My friend, who I’ll call Empress in this story because she really is an Empress, is marking her two-month anniversary of Diagnosis Day.
In my friend’s case, the diagnosis is rheumatoid arthritis. R.A. is incurable, painful, debilitating and potentially fatal. Treatment plans vary according to the individual and healthcare provider. The disease, like many autoimmune illnesses, flares and then quiets like the hesitation between Fourth of July fireworks, making you wonder if each display is another burst of sparks or the blazing finale.
Anyone who has had a medical diagnosis of a nasty disease knows that this particular day will stand out among other days. For many, D-Day can offer a strange relief. Finally, there’s a name for all of the unexplained pain, dizziness or whatever bewildering symptoms. On my D-Day, my first thought was “Hey, maybe I’m not crazy after all.”
On my D-Day, my first thought was
“Hey, maybe I’m not crazy after all.”
I’d had two years of odd rashes on my face, legs and arms. My fingernails warped and rippled. I was always tired. My joints felt like balls of fire. My ribs and heart were sore. I was depressed yet caring for a 7-month-old son while pregnant with my daughter. When my physician called me at home one evening with the results of my most recent round of blood tests and told me that I definitely had systemic lupus erythematosus, I was almost delighted. Finally, a name! Finally, a reason! Finally, a treatment plan!
Photo credit: Albumarium/Chiara Cremaschi
The odd euphoria of D-Day ebbed quite a bit when I realized that remission was not around the corner and that the coming years would require that I change my expectations about certain facets of my life that I thought were part and parcel of who I am. Or was. Or will be.
Still, if I were to place SLE in one hand and my old self in the other, I would hold on to the Me with SLE. I used to let little things get to me but having this disease has forced me to see life from a different perspective. I don’t get ruffled easily. I avoid drama. I appreciate more. Sure, I miss out on some things due to pain, fatigue or my sensitivity to sunlight, but what I do have I hold more closely to my heart than I think I would have pre-SLE.
Empress is moving from the shock of D-Day through the grief of losing a part of yourself without really knowing what the part will be. Yes, there’s a reason for today’s blinding pain and the mental fogginess. The question really is all about tomorrow and the days after that.
Of course, no one knows from one day to the next what will be gained or lost. I would argue that for the most part, most people can live with the belief that tomorrow will be much like today in terms of physical and mental capacity.
For the person with a “Diagnosis” it’s virtually a certainty that each day will be uncertain. Sometimes, I see myself as an adventurer going into each day and night with hope and curiosity. Other times I’m grumpy and tired. We all build our own way of adjusting. I don’t know what the Empress will build for herself as an outcome of D-Day, but I’m hoping it will be a crystalline outgrowth: reflective, illuminating and precious.
Do you have a story about your D-Day that you’d like to share? Let me know in the comments below.
I’ve been practicing medicine in Teton Valley for more than 15 years. I’ve had the pleasure of being a family physician for many of you, and I’ve enjoyed watching your families grow. I want what’s best for you and your family, whether or not you choose me as your provider. What’s best for your family is often what’s best for mine, and when a patient asks me “what would you do if it were your child/parent/friend?” I tell them the truth.
I vaccinate. My kids are vaccinated, as are my wife and I. I recommend all my patients who are of proper age and health get immunized against several diseases that once were commonplace in the United States. The measles, mumps, rubella (MMR) vaccine is one of them. We declared measles eliminated from this country in 2000, but the incidences of disease have increased in recent years.
So far this year we have seen over 100 cases of measles spread across 14 states in this country. The majority of those (92 percent) are related to an outbreak linked to theme parks in California including DisneyLand. The 102 cases just in the month of January puts us on track for exceeding the record number of cases (644) we saw in all of 2014.
While we’ve yet to see a case of measles this year in Idaho, we still need to protect ourselves, our families and our community from it.
What’s the big deal about measles?
Measles is highly contagious.
On average, a person with measles will spread the disease to 18 other unvaccinated people, compared to an average of 2 for Ebola and less than 2 for influenza. Measles can spread even when no symptoms are present (4 days before and after a rash appears). It is spread through the air via droplets from sneezes or coughs and can linger on surfaces for up to two hours.
Measles can be deadly.
Complications from the initial viral infection of the measles can lead to hospitalization and even death. Ear infections and pneumonia are the prevailing complications, and encephalitis (inflammation of the brain) can also result. If a person with a compromised immune system comes in contact with the virus, risk is even higher.
An MMR vaccine is more than 95% effective.
The MMR vaccine is provided in two doses, one at age 12-47 months and the next when the child is 4-6 years old. It is the best defense against catching measles, mumps or rubella. You can also choose to add varicella to the vaccination, (MMRV), which vaccinates against chickenpox. While no vaccine is 100% effective, MMR and MMRV are our best options for preventing measles, mumps, rubella and chickenpox in our children and in the children who attend school and/or play with our children.
Herd immunity doesn’t work if the herd isn’t vaccinated.
The basic principle of herd immunity is that if enough people are vaccinated (immune) to a disease, those who are too young or sick to get the vaccine themselves will be protected. Some may argue that not vaccinating their child isn’t such a big deal because the majority of children and people are vaccinated. But there’s a tipping point in herd immunity where if even a small percentage of the community is not immune (unvaccinated) it puts the entire community at risk.
The takeaway here is that I hope you, like I do, will vaccinate yourself and your children against these diseases that are now making appearances in our country despite having been wiped out at one point or another.
Talk to your healthcare provider if you have questions, and understand the potential consequences to your family and to the community as a whole based on your decision to vaccinate or not.
Your 1095_A should arrive in the mail in early February. If you want it before then, log on to Healthcare.gov and print out a copy from your account page.
You may receive more than one 1095_A. Keep all of the forms for tax filing purposes.
If you received health insurance coverage via your employer for part of last year and were on the exchange for even a few months, you will still receive a 1095_A.
You can no longer file a 1040EZ if you received subsidized healthcare. You’ll need to fill out a longer form instead.
There’s a new tax form you’ll need this year if you got insurance through the exchange marketplace in 2014.
Those who received insurance premium assistance will receive a statement (form 1095_A) that needs to be included in tax filing for the year 2014.
The form is a statement of benefits received (called premium assistance or premium tax credits) and indicates what your insurance premium was for 2014 and how much assistance the government provided.
While Idaho is running its own insurance exchange for 2015 through Your Health Idaho, the state participated on the federal marketplace via Healthcare.gov for 2014.
The following is from the Healthcare.gov blog:
Form 1095-A and your tax return
If you or anyone in your household enrolled in a health plan through the Health Insurance Marketplace in 2014, this tax season you’ll get a new Form 1095-A — Health Insurance Marketplace Statement. You’ll get it in the mail by early February and use it to file your 2014 federal income tax return. Keep it with other important tax information, like your W-2 forms and other tax records.
When you get Form 1095-A, make sure the information matches your records. Check things like coverage start and end dates and the number of people in your household. If you think anything’s wrong, contact the Marketplace call center at (800) 318-2696.
What’s on Form 1095-A?
Information about anyone in your household who enrolled in a health plan through the Health Insurance Marketplace for 2014.
Information about the monthly premiums you paid to your health plan.
The amount of any advance payments of the premium tax credit that were paid to your health plan in 2014. These are the credits that lowered what you paid in monthly premiums.
The cost of a “benchmark” premium that your premium tax credit is based on. You won’t get this form if you have health coverage through a job or programs like Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). You may get more than one Form 1095-A if anyone in your household switched plans in 2014 or reported life changes. You’ll get a Form 1095-A even if you had Marketplace coverage for only part of 2014.
You can download copies of Form 1095-A through your Marketplace account where they may be available before you get your copy in the mail.