Electrolyte Balance

Since the transplant, I have been having some minor issues with electrolytes: Na+ (sodium), Cl– (chloride), Mg2+ (magnesium), Ca2+ (calcium), and K+ (potassium). Each lab draw will test for the levels of these ions in the blood. I am going to put phosphorus in there too since they test for it each time as well. Here are my recent results:

ElectrolyteNormal Range2/162/192/222/253/43/11
Sodium135-146139138138137138140
Chloride96-106103103102101104105
Magnesium1.4-1.91.51.51.51.61.51.6
Calcium8.6-10.49.89.910.010.09.710.5
Potassium3.6-5.34.65.35.65.15.25.6
Phosphorus2.3-4.41.82.02.31.82.52.4

Calcium levels have been pretty stable except for the last test. Potassium has been borderline high, and phosphorus has been low quite often. The doctor from the latest call said he was not concerned since the calcium and potassium levels are barely over the limit so I can try adjusting my diet. The problem is I do not know what to adjust. I have not been eating any bananas or potatoes. The only things I can think of are broccoli and maybe nuts (almonds). I need to balance this with phosphorus. Since most foods have both, cutting back on one will affect the other as well.

Previously, a nurse practitioner told me to drink diet soda for phosphates. I have picked up some Coke Zero but I just found this list of beverages and Coke Zero had both phosphorus and potassium. I need to find a beverage where sugar and potassium are very low, but has high phosphorus. From that list, the choices are pretty minimal: wild berry Aquafina, Diet Dr. Pepper, and unsweetened Nestea. Interestingly, Diet Coke has much less potassium than Coke Zero. Maybe it is due to the different sweetener used?

No Anti-Rejection Medications?

I had a video call earlier this afternoon in lieu of an in-person visit with the UCLA Transplant Center for a follow-up appointment. This time, it was another doctor that I have never met before; they must have a huge staff. He went through my lab results and basically made no changes to my medications. Again, my potassium (and calcium this time as well) was borderline high, so he asked me to watch my diet. Blood sugar was still high as well, but I told him my endocrinologist was managing it.

Right when we were about done with the call, he brought up another topic. He said a news crew just left UCLA. They were there to report on a story that UCLA was piloting a program to stop anti-rejection medications for kidney transplant patients after one year. He brought it up so I did not wonder why I did not have that option. From my understanding, essentially patients with a well matched donated kidney can overload on anti-rejection medications during the first year post-surgery, then not have to take any afterwards. Since I was a very good match to my sister’s kidney, they considered me for the program, but decided against it due to the tumor/cyst/growth that is still in the donated kidney. I guess there is a risk that if the object turns out to be cancerous, it may trigger my immune system, which could damage the donated kidney. They decided to err on the side of caution and did not approve me for the program. He did say that my dosage was pretty low already but wanted me to know about it.

Sigh. Not having to take anti-rejection medications would be awesome since that was the most negative part of getting a kidney transplant. However, I am not going to complain since having a working kidney is so much better than the alternative. I will have to have lots of scans periodically to check on the status of the tumor/cyst/growth, but it is a small inconvenience compared to dialysis.

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I could not find any mention of the program online. Maybe it takes a few days to edit and produce the news segment.

Walking Outside 3/8/2021

The weather looked really nice this afternoon so I went for a walk. However, it turned out much colder than it appeared. My Apple Watch said 61°F but I am not sure which weather station it is referring to. I ended up walking 1.67 miles at a pace of 19’42”. It is the first time in a long time that I came in under 20 minutes. My knee is definitely getting better. There is still a slight limp and a bit of pain, but it did not bother me at all. Hopefully, it will be all healed in another week.

I am really getting bored now. I did not do anything today except eat, nap, and watch TV/YouTube. In other news, I got an email from the Korean American Center in Irvine that their Spring 2021 Korean Language Courses are open for registration. It is 11 weeks and costs $199. I am still debating whether or not to take it. I should probably take Chinese lessons since I am basically illiterate but all the courses are in Simplified Chinese and I want to learn the Traditional characters. Anyway, one lesson probably will not help with song lyrics or TV dialogue; it will take a lot of lessons for that level of understanding.

Work Laptop Security

Security is good. There seems to be computer hackers everywhere trying to steal your identity or information. Our work is hit especially hard, since we have hostile foreign nations trying to break into our computer systems daily.

Just today, I got a popup window on my work laptop to enter a password/PIN to enable bitlocker. This is something that blocks the computer from booting up if the password/PIN is not entered correctly at startup. Again, having security is good, but this is approaching overkill. To get to my work files, I now have to enter the bitlocker password/PIN when booting up the computer, then log into Windows 10 with my userid and password, then enable our VPN, which requires the same Windows password plus a six digit code from Microsoft Authenticator. If I need to remote in to my desktop at work, I need to run Remote Access and enter my Windows password one more time. All this is made harder with restrictions on our work password. I think it needs to be at least 20 characters and cannot repeat eight prior passwords.

No wonder people write down userids and passwords on a Post-It and stick it on their monitor.

The Death of Hong Kong

This is another off-topic post; it has nothing to do with dialysis, kidney transplant, or any other health issues.

Before I was diagnosed with ESRD, I used to travel to Asia often. For several years, I was the volunteer CFO for my friend’s company. It was a US company but their main manufacturing site was in Chengdu, China. I would take a week of vacation from my “real” job once a quarter, and travel to Chengdu to do some finance stuff. Since I wanted to avoid both US and China based airlines, I would typically fly with Cathay Pacific, and their main hub was Hong Kong International Airport (HKIA).

All together, I probably transited through HKIA close to 30 times, and actually cleared immigration to enter Hong Kong about a half-dozen times. I really enjoyed the food and culture of Hong Kong. Particularly awesome was the dim sum, since it was invented in Hong Kong. I remember having dim sum at the airport and it was very good. While I was stuck on dialysis, I really looked forward to visiting again. However, with China’s recent takeover, that is looking less and less likely. I used to post in another blog that was very critical of the Chinese Communist Party (CCP). Most likely no one in China has seen my blog, but with the newly passed National Security Law (NSL), there is a non-zero chance I could be detained in Hong Kong and held indefinitely in a Chinese jail. With China’s aggressive cleansing of anything democratic in Hong Kong, it will soon be just like another shitty city in China, and not worth visiting.

In memory of my past visits, here are some photos that I took on my many trips to Hong Kong:

Most of my stops in Hong Kong was transiting to other destinations while flying on Cathy Pacific. With the recent CCP campaign against foreigners in China, and Hong Kong basically turned into a police state, I am staying away from both. There are lots of other countries to visit like Taiwan, Japan, South Korea, Malaysia, and Singapore. In fact, I think my next Asia trip will be South Korea + Japan or Taiwan.

New iPhone 12

Even though I have been an Apple person since the early 1980’s, I have always been slow on getting the latest technology. My first Apple product was an Apple ][+ that I purchased used from a family friend, and I used it to write papers while I was a freshman at UCLA. I then bought a Mac Plus but after the Mac SE/30 and Mac II were available. Even now, my Macbook Air is from 2012. For iOS, I had been using a hand-me-down iPhone 6S, and my “newest” tablet is an iPad Air 2.

I have been having a lot of problems with the Bluetooth on my iPhone 6S. It would connect, but the connection is terrible. The audio would skip, then stop altogether. This is consistent across multiple wireless speakers and headphones, and those devices work fine with other phones and tablets. This past Monday, I finally bit the bullet and bought a new iPhone 12. It was blue with 128GB of memory. I looked at the Pro version but could not justify spending a lot more basically for a better camera.

I am still trying to get used to not having a home button. The Face ID seems like a good idea, but with the pandemic and mask wearing, it is actually much slower than using the fingerprint method of previous iPhone models. I find myself punching in the passcode all the time, and unconsciously searching for the home button with my thumb.

I think the next item on the purchase list is a new Macbook. I almost bought one of the new M1 models but decided to wait and see if there will be more models out this year (14″ Macbook Pro), or if there will be a M1X or M2 processor. My old iPad is still good for Zoom calls and the occasional game so that can wait.

More Critical Illness Insurance Update

In a previous post, I mentioned that Allstate approved and paid me $50,050 for my kidney transplant since it was covered under the critical illness insurance I enrolled in at work. They were also reviewing some older illnesses that I assume they found in the backup documents for the transplant claim.

Since then, Allstate approved my claim for ESRD, which also pays out $50k. I just received the check in the mail yesterday for $49.790; I think I missed a few premium payments while I was out on medical leave for my heart surgery. When I called Allstate a few months ago regarding this “potential” claim (I had not filed a claim yet), they said usually claims are limited to one-year after starting dialysis, but to try anyway. I guess 3.5 years is not too late.

That leaves an open claim for my heart surgery from November of 2019. Again, I did not file any claims but Allstate started on anyway. I did send in some requested backup documents a few weeks ago. In the benefits document, CABG surgery was covered at 25% so I was expecting $12,500 if the claim was approved. Well, this morning, Allstate sent me a message that the claim was approved for $50k again. I was confused so searched and found the EOB (explanation of benefits) document for that claim, and it turned out it was for both a heart attack and the bypass surgery. Heart attacks are paid out at 100%, so that is where the $50k came from. The CABG surgery was denied since it was considered the same “event” as the heart attack. So all together, Allstate is sending me $150k in total claim payouts. I sure hope this is not taxable.

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I wonder if I waited for 90 day after the initial ER visit in November 2019 for the CABG surgery, would Allstate treat that as a separate event/claim and pay out another $12,500? I would probably be dead now though.

Missing K-Pop on Spotify

I literally just signed up for Spotify Premium three weeks ago, and today, about 50% of my playlist disappeared. After Googling a bit, it turns out that Spotify’s license with Kakao M has expired on March 1st, so Spotify had to remove all the songs that Kakao M distributes. I read somewhere that is about 35% of Spotify’s K-Pop songs.

Nothing. There were a lot of songs on the playlist here just this morning.

This totally sucks. I had just got into a lot of independent artists and Korean R&B, and most of those artists’ songs have disappeared. The big 3: SM, JYPE, and YG are still there, along with some other larger companies, but a lot of small and indie artists use Kakao M and it is all gone. I believe it is because Kakao M wants to increase their streaming service, thus eliminating competition with Spotify. Spotify never had a license for South Korea anyway. What this does is remove access and license income for all these artists worldwide without any alternative streaming services. Where is Kakao M’s streaming service in the US? Do they even have one ready for launch? Do they think fans will pay for another streaming service just for 35% of the Korean music market? Delusional. What will happen, for me anyway, is if this is not resolved within a few weeks/months, I will just cancel Spotify Premium and find somewhere to get my K-Pop.

https://twitter.com/blobyblo/status/1366051073723494400?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Etweet
Tablo of Epik High is not happy about this. they just released a new album and it’s not available on Spotify anymore.

Sometimes anti-competitive and monopolistic policies by companies come back and shoot themselves in the foot.

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I forgot. Another reason I paid for Spotify Premium is that it is part of the entertainment system in my Tesla. There is a Spotify button but it only works with premium accounts, i.e., not the free accounts. It is convenient to listen to my playlists on the computer or phone, then jump in the car, and have the music continue on the same playlist. However, that all becomes moot when the songs are not even available on Spotify anymore. I also have about 90% of the older K-Pop songs in iTunes as MP3 files so I guess I can go back to copying files to a USB drive and inserting that into my car. Currently, the K-Pop genre on my iTunes Music app has 4,110 items or 10.1 days, and taking up 34.26 GB on the SSD.

Soda Consumption

Before having all these health issues, I used to drink a lot of soda. In college, instead of coffee, I would drink Mountain Dew to stay awake while studying. I never went the Jolt Cola route, but a lot of classmates drank that instead.

Fast forward to my previous job. We had a display refrigerator in each break room with free cans of soda. I drank a lot of regular cola and root beer while working there. I did not like the taste of the artificial sweeteners used in diet soda. When I found out I had type 2 diabetes, I started drinking diet soda, and later Coke Zero. Finally, with ESRD and dialysis, I was told to avoid sugar and dark sodas because of the phosphoric acid.

Now after the kidney transplant, my phosphorus levels are consistently low, even with taking phosphorus supplements. I was taking 250mg of Virt-Phos twice a day. During the last clinic appointment, I told the nurse practitioner that I was eating more cheese and drinking more milk. She mentioned that those foods have a lot of fat and calories, and I should drink more diet soda. I have not had any soda except diet 7-up in about three years, so I went to my local Albertsons and bought three cases of Coke Zero. I also asked my parents to pick up some at Costco, and they came back with a case of 35 cans. Now I am drinking a lot of water, and two cans of Coke Zero each day. Hopefully that will raise my phosphorus levels without affection potassium levels too much.

More recycling

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Evidently, it is now called Coke Zero Sugar instead of Coke Zero. Other than the “new” packaging, I did not really notice any differences. Of course, I have not had a Coke Zero for several years so I still remember the old packaging. I also was unable to find all the different flavors. There was only regular Coke Zero (Sugar) and cherry at the local Albertsons. I really want the vanilla flavored ones, and there is an orange flavored one as well. I used to drink the lime flavored Diet Coke too, but I could not find that either.

Dim Sum Lunch

A friend of my parents came by around noon and dropped off some take out dim sum from a place called Lunasia. They have restaurants in Alhambra, Pasadena, and Cerritos. The food was pretty good, I would give it ★★★★☆, but items were kind of pricy. Let us compare between Lunasia and The Dim Sum Co., which is a take-out place in a Vietnamese-Chinese supermarket.

ItemLunasiaThe Dim Sum Co.
Shrimp Har-Gow$6.18 (4 pcs)$3.99 (4 pcs)
Pork and Shrimp Siu-Mai$6.18 (4 pcs)$3.99 (4 pcs)
Lotus Leaf Sticky Rice$6.18 (2 pcs)*$3.49 (2 pcs)
Steamed BBQ Pork Bao$4.18 (3 pcs)$3.68 (3 pcs)
Pork Spare Rib$5.18$3.49
Egg Custard Tarts$5.18 (3 pcs)$3.49 (3 pcs)
Sesame Balls$4.18 (3 pcs)$3.22 (3 pcs)
Pan-Fried Turnip Cake$5.18$3.49
*The Lunasia version had a piece of abalone in it, which makes it more expensive but not necessarily more tasty

I would give The Dim Sum Co. a score of ★★★☆☆ so you would expect Lunasia to be more expensive, but how much? Some of the items are just a bit more, and some are about 1.5x the price at The Dim Sum Co. Since the closest Lunasia location is in Cerritos, the longer drive and higher prices is not worth the slightly better quality of food. My mom seems to like Lunasia and wants to order from there next time. She does not drive.

Chinese restaurants never provide nutritional information so no idea on calories, fat, carbs, or sodium. It is probably all bad for you.

https://www.instagram.com/p/CKmN8cmlIW4/?utm_source=ig_web_copy_link

Hypotension

While I was on dialysis, especially after starting hemodialysis again after heart surgery, my blood pressure has been all over the place. I published many posts with a record of my blood pressure readings during dialysis, and it can range from over 200 to under 100. I usually do not feel anything when the blood pressure is high, but I would feel dizzy and nauseous when it drops below 110, especially when standing. I was taking three different medications for blood pressure, but it was still pretty much out of control.

Post transplant, my blood pressure would still fluctuate wildly, even though the new kidney was doing its job of clearing fluid from my cells and bloodstream. They kept me on 25mg of Metoprolol Tartrate and also 30mg of Nifedipine ER (extended release). Initially, my blood pressure would still reach 190-200, but some of it was due to the prednisone I was taking. As the doctors reduced my anti-rejection medication, I feel my blood pressure was becoming more stable. Earlier this week, I think it stayed within 110 to 160 for the systolic measurement. After Thursday’s clinic, they cut my prescription of Mycophenolate completely, so I am on the minimal dosage of prednisone, and about the same dosage of Tacrolimus as when I was discharged.

Since Thursday, my blood pressure has been pretty stable. I have only been taking the Metoprolol since I am very sensitive to Nifedipine, and I did not want to drop my blood pressure too much and have hypotension. Today at dinner, I measured 159 sitting and about 135 standing so I took the Nifedipine pill; I believe I have skipped it for the past two days. Anyway, I felt fine for awhile, but when I got home (from my sister’s house), I started feeling dizzy. My sitting blood pressure was about 95/60 which is super low for me. The earlier blood pressure reading must have been an error and I should have not taken the Nifedipine. I am trying to stay seated as much as possible since each time I stand up, I feel dizzy. Hopefully it will pass soon. At dialysis, it usually takes 30 minutes to recover if I have hypotension post-dialysis.

One month history of blood pressure readings. Since I measure multiple times a day, this gives the range of values. There is a definite, if slight, decreasing trend in the values for my systolic blood pressure readings.

Cystoscopy

From the UCLA Transplant Center discharge manual:

Cystoscopy is used cor general observation of the bladder, and to aid in the diagnosis of bladder and urethral disorders. It is also a way to remove stents from the bladder.

I had an appointment today at UCLA Clark Urological Center to have the stent removed. It was placed between the new kidney and bladder to help the ureter connection heal. The appointment was initially scheduled for 1:00 pm but was moved this morning to 2:00 pm, which caused me to sit longer on the freeway driving home.

I left my house at noon and got to UCLA Medical Plaza at 1:30 pm. I checked in and soon a nurse/assistant came out to get me and prep me for the cystoscopy procedure. Basically, I had to remove all clothing from the waist down, put on a gown, then she wiped my groin area with iodine and injected some lidocaine gel into the urethra opening. Then she went to get the doctor. I waited… and waited… and waited… for about 40 minutes with no pants on and trying not to fall asleep. The doctor finally came and it was the same surgeon that did my kidney transplant surgery. He said a few things, grabbed the camera device, inserted it, and grabbed the stent in about 60 seconds. Done. I was then given some wet and dry paper towels to clean off the iodine, while the nurse was still cleaning up the room. She did say, “Don’t mind me.” while I was standing with no pants on. Ha!

The procedure hurt a bit but nothing like the removal of the foley catheter after three days. I paid for parking ($14) and started driving home. I left UCLA at about 2:40 pm, and did not get home until after 5:00 pm. I knew it was going to be bad from years of driving home from work, but this was a lot worse since it was about 15 miles further on the 405 freeway. I had Autopilot on most of the way, so I was free to observe lots of shitty drivers. Since my carpool sticker expired, I stayed out of the HOV lane even though I drive an electric car. Looking at the cars in the lane though, about 50% were single occupant vehicles. In the four years I drove in the carpool lane, I have only seen someone get pulled over once. I guess if the CHP does not enforce the rules, then every asshole driver will cheat and jump into the HOV lane. Judging by the traffic however, I probably would have saved 10-15 minutes on my 2.5 hour drive home. Not worth it.

So now I think I am done with post-transplant procedures. I still have some stitches sticking out of the incision. I forgot to ask the surgeon about it. I am going to clinic once a week now so I will ask the attending doctor next Thursday.

Post-Transplant Peripheral Neuropathy (update)

Both my parents and my sister asked me whether the kidney transplant fixed the pain in my feet. The answer is a resounding no.

I have had pain from peripheral neuropathy before I found out about my kidney failure. My understanding is that the numbness comes from damaged or dead nerves caused by uncontrolled diabetes, and essentially there is no cure. I was lucky that I did not experience much neuropathy during my hospital stay, or even the first few weeks of recovery. However, neuropathy pain from last night and tonight have been pretty intense, and is preventing me from sleeping right now even though it is 2:00 am.

Last night, the pain was pretty high up on the outside of my left ankle. I have never experienced pain there before. Since it was kind of high up on my lower leg, I could apply pressure to the pain point and actually feel something, usually more pain. This was different than all the previous pain points where I could not feel any external pressure on the pain point. Tonight, the pain is in the same area but a bit lower. Like last night, I could push on the area and manually trigger the pain. I tried using a massage wand on the spot, but that just made it worse. The Tylenol I took has not helped yet so it looks like it will be a long night of pain attacks. I also had some sporadic pain in my right foot from neuropathy, but the entire lower from the knee down is still hurting from the fall I took at UCLA. The pain in my right leg gets a lot worse after 15 minutes of walking so I have only walked every other day recently. The nurse practitioner at UCLA said it may take 4-6 weeks to heal from a fall to the kneecap so I may have to limp around for another three weeks.

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Update: 2/26/2021 9:04 pm

So all the pain attacks have pretty much stopped for the moment. It was pretty bad yesterday while driving home from UCLA after my clinic appointment. In the hour drive home, I had three places on my left foot experience shooting pain, and one place on my right foot. Usually, the pain is limited to one location at at time, but this time, the pain was pretty much constant with four different locations hurting at random.

Of course I rather have the kidney transplant than to go back to the way things were but this multiple pain points at the same time is killing me. Good thing most of the pain was in my left foot, which is not used when driving.

Apple Music Player

I have a love hate relationship with Apple. Most of the time, their hardware and software is great, but expensive compared to PC alternatives. Other times, they just suck. Most of the issues I have had is related to software updates, either on my Mac or on iOS devices. It is as if Apple does not test their software releases and updates. Each time I have a problem and Google, there are a ton of hits as every user seems to have the same problems. Why were not these widespread issues caught in software quality assurance before release?

Just now, I opened the Music/iTunes application and all my imported music is gone, all 43 GB of MP3’s. The only items showing are songs I purchased from the iTunes store. Since I still have almost no room on the Mac HDD, the files are obviously still on the computer. Why did Music drop the library? No idea, but it appears to be common after a Catalina OS X update. I am reimporting the library XML file that is in the music folder to see if it helps. I also noticed that the app reset the directory path to the Music folder. I definitely did not do that. Why would the software reset the path itself?

Even worse, each time I Google a problem, there is almost never a response from Apple. There are lots of users giving mostly useless advice, including restart, reset, or even a factory reset. That is not a solution if I have to rebuild the entire computer’s software library. In this case, I have a lot of playlists that took a lot of time to organize. It looks like Music is reimporting all the songs again; hopefully I did not lose all my playlists since they also auto-sync to my iPhone and iPad.

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Dang it! Music finished importing the last library file and of course, it is not right. There are missing playlists, and the computer said it could not restore some of the files because they are missing. It does not tell me which files are missing either. The worst part, the “recently added” part is all messed up. The list used to show when I imported songs/albums going back years. This is very helpful when I want to check out music that was more recently imported versus stuff that has been on my computer for awhile. Now, everything shows being added “today” and seems to be in random order. I guess it is time to back up all my MP3 files to my NAS and start over. I am now actively looking for an alternative to Apple’s Music app. Hopefully I can find something better that will support iOS devices too.

Endocrinologist Appointment

I had a Zoom telehealth appointment with my endocrinologist. I had been sending her office email updates post-transcript but she wanted to discuss my blood sugar and medications. UCLA also has been asking me to see my endocrinologist too.

The appointment went well. I had given her assistant all my blood sugar readings for a week. Since I am already at the maintenance level for prednisone, she does not think my blood sugar will decrease further from reducing other medications. The pill I am taking, Januvia, does the same function as the HumaLOG, which is to control blood sugar due to food. Since my blood sugar is consistently above 200 during the day, she is replacing the Januvia with a long-lasting insulin. She had prescribed Toujeo previously but I never used it. Now I will need to inject two types of insulin each day. Ugh.

The pricing on the pen needles also suck. At UCLA, I had a copay of $30 for a box of 32 gauge 4mm needles. My local pharmacy wanted $44 as copay for the same needles. I have not checked my mail order pharmacy for prices. On Amazon, there are a lot of inexpensive options for the same size needles. However, none of them will deliver to my house, probably because you need a prescription in some states to order insulin needles. I did find another mail order diabetic supply company that has 100 needles of the same size for $11 per box of 100. Even with shipping, that is much cheaper than either of my pharmacies. Hopefully a needle is just a needle so as long as it is the same size, the needle will work with both pens.

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This is what I initially received from UCLA along with the HumaLOG pens. I looked at the pharmacy receipt and UCLA’s price was $71.50, and my copay was $30. On Amazon, the same item with 90 needles cost $45, but there are other sellers selling for as low as $15. Of course, I cannot order since no one will ship “prescription medical devices” out to patients. You probably have to be outside the USA to receive these items. Our medical insurance system is so corrupt.

I also tried getting needles at Albertsons pharmacy. My endocrinologist sent over a prescription for Droplet pen needles, same 32 gauge 4 mm needles as the BD ones above. Albertsons said my copay was $44 but this item clearly sells on Amazon for $13.89 a box. Again, I cannot order it from Amazon due to our corrupt medical insurance system.

Searching online, I found a company called Medical Supply Corner selling the Droplet needles for $9.99 for a box of 100. I ended up ordering three boxes to spread out the $6 shipping cost. They also have a four box pack for $40 that I did not see before ordering. I used my FSA debit card and the transaction went through. Hopefully the will ship the items to me but I am expecting the order to be blocked, or maybe the SWAT will come knocking to get the needles back.

Allstate Critical Illness Insurance Update

As I mentioned before, I signed up for this extra insurance since the beginning of 2017, but never bothered to fill out any claims. Based on the recommendation of our company’s benefit department, I even chose the highest coverage level, which is $50k per incident.

When my kidney transplant surgery was scheduled, I made sure I printed out all the claim forms since I did not do so for dialysis and heart surgery. I handed the documents to the post-transplant coordinator who then gave it to a social worker. She managed to get the attending doctors to fill out the form and return them to me. I still do not know how Allstate received the claim but they entered three claims into their system: kidney transplant, heart bypass surgery, and ESRD/dialysis. The weird thing is that the UCLA social worker said I needed to fill out some sections of the form so she is returning them to me. Did she also file them with Allstate? Why did Allstate start three claims instead of one? How did they even find out about the other two incidents if I did not file any claims? Weird.

By the time I found out that the claims were filed, Allstate had already approved the kidney transplant claim. They approved the entire $50k amount and when I got home from two weeks in Westwood, the check was already in my mailbox. Today, I got an email saying that another claim status was updated. Allstate had wanted some documentation on the ESRD/dialysis start date and an operative report for the bypass surgery; I sent those in last week by mail as well as uploading files to their website. Well, evidently they also accepted the ESRD/dialysis claim, so another $50k is coming. All we are waiting for now is the decision on the heart surgery, which only pays out $12,500.

I just checked my paystubs and the critical illness insurance premium is $47.08 per pay period. Assuming 26 pay periods per year over four years, the total cost of the insurance is $4,896. Taking the total payout so far of $100k, the return is 510% annualized. Not bad.

There is another supplemental insurance I am paying for but the premiums are only $6 per pay period. I do not even know what is covered. I should go take a look to see if anything covered has happened to me since I spent so much time in hospitals and clinics the last few years.

Insurance Confusion

Ugh. Not only does the United States seem to have the most complex health insurance system, nobody seems to understand the nuances. When you have more than one insurance provider, the confusion seems to grow exponentially.

As mentioned before, due to ESRD and kidney transplantation, I have Medicare Part A and Part B. However, I do not have Part D for prescriptions because that’s not part of the ESRD coverage, and I have Blue Shield from work that covers prescriptions. All good so far. Well, post-transplant, Medicare is supposed to cover only the anti-rejection medications, but under Part B for services and supplies, not Part D for drugs or prescriptions. At UCLA, since they deal with this everyday, they billed Medicare Part B for the three anti-rejection medications, and Blue Shield for the rest. After transferring the prescriptions to my regular pharmacy (Albertsons) and mail order (Express Scripts), they both billed the anti-rejection medications to Blue Shield. Two problems: 1) there is no copay for Medicare but there is with Blue Shield, and 2) since our work insurance is self funded, my company ends up paying thousands for the prescriptions when they’re supposed to be paid by Medicare. I called both Albertsons pharmacy and Express Scripts and both said they only bill Medicare Part D and not Part B. Luckily, UCLA pharmacy said they will keep filling my prescriptions as long as the prescribing doctor sends the scripts there. I don’t know if this applies after UCLA hands off care to my regular doctors. The copay is not too bad, only $10 per prescription refill. Since I am paying >$500/month for Medicare, I should probably use it.

Post-transplant, Medicare pays for anti-rejection medications for three years. That was just changed to lifetime coverage. I am 52 so I will get regular Medicare in 13 years. If I am done with dialysis and already had a transplant, why do I need Medicare if my work insurance will pay for the anti-rejection medications? That means I have to keep working or buy my own insurance but surely it’s not efficient to pay a lot for Medicare if it only covers the three drugs. I need to find out more.

More Medication Changes

The doctors are pretty happy with my recovery. During the clinic appointment today, they reduced my dosage of prednisone to just one 5 mg pill every day. That’s probably the lowest and final dosage for me. By lowering the dosage, I also get to stop taking the nyastatin (anti-fungal mouthwash) and pantoprazole (acid-reflux). This is good. Out of the original 17 medications, I think I have stopped taking about six of them.

Progress.

Walking Outside 2/17/2021

The weather was really nice today so I went for a walk outside my house. Since I received a replacement Apple Watch, I was able to track fitness activities again. I walked 1.14 miles with a pace of 23’03”. I felt mostly fine, with no pain from the transplant incision site. However, my right knee and ankle are still hurting. The pain has subsided somewhat but it is still pretty awkward to walk longer distances.

I remember a year ago, during my heart surgery recovery, I set a goal of joining a 5k run in 2020, and actually run the course instead of just walking the route. Then COVID-19 hit, along with a bunch of small medical issues. Now with the kidney transplant surgery, it feels like I am starting over regarding physical activities.

Short-Term Disability, Again

This is the second time I am on medical leave in the past 12 months. The last leave was for my heart surgery when I was out from November 2019 to January 2020. FMLA only provides 12 weeks of leave for a 12 month period. Since the transplant surgery was at the end of January, I qualified for another 12 weeks of medical leave. In fact, my company contracts a third-party company to managed leave administration. After sending in some paperwork, they approved my leave.

This year, our company made a change in the way we manage short-term disability. In the past, employees would need to apply for disability payments directly with the Employment Development Department (EDD). I had to do this last time and the process was very frustrating. The EDD website is terrible, and there is no way to reach a human for help. It took several weeks for me to get my disability application approved by EDD and to receive payment. This year, the third-party company does all the work, and I was just approved for $1,357 per week. The payment is 60-70% of your weekly pay, but maxes out at $1,357 starting in 2021. Our company also provides supplemental disability but the total amount (with state disability) is capped at $1,600 per week. That works out to an equivalent annual salary of $83,200. Working only 30-hours per week and receiving 75% salary did not have any impact on disability payment amounts.

Initially, I did not want to take medical leave since I thought I could “go back” to work within weeks since I am working from home. However, there are a lot of clinic visits and other appointments that it would be difficult to work full-time at the same time.