and with 2,800 feet of elevation change. Embarrassingly, it took me 21 days to complete since I had stopped walking daily due to the recent surgery.
That’s what it says on the pill bottle from the pharmacy but it may as well be magic pills. After taking one pill yesterday, the pain in my gums and tooth disappeared after 15 minutes. The pill didn’t just dull or diminish the pain, it was gone. I can see how this can become addictive if you had chronic pain. Tylenol #3 is not even that potent as an opioid painkiller. That fentanyl stuff must be amazing and scary.
Along this line sufentanil, fentanyl and buprenorphine are being regarded as high potency opioids, methadone, oxycodone, morphine, ketobemidone and hydromorphone as medium potency opioids and codeine, hydrocodone, tramadol and tapentadol as low potency opioids.
After the pain disappeared, I was still wary of eating solid food so I drank a bottle of the Muscle Milk protein shake I bought. It has pretty high levels of potassium and phosphorus but since we just took blood samples for labs today, I have an entire month to make up for it. Still hungry, I drank a second protein shake (milk chocolate Ensure) for dinner. Along with a mixed berry Nepro I had for lunch, I think it’s the first time I drank three protein shakes in one day instead of eating real food.
Nutritional Item
Nepro
Muscle Milk
Ensure
Total
DV
Calories
425
160
220
805
2,000
Total Fat
22.7 g
4 g
6 g
32.7 g
65 g
Saturated Fat
2.0 g
1 g
1 g
4 g
20 g
Cholesterol
6.5 mg
15 mg
<5 mg
26.5 mg
300 mg
Sodium
250 mg
210 mg
210 mg
670 mg
2,400 mg
Total Carbs
37.9 g
6 g
33 g
76.9 g
300 g
Protein
19.1 g
25 g
9 g
53.1 g
50 g
Calcium
250 mg
30%
25%
800 mg
1,000 mg
Potassium
250 mg
580 mg
10%
1,170 mg
3,400 mg
Phosphorus
170 mg
40%
15%
555 mg
700 mg
Three shake meal day
I went to sleep right after taking the Tylenol #3 pill and drinking the two shakes and was able to sleep for 5+ hours. I woke up around 1:00 am since the initial painkiller wore off and I could feel the throbbing pain in my gums again. After lying in bed for 10 minutes, I took another pill and now the pain is gone again. Amazing. I have 15 pills so hopefully my dental pain will go away before I run out.
That was the most sleep I’ve had in awhile
==========
It’s now ~3:15 am. I’m going to go back to bed and try to sleep some more before the second pill wears off.
I had my second major dental appointment today. I mentioned the first appointment was very painful. Well, I just got home after a long day of appointments and my gums are hurting like crazy. I think it’s even more painful than when I was coughing non-stop after heart surgery. The pain is throbbing with each heartbeat and the whole left side of my face is swollen. Today’s appointment was to put in four permanent crowns and work on three more. I can’t believe I have seven new crowns on one side of my mouth. Just the dentist bill for the two appointments came to ~$5,600.
I was in the dentist chair for about 2.5 hours and had to run to an acupuncture appointment right after. As I was lying there on the acupuncture table, all I could think about was the intense pain in my mouth. I just took one Tylenol + Codeine pill; the bottle said I can take two but it also had an opioid warning label. It wasn’t even prescribed for a toothache but I need something strong to dull the pain. Right now it hurts so much that there’s no way I can fall asleep so I’m sitting here typing and hoping the pain will diminish a bit. I’m also hungry since I haven’t eaten all day but with one side of my mouth on fire and the other side with a fresh root canal, I don’t think I can eat anything without killing myself.
Several years ago, my benefits coordinator at work told me about some supplemental insurance programs that we were offering for extra cost. The programs were underwritten by Allstate Benefits and included Critical Illness Insurance and Hospital Indemnity Insurance. I signed up for both since I was already at stage 5 of CKD (chronic kidney disease). For Critical Illness Insurance, I enrolled in Plan 4 which costs about $50 each pay period and pays $50k per illness. That same year, I started hemodialysis in July but never filed a claim with the insurance. With the recent heart bypass surgery, I now have two claims to file.
For some reason, they only pay out 25% for CABG surgery. Maybe it’s not as serious as ESRD (ha!). Also, if you have a second critical illness event of the same type, they will pay again. I don’t know how they would treat ESRD since I went from hemodialysis to peritoneal dialysis and back again. Probably counts as one illness event since I never stopped dialysis. My benefits coordinator said she will help me fill out the claim forms. For sure I can claim both the ESRD and CABG items for $50,000 + $12,500. If I have the transplant this year, then it’s another $50,000 for a major organ transplant. Not bad for $1,300/year in premiums.
The other insurance for hospital indemnity doesn’t pay that well. It pays $1,500 for the first day, then up to 10 additional days at $150/day. You can also only make one claim per year. I don’t know if they will count my CABG surgery as two claims: critical illness plus hospital stay. You really can’t have the surgery without staying in the hospital. If they count it as a separate claim, then it’s $1,500 + $150 x 9 days = $2,850. I also stayed in the hospital for a few days back in 2018 for a foot biopsy. Looking at old medical claim forms, it appears to be three days in May 2018 so maybe another $1,500 + $150 x 2 days = $1,800. I hope Allstate doesn’t drop our insurance coverage because of me.
If any of my claims are paid, I told my benefits coordinator that I’d buy her a nice steak dinner.
The fun starts now! Back on January 10th, I went to see a podiatrist for a check up since I’m diabetic and have peripheral neuropathy. Since the podiatrist was a specialist, I paid my $40 co-pay and thought everything was fine. Well, the podiatrist office finally filed the insurance claim, and I got the following statement of benefit from my work insurance.
The podiatrist office billed $274.00 for my visit but the negotiated rate for Blue Shield is $194.53. My insurance then determined that since I have Medicare starting 1/1/2020, they are the primary insurance, and should cover 80% or $155.62. Therefore, my work insurance only needs to cover the remaining 20% or $38.91. On my call with my work insurance yesterday, they said I need to give all my providers a copy of my Medicare card so they can bill Medicare. For this claim, I should get my $40 back once Medicare pays. I had a lot of doctor appointments in January. Since none of the claims have been processed, I will need to do this with 5-6 providers and lots of claims.
I see some potential problems with this. First, once I pay my co-pay, it’s very hard to get that money back. I have to follow up on each claim to see if and how much Medicare pays, and harass the doctor’s office for refund. Also, who determines which insurance is primary? What if Medicare decides they are secondary and my work insurance should pay 85% first? Also, for the claim above, the plan rate was less than what the podiatrist billed. What is the Medicare plan rate? I think it’s often less than private insurance reimbursement rate. So what if Medicare’s rate is only $100 and they pay 80% or $80? What happens then? What if the medical provider does not accept Medicare in the first place? Sometimes I think having a single health insurance payer, like they do in Canada, is much easier on the consumer. Doctors and hospitals will probably lose out though since reimbursement rates will definitely be lower.
The acupuncture session felt different today. I think the timer was only 35 minutes today but felt much longer. There was slight pain in both my feet and my right hand; usually after the first pinprick, I don’t feel anything afterwards. The was also a lot of numbness in my feet and some in my scalp of all places. I do think I have more sensation in my feet; I can feel the carpet texture more when I walk around at home.
WebMD says this is for dental pain. My acupuncturist usually sticks a needle in each hand in this location for peripheral neuropathy.
I asked the acupuncturist about it and she said she included a new acupuncture point today. She did seem puzzled at my description of the differences. I don’t think she expected me to feel anything different. We also had a good conversation at the beginning of the session. I was mentioning eating salad to be healthy and she said that she doesn’t recommend eating too much raw food. We then discussed “hot” and “cold” food in Chinese Traditional Medicine. I don’t know much about it but heard it discussed a lot by my mom growing up. She also said that students had to learn the Chinese names for traditional herbs. She know all their names using Pinyin but not in English.
==========
It’s about 5:00 am in the morning Wednesday and my hand still hurts if you press on where the acupuncture needle was. I told my mom last night and she said maybe the acupuncturist hit a nerve with the needle. Wait… isn’t that the point of acupuncture? If they’re not sticking nerve points, what are they aiming for with all the needles?
It’s been almost two weeks since the surgery. I still keep a bandage over the incision even though it has stopped bleeding for a few days. I showed my arm to the nephrologist today during dialysis. He put his fingers on the bandage and gave a nod of approval. Evidently you can feel the blood rushing by in the newly connected vein. You can definitely hear the blood flowing; it makes a loud whooshing sound.
I don’t know how long it takes for the incision to heal. There is still sutures in the incision; I won’t get that removed until next week. Meanwhile, the area is still pretty swollen and looks pretty ugly.
My right forearm
I don’t know what the second small cut is for. I’m pretty sure the incision will eventually close up and heal but I’m a bit anxious about the actual fistula. I’ve seen many of them at the dialysis clinic and they are all really gross looking. I guess it depends on the age of the fistula but a lot of them are huge purple-ish bumps on the arm. An old Chinese lady was bleeding profusely from her arm after dialysis even though she sat and put pressure on the fistula for 15 minutes. Not looking forward to all this.
The California EDD must have processed my return to work form since they sent me another check for 1/28 and 1/29. Looking at the check stub, I realized I screwed up the dates again. I must have misread the form and put in the wrong dates. There is a field for recovery date and another one for return to work date. Like an idiot, I put down 1/30 for both instead of 1/31 for return to work date. I was actually still out on leave on 1/30, which means no pay from work. The difference for one day of disability is $178.66 before taxes. To change my return to work date and get that money will require a doctor to fill out a four page form. $180 can buy a nice meal but I think I’m going to forget it. It’s going to look very stupid filling out another disability justification form for just one day when I’ve been ok for the past few weeks.
At least now I know to read the damn forms more carefully. I will need to to all this again in a few months if the live donor kidney transplant goes through. The recovery for that is also around three months.
When I got to the dialysis clinic this morning, my pod or section was pretty empty. I think there were only three out of eight chairs occupied. Across from me was an older white lady with her son, and an Asian girl. I’ve seen both of them before with wheelchairs and scooters so I was surprised not seeing anything parked around their chairs. Dialysis really sucks already; not being mobile sucks even more. I was in a wheelchair for about two weeks after heart bypass surgery and didn’t enjoy being wheeled around.
Anyway, I was happy for a brief moment because I stupidly thought that maybe their condition has improved so they could walk in/out on their own. Nope. When the older lady was done, her son pulled a wheelchair from somewhere for her to sit in. A bit later, an older man (father?) and another girl (sister?) came in with an electric scooter to pick up the Asian girl. Bummer.
I mentioned before that there are lots of patients at the center using canes, walkers, wheelchairs, and scooters. I guess dialysis is usually not the only medical condition for kidney failure patients. Out of the five patients I can see in my pod now, one has a scooter, two are in wheelchairs, and the other two need a cane to get around.
The statistics on dialysis are grim. I post some numbers before but basically >50% of patients die by five years, and only a small percentage is eligible for a transplant. Why? If God is loving and we are His spiritual children, why is there so much suffering? This is only one disease. What about cancer patients? Mental illness? Life is so depressing.
==========
There is one dialysis patient, let’s call him H. He was in my pod the previous time I was on dialysis and now he’s in my pod again. H has one leg amputated below the knee so he is in a mobility scooter. He also requires medical transport, usually a minivan, to pick up and drop off at the dialysis clinic. I think H has a lot of other health issues. I used to sit right next to him and he is on the phone all the time with doctors, much like I am now post-heart surgery. I also heard a lot of complaints about H from the dialysis nurses. Evidently he’s been to almost every dialysis center nearby, and is a difficult patient. I know he complains about the needles in his fistula often, and would request a specific technician, even though that technician is working in another pod.
Anyway, it feels like H has been on dialysis for a long time. I took a closer look at him on the way out yesterday and he looked terrible, like his health had deteriorated a lot over the past few months. There was another patient at the clinic, let’s call him K, that has been on dialysis for over 25 years. I don’t know how H and K are handling dialysis. The only thing keeping me sane during dialysis sessions is the hope of a kidney transplant. I haven’t really thought about life on permanent dialysis. However, this is the norm for most dialysis patients; they are not qualified for a kidney transplant due to health, age, or other reasons.
The last time I went to cardiac rehab was on Monday, January 27th. I had a dentist appointment on January 28th, and my mouth was hurting afterwards so I skipped January 29th. My outpatient surgery was on January 31st, and I haven’t gone to rehab since then.
I wanted to go this morning but I couldn’t get out of bed at 6:30 am when my alarm went off. I guess I got in the habit of not exercising after only a week. I have a endodontist appointment tomorrow so I can trying going Wednesday morning. The vascular surgeon said no heavy exercise for three weeks, and do not life over 5 lbs with my right arm for two weeks. His office was supposed to communicate that to the cardiac rehab nurse last week but I’m not sure if that’s been done. I think the rehab program won’t let me continue without the written note from the surgeon anyway.
==========
Oops, this was in draft since yesterday. I think I went to bed last night without clicking on post. I emailed the cardiac rehab nurse and she just called me back. I guess they did get a note from my vascular surgeon on February 4th. I can go in tomorrow but no arms exercises until the 18th. I told her I would restart tomorrow with cardio so I’m committed. A bit of accountability is good, otherwise I’ll sleep in again.
DaVita’s website also has a page on Fluid Control while on dialysis. Since most dialysis patients don’t produce much urine, fluid control is very important in controlling blood pressure and avoid edema. Each dialysis session, the nurse listens to my lungs to see if there is any fluid in the lungs which could lead to shortness of breath or pneumonia.
The website also give a lot of tips on controlling fluid intake:
Limit the amount of sodium and spicy foods in your diet.
Be aware of hidden fluids in foods. Foods with high water content include gelatin, watermelon, soup, gravy and frozen treats like PopsiclesTM and ice cream.
Stay cool. Keeping cool will help reduce your thirst. Try drinking cold liquids instead of hot beverages.
Sip your beverages. Sipping will let you savor the liquid longer. Use small cups or glasses for your beverages.
Try ice. Many patients find that ice is more satisfying than liquids. Try freezing your allotted amount of water into an ice tray. You can also try freezing approved fruit juices in ice trays for a special treat. Remember to include the ice you consume when tracking your fluid intake.
Take your medicines with your meal, if possible. Try swallowing pills with applesauce instead of liquids.
Battle dry mouth by using mouthwash or brushing your teeth. Sucking on hard candy or a wedge of lemon or lime will also help.
If you have diabetes, maintain good blood glucose levels. High blood glucose levels will increase your thirst.
I pretty much do all of the above to control fluid intake, especially the ice trick. I carry a small thermos with me with ice chips. Rather than drinking water, I will melt a few ice pieces on my tongue and lips in order to quench thirst. It works fairly well.
I’ve been pretty good at keeping weight gains between dialysis sessions to minimum. I think I was averaging about 1.0 – 1.5 kg per two-day periods. After starting work though, I’ve been putting on more weight due to eating more during lunch, and drinking more fluids since the dispensers are very convenient.
Here’s a similar page from Fresenius’ website. They are the other large for-profit dialysis company, and they also make dialysis machines.
I created an account on DaVita’s website even though I’m not a patient. They have a lot of information on kidney failure, dialysis, and diet. I was specifically interested in their Diet Helper™ which has a lot of recipes and nutritional information.
Today, I received an email from DaVita pointing to the Employment page of their website. Basically, the email says dialysis patients should keep working if possible because it keeps you healthier and happier. My dialysis social worker says this too. It’s better for your mental health if you can continue working instead of quitting and getting Social Security disability.
Working and Dialysis
There could be another reason DaVita want their patients to keep working. 90% of their patients have Medicare as their primary insurance. Medicare reimbursement is pretty low so all their profit comes from the 10% with private insurance. I know I pay about 10x the Medicare rate to St. Joseph Hospital for dialysis in the past. Once I switch to Medicare as the primary insurance, that reimbursement amount will be a lot less.
Having not worked for three months and being on hemodialysis for most of that time, I would agree that working is good for your mental health. I was going crazy sitting at home all the time. Often I lost track of what day of the week it was since I didn’t have the weekly work schedule to keep track of time. Also a lot of my non-family relationships are with co-workers and not having regular contact for three months was very isolating. Of course, work has its own set of issues, namely stress and fatigue, but if you can work, you should try to work as long as possible.
There are a lot more brands of protein shakes than just Ensure. I only compared Nepro and Ensure because Nepro is practically the only product designed specifically for dialysis patients, and we have a lot of Ensure High Protein at home already. I did a search of Amazon for the most popular protein shakes and got this list. The Nepro column is in there for comparison; it’s not that popular:
Brand
Nepro
Premier Protein
Boost High Protein
Orgain Clean
Ensure Max Protein
Core Power
Muscle Milk
Iconic
Flavor
Mixed Berry
Café Latte
Rich Chocolate
Rich Chocolate
Milk Chocolate
Chocolate
Chocolate
Café Latte
Serving Size
8 oz
11 oz
8 oz
11 oz
11 oz
11.5 oz
11 oz
11.5 oz
Calories
425
160
240
140
150
240
160
130
Total Fat
22.7 g
3 g
6 g
2 g
1.5 g
3.5 g
4.5 g
2 g
Sat. Fat
2.0 g
0.5 g
1 g
0.5 g
0.5 g
2 g
1 g
0 g
Cholesterol
6.5 mg
20 mg
10 mg
16 mg
20 mg
15 mg
15 mg
10 mg
Sodium
250 mg
220 mg
230 mg
240 mg
140 mg
160 mg
250 mg
220 mg
Total Carbs
37.9 g
5 g
28 g
10 g
6 g
28 g
7 g
8 g
Protein
19.1 g
30 g
20 g
20 g
30 g
26 g
25 g
20 g
Calcium
250 mg
650 mg (50%)
380 mg (30%)
50%
50%
70%
30%
25%
Potassium
250 mg
360 mg (8%)
470 mg (10%)
300 mg (9%)
10%
600 mg (17%)
770 mg (22%)
380 mg (11%)
Phosphorus
170 mg
620 mg (50%)
25%
NA
40%
NA
40%
40%
Amazon
24/$57.00*
12/$23.99
24/$28.98
12/$20.91
12/$26.16
12/$23.79
12/$9.28
12/$33.99
Price/serving
$2.38
$2.00
$1.21
$1.74
$2.18
$1.98
$0.77
$2.83
*Price direct from Abbott Store
Once again, Nepro seems to be the fat bomb with the most fat, carbs, and calories per serving. What I’m most worried about however, is the levels of potassium (K) and phosphorus (P). Since Nepro was designed for dialysis patients, it makes sense that it would have low levels of both. Most of the other protein shakes listed have lots of both, assuming NA for P means at least 40% DV. If I wanted to keep both K and P low, then I’m stuck with Nepro or Ensure Original/Plus/High Protein. If I had to get something else, I guess Boost is a viable option, except it’s made by Nestlé, the evil food corporation.
Boost High Protein shake at Amazon
I wish Orgain would detail how much P there is per serving since everything else looks okay. The ingredients for the Clean Protein Shake includes sodium phosphate, magnesium phosphate, and tricalcium phosphate. Usually if there are several ingredients with something phosphate, there’s probably a lot of P in the product. There also seems to be a sale on Muscle Milk since it’s only $0.77 per carton. Maybe I can buy it for my mom since her kidneys are fine so the high levels of P and K is okay.
The best option is probably to eat well balanced meals so I don’t need to drink protein shakes. That’s not that easy now that I’m working again. Often, none of the food choices look appetizing to me. Also, it’s hard to figure out nutritional information for my parent’s home Chinese cooking.
I went to the KidneyDiseaseSupport Group at Saddleback Church today after dialysis. Since I didn’t switch shifts, I left the dialysis clinic at 1:10 pm and made it to the group at ~1:35 pm. The meeting started at 1:00 pm but I emailed the organizer so they know I will be late.
It was a full house again, with probably 35 people in attendance. I missed most of the introductions but there seemed to be several newbies who have no idea about ESRD, dialysis, and transplant. The organizer asked how I was doing so I gave a quick update about the PD catheter removal and fistula surgery to the group. Interestingly, in the group there was a donor who came with her recipient, and someone considering to donate a kidney to his mother. There was also another person who is on her fourth transplanted kidney in ~20 years. How is that possible when my wait time is 6-10 years?
Another gentleman also had fistula surgery last week but he had a new type of graft put in. He said his veins weren’t suitable for a regular fistula so they had to insert a graft. However, he was able to use the graft right away. I guess they can stick the dialysis needles directly into the graft, without waiting for the surrounding blood vessels to heal.
It was also interesting to see the large number of local patients that were listed for transplant at the Mayo Clinic in Phoenix, AZ. They even know which temporary housing to stay at while testing or recovering from transplant. I’ve considered this option but maybe I’ll give it more thought if both my living donors get rejected again.
A coworker told me Friday that he has to attend the cardiac rehab program at St. Joseph Hospital as well. Since we’re both working, I guess we’ll see each other MWF at 7:30 am when the gym opens. It’s the only time we can go and still make it to work at a decent time. He had a pacemaker put in last year sometime. I don’t know why he needs to do cardiac rehab now; I don’t think he has any external factors like a transplant center asking him to go.
I did say that the gym was pretty small and I haven’t been too impressed with the program after five sessions. The facilities at Hoag Hospital seem much better equipped but I think St. Joseph Hospital is the closest program and kind of on the way to work. It’s probably impractical to drive to Irvine or Newport Beach for Hoag.
I haven’t booked anything for this San Francisco trip I’m planning. With my peripheral neuropathy, having to sit for long time is really uncomfortable. The worst is dialysis since after you sit down, you can’t really get up and move around. I’ve seen patients disconnected during the session so they can use the bathroom, but it’s pretty rare. Also bad would be sitting in an airplane, so that is why I was looking at first-class seats on such a short haul flight. Finally, having to show up early at an airport because you don’t know how long the TSA line will be, then sitting at the gate for hours also sucks. John Wayne airport is great for this because I don’t think I’ve ever waited more than 20 minutes to get through the security checkpoint. For LAX, I’ve seen 10 minutes to an hour and a half for international flights.
Another flight option to the Bay Area from John Wayne is JSX. They have the same owners as JetSuite, a private jet charter company. JSX flies EmbraerERJ135 and ERJ145 jets, which hold 30 passengers. These jets are also flown by American Eagle. JSX advertises their flights as “private-like jet” but they’re really small regional passenger jets. They also have a very small list of destinations. However, JSX has their own terminal and operate as a charter so no TSA checkpoints. I guess that’s the “private-like” part of the experience. You go to their hanger about 15-20 minutes before the flight and just get on the plane. Easy, and less time sitting around with my numb feet.
For my planned trip, JSX flies between John Wayne (Orange County) and Oakland International airports. One way flights are as low as $129, which is $10 cheaper than Alaska Airline first-class seats between John Wayne and San Francisco International. Which is better? First-class seats in an Embraer E175 or a regular seat in an Embraer ERJ-135/145? I think JSX wins because of the ease of check-in and boarding, but they don’t have that many flights. Also, their hanger is away from the main airport terminal with public transplantation. We would have to get an Uber or Lyft to get to/from JSX, whereas BART will go directly to either SFO or OAK. So the new plan would be to fly from SNA to SFO, then take BART to Union Square. When coming home, either take BART to Coliseum Station and Uber to JSX, or ride Uber for the entire trip from Union Square to JSX, then fly JSX from OAK to SNA.
Date
Flight
From
ETD
To
ETA
Price
2/29/2020
AK 3453
SNA
3:00 pm
SFO
4:35 pm
$139*
3/2/2020
XE 332
OAK
7:30 pm
SNA
9:01 pm
$129
*First class. Cheap seats are $69.
YouTube review of JSX
This is probably the closest I’ll get to flying on a real “private” jet. My previous boss had a Gulfstream G500, and my current company owns a Gulfstream G650ER. I haven’t been on either one. The cost for buying and operating a private jet is astronomical. Our G650ER costs about $72 million and we spend a couple $ million each year on operating costs. They are also very expensive to charter or lease. Here is a G650 going for $15,469/hour. If you have 500 friends, you can get a Airbus A380 for $51,564/hour.
Can’t fly in and out of John Wayne Airport with an A380
After six sessions with my therapist, I think we’re moving beyond the introduction and goal setting stage. She thinks unresolved grief is playing a large part in my life, so we’re going to go through a book called The Grief Recovery Handbook. The subtitle of the book is “The Action Program for Moving Beyond Death, Divorce, and Other Losses including Health, Career, and Faith.” I just bought a paperback copy from Amazon. I’ll try to read a few chapters during dialysis tomorrow.
After drinking a couple bottles of vanilla Ensure High Protein, I wanted to try some other flavors. There are lots of varieties of Ensure so I compared some nutrition values:
Nutritional Item
Original
Plus
High Protein
Max Protein
Serving Size
8 oz
8 oz
8 oz
11 oz
Calories
220
350
160
150
Total Fat
6 g
11 g
2 g
1.5 g
Saturated Fat
1 g
1 g
0.5 g
0.5 g
Cholesterol
<5 mg
10 mg
20 mg
20 mg
Sodium
210 mg
210 mg
210 mg
140 mg
Total Carbohydrate
32 g
50 g
19 g
6 g
Protein
9 g
13 g
16 g
30 g
Calcium
25%
25%
40%
50%
Potassium
10%
10%
10%
10%
Phosphorus
15%
15%
25%
40%
Vanilla flavor for all varieties
Looking at cholesterol and phosphorus levels, the original shake is probably best, though there is only 9 g of protein. After all, these are protein shakes. I wonder how Abbot decides on the nutritional content of each Ensure product. Do scientists or nutritionists come up with the recipe or does marketing?
Amazon seems to have the best prices: you can get a 24 packs for ~$26, or a 16 pack for $20. Target sells six packs for $8, which is more expensive but you don’t have to buy a lot at once. I think I want to try out the chocolate and the strawberry flavors. Abbott’s website lists a lot more flavors but they’re hard to find in stores.
Banana nut! Does that have more potassium than the other flavors?
Life with chronic diseases 