X-rays and Health Insurance

I have a high deductible health insurance plan.  If you work for corporate America, chances are you do too.  To paraphrase the HR representative of the company I’m retired from, “we switched to high-deductible, account-based health benefit plans, because, frankly, we can’t afford not to.”   In my interpretation, these plans are intended to:

      1.  Reward preventative health maintenance – most of these plans pay preventative services such as annual physicals and lab work as well as preventative medications – at 100% with no deductible,

2.  Protect against catastrophic loss.  If I’m looking at a $500,000 medical bill, my out-of-pocket maximum of $5,000 seems quite reasonable, and

3.  Drive responsible spending on the part of the patient.

When I went to the hospital to get my foot x-rayed last week, I told the admitting clerk that I had a high deductible plan and would end up paying the bill anyway – and asked the cost of the x-ray.  She smiled, said she had a high-deductible plan, too, and proceeded to tell me that she didn't know and couldn't accept payment anyway.  “Just wait for the bill to come and pay it,” she advised.

How am I supposed to spend responsibly when I don’t know what the cost will be?  Granted, I had only the one hospital that would accept my insurance plan (or so I was told), but surely they know the price of an x-ray.  Even though I was a captive audience, it would have been nice to know what to plan for.  

Just for fun, I went to the web site of the hospital where I had the x-ray.  The only reference to cost – anywhere on the site – was a mention that uninsured patients that did not qualify for any other discount could get a discount of 25%, with an additional 15% off if they paid the bill in full at the time of service.  Good to know – but because I technically AM insured, I suspect they wouldn't have offered me a discount anyway. 

As more and more people find themselves with high-deductible health plans, we’re going to want to know what we’re paying for – before we pay for it.  We may choose to decline tests – or at least defer them – based on our own cost/benefit analysis.  My own example – I really wanted to know whether or not my foot was broken, so I went forward with the x-ray even though I still have no clue how much I’ll end up paying for it.  But if I had to pay for the cholesterol test my doctor ordered, I would have skipped the test this year.  My cholesterol levels were just fine last year and I have no risk factors for any of the diseases that high cholesterol would indicate.

Turns out that cholesterol testing is considered preventative.  Now we know.  

Epilogue:  Fast forward about six weeks.  The hospital dutifully billed the insurance company, which dutifully told them to apply their agreed-upon discount and send the bill to me because I had not yet met my (high) deductible.  The bill was about $176, which is less than I had anticipated.

Chi Running - Strengthen Your Feet

Roll the sole of your foot over a golf ball
to help strengthen your feet

Every time I've had foot pain after a long run, I've thought about telling my doctor about it, but haven’t done it because I was sure he’d tell me not to run.  I finally told him about it at my annual physical on Tuesday.  He poked and prodded, and told me he suspected a hairline fracture of the big toe at the point where it reaches the arch of the foot.

A bit of history – the fracture he suspected is called a “march fracture” because soldiers would often get fractures in the same spot after long days of marching.

I had the foot X-rayed on Wednesday, and got the results back on Thursday.  The x-ray was normal!  Big sigh of relief.  But – the doctor still wants me to stop running for a few weeks.  Nooooooooooooooooo!  He recommends non-weight-bearing exercise for the non-running period.

Sigh.  I guess it’s swimming, stationary bikes, and some serious foot-strengthening for the next couple of weeks.  Danny and Katherine Dreyer, authors of Chi Running, recognize just how important the feet are to running and recognize the need to keep your feet both strong and flexible (not to mention relaxed) while running.  They have devoted a section in their Injury Prevention and Recovery chapter to exercises focused on stretching and strengthening your feet. 

Runner’s World Magazine agrees.  Kelly Bastone states in a July 11, 2012 article, “Runners' mighty quads and glutes reach long-mileage readiness well ahead of the smaller muscles in the feet and ankles. Yet this supporting cast plays a key role in achieving peak endurance.”  And while the Runner’s World article seems to assume that runners are pushing off with their feet (explicitly contraindicated in the Chi Running technique), it goes on to affirm that “[strengthening the feet] develops the muscle control you need to prevent overuse injuries from high-mileage workouts."

Chi Running – Lesson 7 – Upper Body and Arms

Chi Running Lesson 7 is about what you should do with your upper body, your arms in particular.  I mentioned when I wrote about Lesson 5 that it seemed that my upper body was also rotating around the pivot point (T12 – L1 – Hut Hut).  Lesson 7 had me practice keeping it focused forward and swinging my arms to the rear.

Balance is a key tenet of Chi Running.  As your column falls forward (leveraging gravity) and your legs swing out the rear (leveraging the force of the road), the arm swing to the back acts as another force going in the opposite direction of the body, or another form of balance.  Gotta love physics!

I had to think about what I was currently doing with my arms, and the answer came back, “pretty much nothing.”   I keep my arms bent at the elbows, close to my sides, with hands relaxed.  Granted, it took me a long time to unclench the fists, but that was well before I started practicing Chi Running.  So I had to make a conscious effort to do something with my arms – keep them in the same position but swing them to the rear.

I did the lesson as the authors intended – for the most part.  My course for the day was a 10K.  I ran the first ten minutes focusing solely on swinging my arms to the rear.  It was a little awkward but I got used to it.  The next ten minutes, I added a focus on the pelvic rotation.  Check.  The next 10 minutes I attempted to add the lean.

Here’s where it got tricky.  There was a fairly strong wind from the south, and it seemed like when I was running against the wind, nothing worked right.  I’d lean and the wind would push me back.  I felt my legs tense from the glutes all the way down to the big toes.  When I was running against the wind, it was all I could do to focus on keeping my legs relaxed.  The wind was a force I hadn’t expected - and a force to be reckoned with.

I came back from the 6.25 miles a little sorer than I would have liked.  My right foot was especially sore.  Ouch.  Did I re-injure it?  Or is it just not strong enough to withstand the pounding on the long runs? 

Chi Running – Lesson 6 – Swing your legs to the Rear

Chi Running Lesson 6 combines the pelvic rotation and the lean.  If this is done correctly, it will allow your legs to swing out the back of your stride.  Key words: if done correctly.

As I did this exercise, my legs didn't feel different.   I wasn't worried about my legs swinging to the rear, because my footprints in the sand earlier this week showed me just how long my “out the back” stride is.  I did feel my pelvis rotating – some of the time.  What was happening – I think – is that I would level my pelvis and notice the rotation.  Then, shortly thereafter, I would notice that I was feeling tension in my calves and ankles.  In an attempt to relax my lower legs, invariably I would let go of the lower abs, too, and there went the level pelvis and the smooth rotation. 

I still have not mastered the art of keeping my lower abs contracted while relaxing everything else.  This is what I will work on for tomorrow’s fun run.  

Chi Running – Lesson 5 – Pelvic Rotation

T12!  L1!  Hut! Hut!  Sounds like a quarterback calling plays, but actually, it refers to the “pivot point” in your spine – the place where the curve of your upper (thoracic) spine meets the curve or your lower (lumbar) spine.  In Chi Running, this is the point from which all of the motion of your lower body begins.

Lesson 5 is an interesting lesson because the focus is strictly on awareness.  You don’t actually do anything different.  The point of the lesson is to feel your pelvis rotating.  Well, OK, for me there is something I will have to consciously do.  Relax.  Relax.  Relax.

Here’s the exercise – lovingly referred to by the authors as The Pool Running Drill.  What a great visual image!  I think every kid has had the experience of running alongside a pool and hearing that dreaded whistle followed by a loud “WALK!”  My daughter was a lifeguard for several years and put many a child in timeout for continuing to run.  So, to avoid timeout (and to do the exercise), the idea is to transition to the fastest walk you are capable of.  According to the authors, this exercise will really allow you to feel your pelvis rotating (at T12/L1).

I ran about a mile before my inner lifeguard blew the whistle.  Shifted into the fastest walk I could muster, and sure enough, I could feel my pelvis rotating.  Success!  When I shifted back to a run I could still feel the rotation, but it seemed like it was my upper body rotating rather than my lower body.  Hmmmm – this is not right.  I tried it a few more times over the length of the run.  The exercise did what it was supposed to do; it made me feel the rotation.  Lesson 6 will show me how to use the rotation.

Let’s see – when do I get to the upper body focus?  Not until lesson 7.  Sigh.  Gradual progress…

Chi Running - Back to the Sand

After a couple of fun runs – one with a new running group I’ve joined – it’s back to the Chi Running lessons.  I decided to repeat Lesson 4 – which is learning to relax your lower legs and develop a proper mid-foot strike – in my new shoes.

On the run to the park, once again, I focused on relaxing the lower legs, ankles and feet.  I caught my left calf tensing up more than once, and made the deliberate effort to “let it go.”   I didn’t feel any tension in my right calf, so I assumed that it was perfectly relaxed.

Well, it may have been relaxed, but I’m still consistently pushing off with my right toe.  When my left leg is relaxed I get beautiful, even footprints in the sand.  But even when my right leg feels relaxed, I get the toe divot, which indicates that I am still pushing off with my toe.

I brought the camera along and took this photo of the footprints.  I did note something kind of cool – look at how far apart my footprints are.  I am 5’ 2 ½ inches tall (yes, I count the half), and when I run with my feet under my column I feel like my stride is pretty short.  Au contraire – it appears I have a pretty long stride out the back.  I kept my shadow in the photo to remind me to keep my posture tall.

I plan to move on through the lessons and come back to the sand next spring.  I suspect the sand will be covered with snow until then.

Chi Running - Treadmill Time

I have to confess – my first time on the treadmill after several months running outdoors was, well, less than optimal.  It seemed that once I pushed the “start” button everything I had learned about Chi Running left my brain.  I was back to my old habits.  I wasn’t holding my posture correctly, and my feet – even in my brand-new shoes, felt heavy.  To top it off, my right toes went numb during the run.  I hate that!

The second treadmill run was a little better.  Per the authors, I focused on keeping my posture tall, keeping my lower legs relaxed, and lifting my heels.   I slowed the treadmill down from the last run.  I noticed, however, that I struggled with keeping a lean and when I wasn’t leaning my feet were hitting in front of my column.  And once again, my right toes went numb during the run.  I really hate that.

Is it the treadmill?  My technique?  The shoes?  My feet?

I emailed Brian at Wasatch running.  He suggested we take on the easy one first – the shoes.  In his experience, numbness in the toes is caused by the shoe not being wide enough.  He had put me in a narrow-width shoe, and was happy to exchange it for a normal-width equivalent – in a better color, too.  Bonus!

The third treadmill run was much better.  My feet stayed with me this time, instead of straying off to never-numbness-land.  I continued to focus on relaxing my lower legs.  And while I haven’t gotten to the lesson on cadence, the authors suggested checking my cadence on the treadmill.  At 6 mph my cadence is 88 bpm.  At 6.3 mph my cadence is 88 bpm.  At 6.4 – 88 bpm.  At 6.5 – 88 bpm.  According to Chi Running, this is a good thing.  In Chi Running, your cadence stays the same; your lean controls your speed.  Can’t wait to time my cadence on the pavement.

I’m ready to resume my lessons – outdoors!