Stop Limiting Beliefs!

This is a great explanation of how the brain reacts to new information. Our brains are lazy, but we can change gears with constant reminders of the two solutions he mentions. Really helpful read.

Pointless Overthinking

As you may or may not know, a limiting belief is any belief of yourself where you believe you cannot do or achieve something.

For example:

I can’t do well at at this project because of my boss hating me.

I can never start a successful business because my family has always failed at starting their own business.

I won’t go to the gym, because I’ll look like an fat old slob and people will laugh at me.

You get the point. Most, if not, all of us have had these beliefs before.

And the annoying thing about them is that they simply hold us back from something we secretly want to do, sometimes even dream of doing, and always sort make us suppress our desires. Terrible.

So what can you do about them?

I’ll give you two pieces of advice. Two pieces that have helped me breakthrough limiting beliefs.

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Medicare New Opioid Rule Starting January 1st

The following has been compiled by The Alliance for the Treatment of Intractable Pain (ATIP) for chronic pain patients to navigate the new Medicare opioid prescribing rules coming January 1, 2018, in the United States. I hope this helps the people that will be affected to not have interruptions in their opioid prescriptions. Please pass this information on to others that may be affected.

Much Love & Many Prayers,
Cindy

From The Alliance for the Treatment of Intractable Pain:
This January, changes to opioid and other controlled prescription medications will occur as CMS (Medicaid/Medicare), and many private insurers begin implementing the CMS Final Call Rules.

Opioid/controlled prescription coverage issues are summarized here:

CMS expects sponsors to implement the following formulary-level opioid safety edits (opioid safety edits) at the point-of-sale (POS) in 2019:

1. Soft edit for concurrent opioid and benzodiazepine use
2. Soft edit for more than one long-acting (LA) opioid
3. Care coordination (soft) edit at 90-199 morphine milligram equivalents (MME)
4. Hard edit at 200 MME or more
5. Hard edit 7 day supply limit for initial opioid fills for opioid naïve patients

IF you are under 90MME, and are not taking concurrent benzodiazepines or other “potentiators”, this should not affect your coverage.

IF you are between 90-199MME, a one-time soft edit on the part of the pharmacist will be required. If you have only one prescriber and use one pharmacy, then you should only need this safety edit once per year.

IF you are at 200MME or over, you will need to find out from your insurer if they will cover your medications at your MME.

A soft edit requires the pharmacist to contact the prescriber to confirm intent. If it is confirmed, the pharmacist will enter a code to override the edit and fill the prescriptions. A soft edit can be resolved at the POS.

A hard edit requires the pharmacist to contact the insurer (or sponsor) to determine if they will cover the prescriptions. Hard edits are not resolvable at the POS, which is why ATIP encourages all patients to consider the following information to help determine your coverage for next year and take action to hopefully prevent disruptions in your prescription coverage in January.

EXEMPTIONS:

From CMS: “Part D sponsors are expected to develop specifications that exclude beneficiaries who are residents of a long-term care facility, in hospice care or receiving palliative or end-of-life care, or being treated for active cancer-related pain from all of the opioid safety edits. Sponsors should use all information available to them to reasonably exclude these beneficiaries from triggering the edits at POS in the first place.”

Sponsors should also apply specifications to account for known exceptions, such as, high-dose opioid usage previously determined to be medically necessary such as through coverage determinations, prior authorization, case management, or appeal processes.

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Below are steps you can take to evaluate and/or maintain your prescription medication coverage for next year:

1. Know exactly which opioid medication(s) you are on and at what dose.

2. Know how many MME’s you take per day.

(To determine your MME, please visit: https://opioidcalculator.practicalpainmanagement.com.
Select “opioid conversion calculator” to convert any opioids to oral morphine, with thanks to Dr. Jeff Fudin)

3. Know if any of your opioid pain medications will require a Prior Authorization, and if so, have that done now.

4. Consider asking your provider if the codes for Palliative Care could be added to your chart/prescriptions, if your provider thinks you might qualify for treatment under the Palliative Care exemption. The general code for Palliative Care is Z51.

4. Have a conversation with your clinician(s) and ask if they are aware of these upcoming Rules, and if not, share the links provided below with them.

5. If you don’t have a prior authorization, ask for a “coverage determination” from your insurer (CMS calls them “sponsors.”) This will require you to know your medications and MME’s. With that information, you can ask your sponsor:

“I am requesting a coverage determination. I take xxx & zzz opioid/benzodiazepine/potentiator medications. Will my medications be covered? If you don’t know, may I speak with a supervisor who does know?”

Then use that information to work with your clinicians and your pharmacy.

If you experience a denial of coverage, you have a few options:

Ask your clinician to schedule a clinical care conference with your insurer to explain why you need certain medications.
Ask your clinician if they will arrange a peer-to-peer conference with a clinician from the insurer to explain your medical necessity.
If denied, ask your provider to get the name and license # of the physician who denied your coverage
Use all the information you collected to file an appeal with CMS, either on your own or with the help of a loved one or patient advocate.

Helpful links:

• For additional information regarding the final 2019 Medicare Parts C&D Call Letter, please visit https://www.cms.gov/Medicare/HealthPlans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf.

• For additional information regarding the 2019 Part C and D Regulation (CMS-4182-F), please visit https://www.gpo.gov/fdsys/pkg/FR-2018-04-16/pdf/2018-07179.pdf.

• For information on Medicare Prescription Drug Appeals and Grievances, visit https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/CoverageDeterminationsandExceptions.html.

• For additional information regarding the CDC Guideline for Prescribing Opioids for Chronic Pain, please visit https://www.cdc.gov/drugoverdose/prescribing/guideline.html.

• To review the CMS Roadmap to Address the Opioid Epidemic, please visit https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Opioid- epidemic-roadmap.pdf.

• To review the Medicare Prescription Drug Coverage and Your Rights, please visit https://www.cms.gov/Outreach-and- Education/Outreach/Partnerships/downloads/yourrightsfactsheet.pdf.

• Any general questions related to the Medicare Part D opioid over-utilization policy may be sent to PartD_OM@cms.hhs.gov.

• Questions related to submission of opioid safety edit information should be sent to partdformularies@cms.hhs.gov.

Reinventing The Wheel

Sometimes hubby and I go to a motocross track on the weekend. Hubby races a sports quad, and I really enjoy going too because I grew up around fast cars because of my brothers. I am familiar with the noise and the smells. My dad owned a shop for car repairs, so it was something I was always around. The smell of grease and oil actually reminds me of good memories and that has continued with my hubby.

When we first started going to the track, I was in much better health. Traveling to the motocross tracks was easy, and I could run from jump to jump watching them ride. Since my pain level has increased, we’ve had to improvise.

Hubby brings a generator so I can plug in my heating pad. I have sat in 90-degree heat with it against my back. On the sweltering days, he brings a powerful fan that everyone enjoys. We have a pretty good set up. I know how lucky I am that he helps me to be as comfortable as possible.

The obstacles have been worked out so I can enjoy being there even though I have chronic pain. Hubby loads up all my extra bags of needed items for the trip. I will decide when to take medication or apply a patch, so it is all working together for the most extended moments of pain coverage during the trip and watching him race.

Before chronic pain, I made videos of the guys riding which I really enjoyed doing. Now, I video from a stationary position because I cannot run around the track anymore.

Everything in my life had to change to accommodate my illnesses and going to the track was one of them. At first, I fought it. I wanted life to be like it always had been for me, no struggle to do the things I love.

I am a creature of habit, so I am not too fond of change, but I needed to reinvent myself. I was tired of grieving my old life or the life that I thought I should have. I was profoundly depressed and full of anxiety, and I decided I needed to change. I am learning to reinvent the activities I love by finding solutions to each problem I faced. It’s been two years since I started the process of determining what I needed to do to have a fulfilling life even with chronic pain. Bottom line: I have to accept it.

You may cringe when I mention acceptance of pain. Change is hard, and many people think if you accept your pain, you give up, but it does not have to be that way.

Acceptance is only accepting that you need to make changes to your life.  That is all you agree to. You need to look at it differently and get creative.  If life gives you lemons, make lemonade!

This is accomplished by learning new ways to do things you love to do.  The activity may not be exactly the same, but the passion will be there.  You just have to look for it.

Life is messy and painful. It is so hard for me to accept that, but that is what we must understand when living with chronic pain. Reinventing yourself or your activities will not make it easier, but it can resemble the life you had before.

I encourage you to take an inventory of what you loved to do in the past that you can no longer do because of your illness. Break down each problem by finding solutions one by one, then you will reinvent your life.

Much Love & Many Prayers,

Cindy

Photo credit: Cindy

Words For Healing

I have missed writing, but when I am doing advocacy work, I seem to fall in head first and get lost. It seems like everything is urgent because it takes so long to finally see the results of your hard work.  You can hardly tell that you are making any difference. It really is hard work to go in with credible information.  I applaud anyone that has made the trip to visit their elected officials and given them an education on what the chronic pain community is going through these days.

I have taken to twitter encouraging everyone in the chronic pain community to get their voices heard by reaching out to their legislators.  I had a few people that said they were too scared to speak out because of retribution, ie: they will lose access to the small amount of medicine that they need to be able to function.

I completely understand the fear in speaking out. I feel the same. Knowing that people are afraid to speak out compels me to be the voice for them also.  For someone that has no other legal and affordable options than their current opioid medications, it must be agonizing everyday counting their pills and worrying if this is the last bottle before the pain is unbearable. That breaks my heart.

If you decide to go to your representative, here’s a link to find out who you should contact and how to reach them.  If you want more information about advocating for the chronic pain community, contact me. There is plenty that can be done from home.

I also began a writing group last week.  There are about 8 of us and we are made up of 8 different perspectives, so I’m loving that.  So, far it has been mostly timed free flowing writing. I’m excited to see what the future groups will hold.  We are all looking for different things from the group.

I am thankful for the gift of writing.  Being about to express myself through words is healing.  I know most of you that are reading are writers also.  Do you stick to one style of writing or do you use different mediums – free write, poetry, prose, spiritual, song lyrics, blog post- to convey your feelings?

I believe that what every you write, whether it’s a tweet or a post, you should edify others. Honor them.  I am appauld by the comments I read on twitter and facebook; the unnecessary meanness in the words people type anonymously behind their computer screen. I do not understand why people are so mean.

But let’s be different.  Today, make a positive tweet about your life with your chronic illness.  Publish a uplifting post about another’s triumph over struggle.  Just put some love out there to combat the hate.

Much Love & Many Prayers,

Cindy

 

 

 

 

He Cares For You

Cast all your anxiety on Him because He cares for you. 1 Peter 5:7

I memorized this verse a very long time ago when I was teaching a Sunday school class for 1st graders. It’s a simple verse that even the kids could memorize.

How can a Bible verse help you in today’s world? If your hope is in Him, you know there will be a glorious day when all the pain ends. That’s literally what keeps me going every morning when I wake up.

I do not believe meditating on a Bible verse relieves chronic pain.

Every morning I’m usually in the same amount of pain when I wake up. It’s not easy to keep going, but my hope is not from this world. Knowing there will be an end to the pain gives me the hope I need to continue my life.

It is like a birth. You know at the end of the pain there will be a reward of a baby when it is over.

I choose to look at my salvation in that way also. Life is hard with physical and emotional pain. This world is not our world. We will feel pain of all kinds, but there is a reward much greater than we can imagine.

This verse helps me trust in God giving me peace so that I can focus on what is important, helping others, instead of worrying.

Do you have a Bible verse that carries you through hard times? Please share. It could encourage someone else. You never know the impact you can make by reaching out to help others.

Much Love and Many Prayers,

Cindy

A Drop in the Bucket

I met with someone from my House of Representative’s office yesterday afternoon about how chronic pain affects our lives.

I think it went well. I presented the information in four parts: life with chronic pain after the CDC recommendations, addiction, chronic pain, and suicide, and legislative solutions. He seemed to listen and wrote a few things down.

I have done what I can by having this meeting. What this office does with the information is up to them. I don’t know if I made a difference or not, but I hope that they will remember our meeting when any legislation involving pain and pain research comes up.

I think everyone should do this kind of thing at least once even though it’s not easy to do for someone with a chronic illness. It took me many emails and three months to have the time to put together a notebook of information to leave with their office.

I am not naive thinking this one chat with my Congressman’s office will make an immediate difference. We have an unbelievably tangled mess with the opioids, chronic pain, and why people become addicted. To fix these colliding emergencies will not be easy.

I “put my drop in the bucket,” so to speak. Other people need to do the same, or the bucket will never be filled with individual drops that make it overflow showing a need for action by our government to protect people with pain.

We need to be brave by speaking out, especially about the need for expedited pain research. Everyone might as well get comfortable with the turning tide on opioids. It is not going away.

If anyone wants ideas or information about how to speak to your congressman, please message me. I will be glad to help you make a difference in the chronic pain community.

Much Love and Many Prayers,
Cindy

Photo Credit: jomar-271602-unsplash capital hill

Beautiful People

“The most beautiful people are those who have known defeat, known suffering, known struggle, known loss, and have still found their way out of the depths.  These people have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern.  Beautiful people do not just happen.”      ——Elisabeth Kubler-Ross

We cannot control the things that happen to us, but we can grow through the pain when bad things happen.  There is a purpose, but you cannot see it yet.  He will bring good out of the most difficult situations.

The struggle up the mountain is difficult and challenging, but at the top is a view that is unimaginable.  Keep fighting the fight and win the race.

Overcoming struggles is what make us strong. We weren’t born brave. We develop it through trials, and sometimes those trials seem so unfair.  I always try to remember this is not the world that God intended for us.

Rest in knowing you are being transformed. Every defeat that brought you down, the suffering that made you feel weak, the struggles to get through each day, and every loss that broke your heart will be used for good.

Who can you reach out to today with compassion and help them on their journey and bring beauty from your pain by helping others with your own experiences?

I hope you will do that this week because everyone needs to hear the encouraging, “You got this.”

“You never know how strong you are until being strong is your only choice.”
—-Bob Marley

Much Love & Many Prayers,

Cindy

The Perspective of Chronic Illness

I wanted to share this quote I found today that might help someone with their daily struggles with chronic illness.

“I choose joy… I will invite my God to be the God of circumstance. I will refuse the temptation to be cynical…the tool of the lazy thinker. I will refuse to see people as anything less than human beings, created by God. I will refuse to see any problem as anything less than an opportunity to see God.” ——Max Lucado, Upwords

Circumstance.

Perspective.

Two significant words in this world today for everyone, not just people with chronic pain.

We cannot be ruled by our circumstances. Our lives are easier to live when we look for the beauty in our broken parts and in the world and when we accept where we are at in that point in time.

However, our perspectives do rule our lives, and it is something we can work on changing.

Some people get angry when the talk is about “controlling pain with your mind.” No, I do not believe you can control your pain with your mind. But I do believe the journey can be lighter with a change in our mindset.

Today, find one thing that is good in your life and praise Him for it.

Much Love and Many Prayers,

Cindy

Goodbye Hurricane Florence

I have been sitting at my desk just staring.  I am exhausted, but I’m still trying to keep going.  It has been a little over one week since I began preparing for Hurricane Florence to hit us. 

The storm nailed our area.  Went right over us. We are ok, thank God, but so many other lives have been completely devastated.

I cannot imagine the pain that people all around me are in today. I am really sad today even though we have been spared the worst.  I’m sad for what the people with pain are going through trying to survive if they lost their homes, their medicines, or other medical devices. 

I know that BCBSNC has a healthline for it’s members in North Carolina 1-877-477-2424.

There is also free for this area MDs live through Teladoc 1-855-756-8708  & MDLive 1-888-959-9516 .

Also, call Magellen for national crisis line for help in this area 1-800-327-7451

If anyone wants to volunteer, North Carolina Organizations Active in Disaster

Like everyone else, I pushed my body way past the breaking point, and then some, to do what we had to do.  I wanted to keep mom comfortable while power was out. Being 83 years old, I was more concerned about her with the heat than anything else.

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We cooked some really great food on the grill during the storm.  I’m sure I gained 15 pounds. Hot eggs with sausage and english muffins each morning is not bad.  This picture was during the calm after the storm.  We didn’t take the time to take pictures of the other meals but believe me, we ate good. So, thankful.

 

We are so blessed with only water damage from the roof leaking, so that makes me feel guilty for even thinking about feeling bad at this moment while looking out the window at the perfectly Carolina blue sky.

A couple of my friends bailed and can’t get back.  One friend is stuck with only 5 gallons of gas a neighbor graciously gave them because someone siphoned my friend’s gas out of their truck. Another good friend’s daughter lost everything of hers and her three children.

On a happier note, we have some really great neighbors across the street that stood in line for a long time to go in groups of ten at a time into the grocery store to get food for all of us.

At the same time they were there, we were also able to get out on one road to a small town with a small Walmart.  The shelves were empty, but they had water. While the store was extremely packed and busy, everyone was being polite and helpful even though we were all worried about getting back to our homes because of the continuing down pour and the fact that the flood waters were rising fast.

When the worst of the storm was over for us, we were able to help other friends out with gas, water, and food.  I have seen first hand how a disaster brings out the best in people, but I would like to catch the thief that stole gas from my friend!

A note about the support group and advocacy work: 

I sent a proposal to a new church about using their facilities for our meetings.  The storm will likely slow down the progress of it being approved.  I will just need to have patience.

Even before the hurricane, the physical pain put me in bed many times during the day leaving me unable to get things completed. 

It is very hard to get anything started, much less finished because I must stop in the middle of something because my body starts saying “no more!”  My mind won’t stop thinking about all the things I am trying to accomplish while I am laying there staring at the ceiling. 

I ordered a mobile desk that I thought would slide under the bed. I was hoping to continue working on the computer with the tilted desk slid under, but it did not work.  It wasn’t long enough to put the computer right in front of me. I thought I had found a solution to laying flat and working on the computer. I will figure it out, but it is frustrating to lay in bed with ideas of things that need to be accomplished.

Before the hurricane hit, I had an appointment with this area’s director for my Congressman to discuss the future of people with chronic pain.  Of course, Hurricane Florence changed that, too.  It will take time before this can be followed up on because his first priority right now is the victims of Hurricane Florence.

Someone recently told me it’s ALL baby steps. That’s what life is.  It is short-stride baby steps every step of the way. With this storm, the people in North Carolina and South Carolina will become strong again.  We will just do it with baby steps. #NorthCarolinaStrong

Much Love and Many Prayers,

Cindy

You Are Strong

Strong quote

Wow, I really have felt this quote the past few weeks.  Every day I wake up living with chronic pain, I have to find my strength to get back up and do it all over again.  Without a focus, living this way causes depression in me, so I have been putting all my attention on starting the support group and getting my office put back together. This has created less time for the blog.  I may be posting less, but I am still here.

I wanted to post this for those that just keep moving no matter what, keep putting one foot in front of the other, just keep going, regardless of their circumstances.  You are strong fighters working through hard, painful things every day. I know what you are going through every day.  You aren’t alone.  Just keep moving.

Move Lyrics by TobyMac

Another heartbreak day
Feels like you’re miles away
Don’t even need no shade
When your sun don’t shine, shine
Too many passin’ dreams
Roll by like limousines
It’s hard to keep believin’
When they pass you by and by
I know your heart been broke again
I know your prayers ain’t been answered yet
I know you’re feeling like you got nothing left
Well, lift your head, it ain’t over yet, ain’t over yet so
Move, keep walkin’ soldier keep movin’ on
Move, keep walkin’ until the mornin’ comes
Move, keep walkin’ soldier keep movin’ on
And lift your head, it ain’t over yet, ain’t over yet
Echoin’ inside your head
Are the words that your sweet momma said
“Shoot for the moon, my dear”
So you took aim out of this atmosphere
Between high stakes and pump fakes
You’re feelin’ like you can’t buy a break
I can hold your hand, but I can’t turn your eyes to freedom
I know your heart been broke again
I know your prayers ain’t been answered yet
I know you’re feeling like you got nothing left
Well, lift your head, it ain’t over yet, ain’t over yet so
Move, keep walkin’ soldier keep movin’ on
Move, keep walkin’ until the mornin’ comes
Move, keep walkin’ soldier keep movin’ on
And lift your head, it ain’t over yet, ain’t over yet
Hold on, hold on
Lord ain’t finished yet
Hold on, hold on
He’ll get you through this
Hold on, hold on
These are the promises
I never will forget
I never will forget, so
Hold on, hold on
The Lord ain’t finished yet
Hold on, hold on
He’ll get you through this
Hold on, hold on
These are the promises
I never will forget
I never will forget
I know your heart been broke again
I know your prayers ain’t been answered yet
But it ain’t over yet, it ain’t over yet
So get up and move, keep walkin’ soldier keep movin’ on
Move, keep walkin’ until the mornin’ comes
Move, keep walkin’ soldier keep movin’ on
And lift your head, it ain’t over yet, ain’t over yet
Lift up your head now, keep walkin’ soldier keep movin’ on
Lift up your head now keep walkin’ until the mornin’ comes
Keep believin’ keep walkin’ soldier keep movin’ on
And lift your head, it ain’t over yet, it ain’t over yet
Songwriters: Bryan Christopher Fowler / Christopher E Stevens / Toby Mc Keehan
Move (Keep Walkin’) lyrics © Capitol Christian Music Group
Much Love and Many Prayers,
Cindy