Wednesday, July 4, 2012

I found an old picture of myself

It was my freshman year in college. I was skinny! OK, so by any BMI table I was not- but I have a large frame (no, really!), and I looked fine. Freshman year of college I was unmedicated. That would all change in the second half of my sophmore year of college. I would never be that weight again, as the meds, and the pounds, increased.

I actually did briefly get skinny one more time in my adult life when I had pretty much stopped eating during a very long and protracted depression when no one wanted to give me an antidepressant because I had just been manic. And then I was put on Zyprexa, and I blew up- I didn't know a medicine could be so bad for weight gain. It was pretty new, maybe no one knew. And when I tried to fight the hunger and diet, I started binge eating, something I had never done before. Eventually I stopped gaining, after about two years, but by then the damage had been done. I was morbidly obese.

I have lost some since- mostly with the help of metformin. I have not been able to get off of Zyprexa. I seem to have a new, slightly lower set point now on the metformin. I am no longer in the "morbid" category. But not by much. I start a diet several times a year- usually weight watchers online or calorie counting recently, but "fall off the wagon" when my mood dips, as it so often does, and then I regain what I lost. The new normal for me on Zyprexa is that, where as I used to lose weight while depressed, I now gain weight.

So far I have escaped diabetes. I take metformin to try to counteract the metabolic effects of the zyprexa (I just wish I had known about it years ago). I take resverotrol. I take chromium. I try not to eat too much processed food or sugar- but have the occasional ice cream lapse. I would like to say I try to exercise, but most of the time it doesn't happen, so I am not trying that hard. I know how vulnerable I am, and I could be just one blood test away from finding out that I have it.

So now the question is, do I want that to be a matter between me and my doctor, or do I want my employer involved? Here is the question. Would you give away your medical privacy away for $500?

I have a high deductible health insurance policy with a health savings account, and I spend a lot out of pocket every year. I can get up to $500 extra in my health savings account by doing 3 things. First, getting a "biometric screening" from occupational health (weight, blood pressure, and various blood tests). Then, I can go online and fill out a health assessment- but only if I have done the biometric screening first. And then, I can get more money if I get my yearly physical- something I was planning on doing anyway.

Well, the biometric screening has to be done in July. In fact, a nurse will be coming from occupational health to our site to do weight/BP checks, and give us lab slips so we can get our lab work done. I wonder if she is just going to tell me my weight, or if there will be any kind of a lecture involved as mine is "not optimal." My physical- which I scheduled 6 months ago, is in August- and will probably do exactly the same- take my blood pressure, weight, blood work (plus a few other things like gyn exam), it makes no sense to do all this twice. Unless you are thinking in the strange logic of an insurance company.

I have to admit, there is a part of me that wants to say to my employer, if you want me to lose weight, fine then. I'm just going to stop taking my Zyprexa, and you can see how quickly the charges add up for an inpatient psychiatric hospitalization.

Because, really, I haven't had many medical charges due to my weight. Yes, I have high blood pressure, and I probably got it younger than I should have- that is about it. I see my primary care doctor 2-3 times a year for this and take a dirt cheap generic ACE inhibitor.

Extra blood work for glucose levels and lipids, etc., would have to be done anyway due to the Zyprexa and my other meds.

Will I give up $500 for my privacy? When I was looking for car insurance, I could have got a better deal with Progressive if I had just agreed to put a gadget in my car that would monitor my driving. NO WAY! But GEICO wasn't that much more, no gadget involved, so the choice wasn't that hard.

$500, and tax free at that, which I know that I will spend (I use up my HSA every year), is hard to pass up. I think I will swallow my pride and see how bad it is. Even though I weigh myself almost every day, I will let them weigh me. Even though I have a blood pressure monitor at home, I will let them take my blood pressure at work. And even though I am scheduled for my yearly physical the next month, and already have an appointment to come in the week before for blood work, I will let them take my blood. It will be interesting to see how results compare- how stable are values over short periods of time, between labs, etc.

What I won't let them do is lecture me. My weight, my blood pressure, my lab values- those are to be discussed between me and my doctor. Someone who knows all of me, my history and my meds. No one else is qualified to tell me anything.

Still, I am selling out. I should tell them what they can do with their $500. I suppose privacy is now a luxury- one that I haven't figured out how much I am willing to pay for yet.

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