Low Carb Almond Flour Bowls

After nearly 10 months of low-carb/ketogenic eating, I’m officially a believer.  20 lbs of body fat gone.  Chronic acid-reflux gone.  Chronic fatigue…not quite gone, but seriously diminished.  I do not believe that there is a one-size fits all food program suited for every individual.  Much or our cultural heritage dictates our dietary needs.  Asians tend to be lactose intolerant because dairy cattle were not a significant part of their historical agriculture trends.  Some people can’t eat nuts of any kind.  I have a pet theory that those of us who have negative reactions to grains and starches come from a longer hunter-gatherer tradition than those whose ancestors farmed cereal grains for hundreds of years.

While that last assessment may be completely inaccurate, I can safely say that my body just doesn’t do well with staple food items that make up the bulk of a grain-oriented agricultural tradition.  If you’re like me, here are some recipe suggestions that can help keep you on a low-carb, grain-free path without missing out on the “good stuff.”  You will notice a few processed food items on this list.  As a general rule, I try to eat organic whole foods almost exclusively.  But sometimes I just don’t wanna, dammit.

I don’t expect to achieve immortality by limiting myself to free-range tofu and grass-fed salt.  Every once in a while I drink diet soda sweetened with aspartame.  If I’m in a hurry, I’ll get a fast food cheeseburger and toss the bun.  I also used to smoke two packs of cigarettes per day, so I’d say my occasionally imperfect eating routine is progress.  I’m also not a chef, and all of these recipes involve a microwave.  I keep hearing that microwaves denature food and can lead to the formation of free-radicals.  I just don’t care.

When I lived in Los Angeles, I always found it amusing how obsessive people could become about food purity over lunch at a restaurant, after spending the previous hour jogging behind a city bus in some of the worst smog in America.  It would probably be safer to live in Montana and eat chewing tobacco for breakfast.  But…I’m getting sidetracked.

Here are the “recipes.”  It is not an exhaustive list.  You can basically make these adjustments with anything that might otherwise involve bread.  The foundation for each recipe is an almond flour cake that functions as a neutral base:

2 tbsp. butter, melted

2 tbsp. almond flour (not almond meal)

pinch of salt

1 egg

1/2 teaspoon baking powder

Stir it all up in a bowl and microwave for 75 to 90 seconds, depending on what consistency you prefer.


— Eggs, any style, with cheese, chives, and bacon pieces.

— Sugar free, low carb pancake syrup

— fresh raspberries and heavy cream

— Bacon, Lettuce, and Tomato with mayo.

— marinara sauce, pepperoni, and mozzarella.

— ground beef, cheddar cheese, lettuce, tomato, and mustard

— roast beef, sautéed onions and peppers, cheese, mayo

— clam chowder, minus potatoes. Sub white flour with almond flour.

— Lox, cream cheese, red onion, and capers

These are just a handful of ideas, but for me they are a lifesaver.  Sometimes I feel like I’ll jump out of my skin if I don’t get my hands on some bread or pancakes.  Any of these treats will do the trick just fine.



Reflections on 10 Years of Sobriety

     Technically, I will not have an official decade of uninterrupted sobriety until Saturday, March 10th.  However, I think I can confidently say that I am unlikely to start drinking again over the next three days, and at this point in my life I don’t have a great deal of free time to sit down and write.  I originally started this blog to share my past experience with substance abuse, and from there it has sort of bounced around.  But it seems fitting to take a look at the past decade in a brief summary.  Hopefully something I share here will help someone find a solution that has been eluding them.
     My own journey toward real sobriety started with an interview I read in an online magazine in 2008.  I had previously been able to abstain from alcohol and drugs intermittently, but inevitably I would succumb to the notion that I was probably just going through a phase.  That never ended well…a fact that I seemed to forget every time I started up again.
     The above picture is a cast photo from the play, “Bill W. and Dr. Bob,” circa 2004.  It is the story about the founders of Alcoholics Anonymous.  I had a small part as an alcoholic lawyer who was on his last legs.  It was an easy role, because my own life was also falling apart.  I was extremely drunk during every performance.  Someone from the cast would invariably have to wake me up during the intermission.  That’s me on the far left, intoxicated.  I don’t recall taking this photo.  I couldn’t even recall taking it when it was emailed to me 14 years ago.  When I managed to stay sober for subsequent acting jobs, it became clear that I was actually a barely mediocre actor.  Probably because I rarely did any of the work required to become a decent one.
     I was a functional alcoholic.  Generally I was able to hold down a job, participate in creative ventures, and maintain relationships (for the most part).  But I took a lot of risks.  I am not an intrepid person by nature.  Under the influence of alcohol, however, I was extremely reckless.  It is hard for me to understand why I was never arrested for DUI, public intoxication, or worse.  I was lucky to some degree, but since I never suffered any legal consequences, the avalanche kept growing.  There was nothing to stop me.  I fell asleep at the wheel…got lost on foot at night in a dangerous neighborhood…was threatened by a drug dealer…nearly ruined a short film that the director had poured his life savings into.  I was an “edu-tainer” for elementary school programs that featured drug and alcohol prevention strategies.  During the vast majority of those presentations, I was either hungover or still intoxicated from the night before.
     As my alcoholism deteriorated, the material aspects of my life somehow managed to improve.  I paid off debts, secured more interesting and better-paying jobs, met my future wife, and moved into a comfortable apartment.  But, internally, I was falling into a black chasm.  An eternal fall.  That feeling you have during a dream in which you have lost your balance on the edge of a cliff, and your mind is trying to decide whether or not you’re dreaming.  That feeling generally became the only “emotion” I was capable of experiencing.
     As I sat in the little office room of our apartment on March 9, 2008, something happened.  It was a beautiful southern California day.  I was finishing up some music composition for a show that seemed to be gathering momentum.  It was the first genuinely good day I could recall having in a while.  Why not have a couple of beers to celebrate?  Surely most of my previous problems with alcohol had been merely situational.  Things were really looking up now.  I could enjoy a nice cold one like a regular grown-up, right?
     By the 3rd bottle, a heavy darkness began to settle over the room.  The sunshine became dull.  The work I had been doing all morning ceased to be important.  The falling sensation began to gain speed.  “This is never going to get better.”
     I do not know exactly what motivated me to take the following step.  I am a natural isolator.  Especially with a few drinks in me.  But I was overcome with a compulsion to reach out to someone whom I had never met.  We would be doing some work together in a few days, and I had no way of knowing how he might react.  Here is the text of the email I sent to him, edited to protect anonymity:
“This email is unrelated to the upcoming (music) show.  It may even seem too personal or just generally strange, and for that I apologize in advance.  I don’t know if there is a God or just random chance, but I’m going to go out on a limb.
I understand that you had some problems with alcohol while you were with (a band). And I read an interview in which you stated that you had been clean and sober for 15 years.
I have struggled with alcohol for most of my adult life.  I have tried everything to stop.  I spent some time in AA, worked most of the steps, and I guess I just gave up.  I don’t know.  I guess the only reason I am writing you is because I have been praying to whatever figment of the imagination of whatever God there may or may not be for some kind of solution.  And the only thing that keeps coming into my brain is, “Maybe you should tell (this person) what’s going on.”  That seemed ridiculous to me, because you and I have never met, and I didn’t want to seem like some nobody musician who is just trying to get chummy with someone who was in a legendary band.
But the same thought keeps coming to mind.  I know where AA meetings are.  I can’t seem to go.  People I knew in AA call me.  I don’t call them back.  I isolate.  I hide.  I pretend that everything is just fine.
Again, I really have to say that I’m sorry if this seems nuts and it makes you feel weird being in the band this month.  I just don’t know what else to do right now.
Frankly, it just doesn’t matter that you were in (a band) in regards to this email.  I just keep hearing the same voice that tells me to tell you what’s going on.  If it was a voice that was telling me to tell the bum at our dumpster, or the minister at the church down
the street, then I would do that.  But I’m not hearing that advice.
The writing is on the wall.  I’m perfectly functional.  I run 20 miles per week.  I have a beautiful girlfriend, whom you will meet at rehearsal.  I have a great family.  I have every opportunity in Los Angeles just waiting for me to grab it.  Friends.  Love from
others.  An audience.  Employment.  Enough money to pay the bills.
And for the past week, every day, I haven’t been able to stop thinking about why it would just be better to be dead.  And whether or not I should bother to write a note.  To be clear, I wouldn’t be writing you if I was actively planning suicide, because I would be busy planning suicide.  I’m too much of a pussy to take my own life.  So I hang out in some sort of limbo. Drinking just enough to try to shut out the resentments and fear, but not enough to get caught by people who are checking up on me.  And I keep praying.
And hoping that one day actual sobriety will be appealing to me.  Because now I can’t stand drunkenness or sobriety.  And I hang out somewhere in between.
I’m going to send this now.  I may regret it.  But I know that if something doesn’t change I will end up like my grandfather — dead in his mid-50s.  From the same thing — a total inability to admit that we are completely powerless over alcohol.
— Adam”
     Almost immediately, this person responded with a willingness, if not eagerness, to help me.  A total stranger.  For the first time in my life, I decided to let someone else do the driving.  I couldn’t drive anymore.  Whatever he told me to do, I did.  I didn’t question it.  I didn’t modify it.  As a result, I never picked up another drink.
     Things are very different now.  Sobriety doesn’t necessarily make life easier.  There have been moments during which the situational aspects of my life became dramatically worse than at any point in my drinking career.  Life is hard.  But I have a toolbox that I use to solve problems now.  A toolbox that was passed down to me, and that I pass down to others.  My wife and I address difficulties together, as a team.  I am able to be present for my young children.  I very rarely worry about what happened yesterday.  I don’t get everything that I want, and that’s okay.  I have learned to let go of things I can’t control (most of the time).
     I am not going to live forever, but I am probably not going to die from alcoholism.  There is a solution…

I Don’t Have Time To Workout!

We’ve all been there.  Most of the time I’m there.  I spend my days taking other people through workouts, and whatever energy I have left goes into chasing my kids around.  To solve this time/energy problem, I have been selecting a few intense exercises and doing them in short bursts.

Before Anne and I had children, we did 10 mile runs every Saturday and I’d spend 6 to 9 hours per week doing some sort of martial arts training.  That’s just not realistic anymore.  Plus, I hate running.

I am always trying to maintain balance in my body.  I spent a lot of years getting injured due to the fact that I would hyperfocus on one thing at a time.  That worked for a while in my 20s, but eventually the repetitive stress can start to add up.  Distance runners and powerlifters usually have some sort of chronic pain issue.  It’s a trade-off.  To win, you have to focus.  Elite athletes know what they’re getting into.

I can’t afford to be injured anymore.  My little boys expect me to carry them when they’re too tired to walk, and I won’t be able to demonstrate proper pushups if I have a torn rotator cuff.  I also don’t have as much tolerance for discomfort as I once did.

If you are also the type of person who feels obligated to train every system, but can’t seem to find enough opportunity, give this a try for a few months:

*It goes without saying that if you are new to exercise, get checked by a doctor, have someone show you proper technique, and WARM UP!!

1X PER WEEK — DEADLIFTS.  Ramping up to a heavy set of 5 reps.  (Around 30 minutes)

2X PER WEEK — BURPEES (with pushups and jumps).  You’ll know when you’re done.  In sets or all at once. (10 or so minutes)

2X PER WEEK — MONKEY BAR HANG.  Until your hands won’t close anymore. Do pull-ups if you’re strong enough.  (10 or so minutes)

2X PER WEEK — STRETCH AND FOAM ROLL THE LEAST MOBILE PART OF YOUR BODY.  I mean dedicated stretching.  Focus on that one area.  (15 to 20 minutes)

That’s it.

There are always going to be naysayers.  “You’ll never finish an ultramarathon with that workout.”  “Yeah, but what can you bench brah?”  “That’s not enough volume to separate all 36 deltoid heads…brah.”

Let me just get out in front of that in this closing.  This is not a bodybulding, powerlifting, or endurance sport routine.  If you’re worried about your delt head separation, then you probably also get 8 hours of sleep, go to things like Happy Hour, and aren’t concerned about running out of diapers.

Deadlifts build maximal strength throughout the entire body.  Every muscle.  I used to think that the chest is neglected here, but anytime I go heavy, one of my pecs will usually spasm.

Burpees will improve endurance, power, speed, and agility, along with working every muscle. (Tell me which ones aren’t burning after a hard round of burpees)

Monkey bar hangs will improve grip and upper body strength, along with shoulder and back mobility.  Working in pullups will only improve upon that.

Dedicated mobility work in a troublesome spot is pretty self-explanatory.

If you decide to give this a go, I’d love to hear about your results.


Fitness Standards For Regular Folks

When people first begin the journey toward improved fitness and overall health, I find that they often don’t have a specific path toward a clearly defined goal.  This is perfectly understandable.  If a person has never really tested the capacity of their own body, fine details can seem pretty elusive.  Generally the goals entail “looking better,” or “losing weight.”  Along that road, some sort of exercise will be involved.  With that in mind, it is helpful to establish progress along an exercise continuum.

First and foremost, I am a proponent of finding something that a person is willing to do consistently.  If all someone ever wants to do is hop on an elliptical machine, that’s terrific.  Does it ignore a genuine need for strength training?  Yes.  Does it forgo the benefits of mobility work?  Yes.  Is it better than sitting in front of a computer for 8 hours, sitting in a car for 1 hour, and then sitting on the couch for 3 hours?  Emphatically, yes.  We could all be doing more, but simply doing something is a great place to start.

If a person is new to the idea of a dedicated fitness program, they might start with a simple Google search.  This can quickly devolve into a rabbit hole of overwhelming frustration.  I often run across strength training forums where I commonly see the standard, “Good strength goals for men are a 300 bench, 400 squat, and 500 deadlift.”  For the average person just starting out, this isn’t realistic, and it can be downright discouraging.  Most people can’t squat properly with any weight at all.  I personally know only 5 people on a first-name basis who can deadlift over 400 lbs, and 3 of us are fitness trainers.  Few people are doing any deadlifting at the family gym I attend.  Obviously the average powerlifter is going to hit those numbers, but powerlifters are not the intended audience of this post.

There are some terrific sites with fitness standards out there.  I personally test myself against a lot of the Crossfit standards, even though I’m not a Crossfitter.  But for the average person with little exercise knowledge, who is just looking for a basic template of realistic goals, the Crossfit standards can seem a bit esoteric and daunting.  So…if you are new to all of this, and have managed to train past the window between a New Year’s resolution and Valentine’s Day, here are some well-rounded, medium term goals that can help build a foundation toward any higher level fitness achievement.

— Finish a 5k without walking.  Barely jogging is acceptable.

— Pushups (chin to floor, perfectly planked):  Men, over 20.  Women, over 5.

— Inverted row from floor (legs straight, perfect plank):  Men, over 10.  Women, over 3.

— Front Plank (flat as a board):  90 seconds

— Bodyweight squats (below parallel):  75

— Single Leg Hip Bridge (full extension, controlled pace):  25 per leg

There will be any number of varying reactions to these standards:  “That’s weak sauce, bro,” or “Pushups are impossible!”  It is of the utmost importance to note that these standards are not going to break any fitness records — that isn’t the point.  Second, most people that I start with have severe strength imbalances:  35 perfect pushups on day one, but can’t do one squat to parallel without rounding the back and coming up on the toes.  I have also come to recognize that genetic factors for women can be all over the map in terms of upper body strength.  Petite women with shorter appendages usually have no trouble hitting 20 or more pushups in a fairly short amount of time.  Tall women with longer arms may struggle for a year just to get one good pushup.

The larger point that I want to make is that it is important to work on our weaknesses.  If you can sprint a 5k, but can’t hold a plank for 30 seconds, less time on the treadmill and more time on the floor can really benefit you long-term.  I’m a perfect example of this.  Lifting heavy things has always come pretty naturally for me.  But until I started running in my 30s, I couldn’t jog one mile without resting along the way, and it would take me hours to recover (chain-smoking didn’t help).  As I became more dedicated to martial arts training, my early progress was slowed by the fact that I simply had no stamina whatsoever.  When I switched my focus from something I could already do well, to something that had always been a struggle, it changed everything.

Not every man will be able to bench press 300 lbs.  Not every woman will be able to run a marathon.  But, over time, you should acquire enough strength and stamina to increase the odds of saving your own life in an emergency.  I have mentioned similar scenarios in previous blog posts, but I think it is important to reiterate them:

— Car breaks down in the middle of nowhere with no cell phone reception.  Are you fit enough to walk several miles back to civilization, possibly carrying a small child?  If you can jog an entire 5k, your odds are better.

— An overloaded bookshelf falls on top of you.  Can you use your arms and hips to get yourself free?  If you can do 5 good pushups, and 25 single leg bridges, your odds are better.

— A loose dog is coming after you.  Can you climb over a fence to safety?  If you can do 3 horizontal inverted rows, your odds are better.

Physical strength won’t save us in every emergency.  Surviving a plane crash or chemical plant explosion will mostly come down to severity and luck, but these things are exceedingly rare.  Most of us have experienced, or personally know someone who has experienced, something similar to one of the 3 scenarios I described above.  For people who spend time on the most basic levels of general fitness, hiking 5 miles to a gas station in the desert will feel like a challenging workout.  For people who don’t, it can become a life or death situation.

Practical Fitness Tips

…There are precisely 368,994,103 fitness tips in existence.  Here are a few more:

— You don’t have to do anything you don’t want to do.  If that includes exercise and healthy eating, you will eventually be in a lot of pain and probably die prematurely.  Everyone has their own ideas about pastime.

— If you are chronically stressed, it is an emergency.  Fix it.  First priority.  It makes no difference what you have to give up in order to do so.  (Note: Doing what you are already doing, only more frantically, will not fix it).

— Obesity is not a disability.  It is a treatable condition.  If food addiction is causing the obesity, that is also a treatable condition.

— Find a physical activity you enjoy and do it as often as possible.  If you hate running, don’t run.  If you hate gyms, don’t go to one.  If you like flying kites, do that.  If you don’t know what a kite is, stop looking at your phone.

— Make yourself do something that is challenging at least once per week.  Pushups, lap swimming, Zumba.  Pick one.

— If do you go to a gym, don’t drive around the parking lot looking for a spot closest to the door to avoid excess walking in order to enter a building in which you are going to get on a machine and walk.

— Stop eating fruit flavored candy.  Fruit tastes just like fruit.

— If you do today what you did yesterday, you will feel just like you did yesterday.

— If you do tomorrow what you did today, you can finish this sentence and put it on a stock photo of a person climbing a mountain.  Or vomiting into a mall trash can.  Depends on what you plan to do tomorrow.

— Stop obsessing about every little health detail that may add an extra 14 hours to the end of your life.  Obsessing about it cancels out any perceived benefit.  (RE: Stress + exhausting all of your friends).

— If you’re 52, stop hanging on to 22.  If you’re 22, stop calling Nirvana “classic rock.”

— If you are expecting that the preceding tips will make you look like a fitness magazine cover, they won’t.  But these things will:

Deadlifts…heavy.  Sprints…until death seems preferable.  Planks, sit-ups, crunches, leg lifts…laughing isn’t worth the pain anymore.  Pushups…all of them.  Pull-ups…until it feels like cardio.  Chicken, avocado, spinach…always.  Cake…never.  Happy hour…nope.  Twinkies…yes, if you fill them with razor blades.

Everything exists on a spectrum.

The State of American Healthcare

After receiving another notice from our insurance company that a payment for service was denied, I thought it was time to share my family’s experience with the American healthcare system. I’m not going to get political about it. Individuals will define root causes based on where they lie on the political spectrum. I am not interested in placing blame, because it is far too convoluted. I am more concerned about how the disarray built in to the American healthcare system is going to give an otherwise healthy individual like me, a stroke.

I am not a healthcare expert, nor a political pundit. But I am one of those Americans who falls in that gray area that none of our politicians seems to know what to do with. I’m self-employed, and I make about as much as a public school teacher. My wife Anne is in graduate school full-time along with an unpaid internship, so as a family of four, we’re making just enough to shave by. Thankfully we have some savings from a house sale, along with a thoughtful extended family. Many Americans in our situation don’t have those safety nets to utilize in the case of an emergency. I don’t really know how they can manage.

15% of my gross income goes toward healthcare expenses, after the subsidy. If it weren’t for the subsidy, it would be 30% or more. The important thing to note here is that we are a healthy family. Outside of routine checkups, there is the occasional issue that Anne and I have to deal with as part of the normal aging process. We don’t have cancer or kidney disease. The good news is that, as a small business owner, I can write off a chunk of those expenses. The bad news is that when there is a billing dispute between a provider and the health insurance company, I take on a second job as a liaison, despite having no experience or qualifications to do so. If I lose the negotiation, then we’re fronting another few thousand dollars that might otherwise go into that thing that people keep talking about. I forget what it’s called. Oh yeah, “savings.”

A couple of years back I listened to an interview with a healthcare economist who described her experience after a cancer diagnosis. I am paraphrasing her statement, but it went something like this, “I am a healthcare economist with a PhD, and I don’t understand the bills and letters that I am getting from my insurance company. So if I can’t understand it, then it will definitely be impossible for anyone not in this field to understand it.” I continually have this experience with what should be routine procedures for a 42 year old man in generally good shape. I never know if I commit to a procedure whether it’s going to cost me $0 or $7,000. Here is a copy of a letter I wrote to a vascular surgeon after receiving a varicose vein diagnosis. I’ve omitted the first couple of paragraphs because they’re just boring details about the procedure:

“…To be perfectly frank, out-of-pocket medical fees have just been killing us for the past 3 years. It never lets up. I spent an hour on Friday trying to get someone at the imaging facility/health insurance company to give me a general idea of what I would be paying for just the MRI/MRA, and no one was able to give me any kind of answer. Our savings is dwindling, and I’m still negotiating other hospital bills. I’m not mentioning this because your office has anything to do with that stuff, as I realize you all have to deal with the same health insurance billing frustrations that I do as a small business owner. Your team is simply practicing safe care and presenting me with viable options. I’m mentioning it because my wife will be done with grad school and working in a couple of years…right about the time we stop paying $1,500 per month to put two kids through preschool. Point being — if this can wait a couple of years without doing irreversible damage do my leg, then it needs to wait. But if I’m playing with fire then I just have to suck it up and move forward into this year’s medical cost black hole. So I need an honest opinion about what my wiggle room is here.”

Fortunately, she responded by telling me that this condition has a slow progression, and unless certain symptoms begin to arise, there is no rush. But this is the standard medical routine in my experience. Specifically, with this vein diagnosis:

– Step 1. See a PCP about an issue, where I sit in the waiting room for almost an hour.

– Step 2. 3 weeks later, take 3 hours off work and drive 45 mins to see a specialist. Get a diagnosis.

– Step 3. 3 weeks later, take 3 hours off work and drive 45 mins to get an ultrasound.

– Step 4. 3 months later, take 3 hours off work and drive 45 mins to get a follow up about the ultrasound. Get a prescription for an MRI.

– Step 5. Start paying the out-of-pocket expenses for the previous 4 doctor visits and the ultrasound.

– Step 6. Contact the hospital that does the MRI to find out how much it might cost me out of pocket. Get transferred to a billing estimate place. Get transferred to a billing counselor. Call my insurance company. Find out absolutely nothing.

– Step 7. Ask the doctor if I can put this process off for a couple of years.

– Step 8. Cancel the MRI.

Four months, a couple hundred dollars, and about 12 combined hours of driving, waiting, consulting, and calling. The only thing that has changed since step 1 is that I bought one pair of vein compression hose for $70. Insurance doesn’t pay for that after all. I mean, how else are they supposed to rake in billions of dollars in profits?

Two days ago, we received a new notice from our insurance company stating that they are denying payment for a procedure that my wife had done last May in the amount of $4,500. The reason for the denial is that the claim was not submitted by the hospital in a timely enough manner, despite being in-network, and previously approved. Nevermind that insurance companies and hospitals can send the patient a bill out of the blue whenever they feel like it. Apparently those rules don’t apply if it’s a major corporation billing another major corporation.

I’ve been through this song and dance before. Ultimately what this means is that the hospital will now send us a bill for $4,500. I will then spend hours working my way up the chain to explain to a disinterested supervisor that, “I did my part. I pay my premiums on time. We made sure that the procedure was in network, and that it was approved. I don’t file insurance claims, you do. If I had known that a billing window was closing, I would have filed it myself. But I did not know this. No one tells me these things.” To which they will reply that since the insurance company isn’t paying, I will have to take it up with my insurance company, or pay the bill myself. To which my insurance company will reply that the hospital did not submit the claim in a timely manner, and I will have to take it up with the hospital.

I already went through this last summer over Anne’s same procedure. The insurance company denied a claim for the testing of a tissue sample, because the lab wasn’t in network, so we received a bill from the lab for around $1,000. I called the hospital, lab, and insurance company to find out why, if we had chosen a doctor in-network, a tissue sample would be sent to a lab that was not in-network. Turns out that the lab was in network when the tissue sample was sent, but it was no longer in network when they billed the insurance company. So…naturally, after all of these companies finish arguing over who is supposed to pay whom, I get the bill. To which I patiently and calmly responded to the last person I spoke with, “I know that you personally are not the orchestrator of this confusion, but please put yourself in my shoes, and then explain to me WHY THE FUCK any of this is my responsibility.” “Sir…I can understand your frustration…”

This situation wasn’t actually resolved. It is under review. I was told it could take 9 to 12 months before a resolution is reached. I assume that once I’ve completely forgotten about this whole thing, and just as I’m thinking about doing something wacky crazy like putting some money into an IRA, I’ll get another bill for $1,000. Because, why shouldn’t I? I don’t have a team of lawyers to fight this screw up. I’m the low-hanging fruit. It’s easy for the hospital, or insurance company, or lab, to sue me if I refuse to pay it. They have a lot less to lose. So I’ll just pay it, and then cynically wait for the next costly expense that I didn’t know was coming. Oh, wait, there already is one!

For this same procedure, we also received another bill last fall from the hospital for around $5,000 (separate from the most recent insurance company denial). Look, I know that we are required to pay a certain amount of money out of pocket each year to meet our deductible. We paid a $500 co-pay, along with another amount up front that I can’t remember. But this was all really starting to add up. The bill indicated that the hospital had been trying to collect the money from the insurance company to no avail, and that I needed to call my insurance company to try to get them to pay. You know, my volunteer job as a debt collector when I’m not at my actual job, trying to raise my children, or on the phone with some other medical organization about another bill that doesn’t seem quite right.

Insurance company — “They aren’t supposed to send you a bill for that amount. Your responsibility is $200 something plus your $500 co-pay.”

Me — “But they did send me this bill.”

Insurance company — “But they’re not supposed to. You’ll have to call them.”

Hospital — “The amount due is $5,000.”

Me — “The insurance company said it’s $200.”

Hospital — “It’s $5,000.”

Me — “Here’s a crazy idea. I know this is totally insane, but how about if YOU call the insurance company. Here is their phone number. They have customer service representatives available 24 hours per day.”

Hospital — “We don’t do that.”

Me — “You don’t talk to the insurance company?”

Hospital — “No. But what we can do is submit this for review, which could take about 9 to 12 months…”

If you’ve made it this far through this rant, I’ll go ahead and share a final medical anecdote from a couple of years ago. We had just relocated to Texas, and most of our life was imploding due to circumstances outside our control. I’ll spare the details, but it was getting pretty ugly. One afternoon, Anne decided to take our son Parker to my Mom’s house so that Anne and I could try to figure some things out without downloading all of the stress onto our 3 year old. A few minutes after she left the house, as I was walking down our hallway I began to experience stabbing chest pains and pressure that pulsed in time with my heartbeat. This had to be a heart attack. I quickly chewed a baby aspirin and drove to the ER a half mile away. In hindsight I probably should have called 911, but you just do what you do in those situations.

The staff quickly hooked me up to a bunch of monitors, gave me some medication to ostensibly calm the effects of a possible heart attack, and conducted a prompt interview. Within a few minutes I was sent through a battery of medical tests. After the doctor reviewed the information he concluded that my heart was fine, and that I had probably pinched a nerve somewhere in my thoracic cavity due to the extreme stress, which was mimicking the symptoms of a heart attack. Whew! What a relief. He also told me that the symptoms I was describing were either a pinched nerve, or an aortic dissection, which would have killed me within a few minutes. Thankfully he didn’t tell me that until after I was in the clear.

Well, it’s a good thing I have health insurance and that the ER is only a half mile away. Sometimes there are happy endings. Oh, wait…the ER isn’t in network and it cost me $2,500. Since the source of our stress was a near disastrous financial situation, I had to ask myself, if I had known in advance that it would have cost me $2,500 to go to the ER for what I thought might be a heart attack, would I have gone? Might I have just taken the aspirin and waited around until I was sure it was a heart attack? Then what? My wife finds me dead on the living room floor? Or maybe I was supposed to call around to different hospitals, and wait on hold with the insurance company, to see which provider was in network, all while possibly in the midst of having a heart attack. If I had called 911, would the cost have doubled or tripled for the ambulance ride?

I am well aware that there are countries which have no hospitals at all. Many don’t even have safe drinking water. I have much for which to be grateful (no debtor’s prison in the U.S. for one). But I can’t help but think that in one of the wealthiest, advanced, and most powerful nations in the history of the world, something is seriously wrong here. To be perfectly honest, I often think about what I could do to help people who aren’t as lucky as I am. Unfortunately, when I have any sliver of free time or extra money that might be dedicated to such a cause, it gets parasitically absorbed by this kind of bullshit.

Stay healthy! (No, I mean really stay healthy so that you don’t have to go see a doctor for any reason…ever).

The Secret To A Healthy Bodyweight

As a good friend likes to say about most things in life…”It’s simple, but it’s not easy.”  There is no secret to maintaining a healthy bodyweight.  Unless there is an underlying metabolic issue (rare), or an addiction that requires mental health treatment, we generally just have to become more conscious about our daily habits.  I often hear people approaching this subject as if there is an ancient magical formula that can only be found by searching the farthest reaches of some tropical jungle.

Here’s the straight talk:  All of us can do this, but most of us don’t want to.  In a culture that prides itself on abundance and indulgence, we expect our struggles to be overcome in a passive manner that is seriously lacking accountability.  “The Cheesecake Factory should have known that I couldn’t resist a second helping of dessert.  I’ll sue them.”

What do you really want?  Do you want to look and feel good?  Or do you want to binge watch Netflix while polishing off a king sized bag of M&Ms every night?  The choice is yours, and so is the result.  Healthy people do healthy things.  Now…before you fall into the “Easy for you to say personal trainer and colossal douche” mind-trap, it is important to re-state where I came from:  Pack of Marlboro reds, 3 pints of vodka, Double Quarter Pounder with Cheese meal (super-sized) — every day for years.  After watching my life crumble from the inside out, I decided I wanted something different, and then I did something different.

Here’s an anecdote that one of my former clients shared with me a few years back.  She and her husband went on a spring trip to Boston with another couple.  My client couldn’t wait to walk around the city and take in its rich history.  The other couple wouldn’t have it.  Their legs were in too much pain as a result of diabetes and obesity.  So the couple offered an alternative: During lunch, they would spend all of their time discussing options for dinner.

Nothing will ever happen if you “start tomorrow,” and you will never have time if you don’t make time.  Incidentally, you do have time.  You just don’t want to give up resentful Facebook rabbit-holes in which you conclude that everyone else’s life is better than yours (it’s not).  Just stop it.

Without further ado, here are the keys to a healthy bodyweight (and a healthier mind for that matter).

— Drink a gallon of water per day.

— Use My Fitness Pal.

— Keep your net carbs at 100 grams or less (total carbs minus fiber).

— Get at least 7 hours of sleep.  (Turn off the screens 8 hours before your alarm is set to go off, and get into bed).

— Meditate 10 minutes every day.  (Headspace is a great way to start learning).

— Get your 10,000 steps.  (There are plenty of wearable fitness devices that can help you track).

That’s it.  6 things.  Here’s the Stephen Hawking scientific explanation:  It works if you do it.  It does not work if you do not do it.