C A L I F O R N I A : born and bred

Dan likes to say that life recently has been coming “hard and fast”. I say it’s a rollercoaster. Moving from one plan to another, spinning 180 degrees with each shift, we both agree that it is a bittersweet combo of exciting, frightening, challenging, and yes, rewarding. A week away from our first anniversary, I couldn’t imagine sharing my life with anyone other than this incredibly driven and loving man.

We’re nearing the end of Dan’s training at The Basic School in Quantico, Virginia and Dan has been assigned his “MOS” (essentially his “job” in the Marine Corps), which will be as a Signals Intelligence Officer. Shortly after learning the exciting news, Dan learned of his orders: those illusive mandates which I understand we will become increasingly familiar. Dan is to “detach” from his command here in Quantico mid-September, and report to sunny Camp Pendleton, California mid-October. Heading “home” to Southern California was our first choice for duty station, and the thought of likely staying there for about three years sounds golden. Of course, in that time Dan will have training, and deployments, but it gives us a new place to call home and raise our little family.

Still, there remained one precious, adorable little hiccup: Wally’s due date of October 15. In the past week we have considered options to deliver Walter at four different hospitals, in four different states, and four different Fetal Heart Programs (who will ultimately perform Walter’s surgery). We’ve considered requesting to stay in Quantico longer, or have me stay with Wally in Virginia, and Dan report to Pendleton. We’ve weighed the options of traveling cross country with two week old newborn; whether to fly or to drive; store, ship, or drive our car; all while trying to limit our time apart and make the best medical decision for Walter. (Oh, and don’t forget managing our little kitty, Sophia, as well).   If there is some complex mathematical permutation to calculate the number of options we considered, I haven’t yet figured it out.

Ultimately we arrived at one conclusion, which allows us the “smoothest” transition, most consistent care, and puts us in the best position to handle any complications Wally may have after birth or down the road: MOVE NOW. In about two weeks, I’ll be headed out to Southern California just shy of 36 weeks pregnant. A week later, Dan will follow – making the cross country drive – and reminding Walter that he’s simply not allowed to make an early arrival before Dad can step foot on California soil. In the meantime, I am busy coordinating our move and transferring my care to an OB, Perinatologist, and Fetal Heart Program, in SoCal. We’ve secured a house on base in Camp Pendleton; but to facilitate the moving process in the interim, we’ll be spending some time with my parents nearing Wally’s arrival. Many moving parts now, means a settled and consistent environment for Walter later.

In many ways, life seems to have come full circle. Dan and I were both born in California, and Walter will begin his own little life at the same hospital where my parents met, and I was born (Huntington Memorial, Pasadena). We’ve enjoyed Quantico, and it pains us in many ways to leave what we have here. We’ll have to say goodbye to Dan’s sister and her husband (along with the chance to see our niece/nephew as a newborn), and pack up our happy apartment which we’ve made home. Wally will never know his first nursery – but I am determined to recreate it in our new house. Still we’re eager to begin our next adventure, in a new home, in a familiar place, and especially near Walter’s “Granny and Grandpa”!

Sophia saying good-bye east coast, hello BEST coast!

 

Celebrating Dan’s MOS

ADAPT AND OVERCOME

As it becomes ever more clear that life isn’t perfect, and indeed Wally’s heart isn’t, my approach has always been to adapt and overcome. Our most recent appointment with the cardiologist threw us a curveball. Granted it was one we could see from home plate, but, a curveball, nonetheless. While Wally’s overall growth has been right on track (3 lbs, 10 ounces at 31 weeks), and measuring a week ahead in size, his heart is growing a little less perfectly than we had initially assessed. 

We knew that Wally’s Pulmonary Artery was small, but it has been lagging behind more significantly than before. The need for immediate newborn surgery now grows more likely. According to our cardiologist, “it’s on the fence” as to which surgery will be necessary (newborn vs. 4-8 weeks post birth). In the world of hearts, especially baby ones, millimeters mean miles – so our next months appointment will prove especially vital in assessing any improvement. Ultimately, Walter’s newborn echocardiogram after birth will be the most telling. From those images our cardiologist and thoracic surgeon will make their decision. So for now, we’re touch and go. The expectation for October is murky, but our anticipation for Wally’s arrival riddles us with excitement more and more each day. We’ll hope for sun, but plan for showers (and just make sure to pack an umbrella in the hospital bag).

In the next week or so, my OB will be looking to schedule the official induction date – which is happy news! Coordination will run much smoother when all the moving parts can be alerted and ready ahead of time. Plus, with family across the country, it helps me make sure travel allows us to get some extra support in place – especially with the likelihood of an immediate surgery. 

Plans change and then they change again. I don’t doubt that the shaky outline of how I imagine Wally’s birth progressing will be far different from reality, but, we can always prepare. Up until this point I had been very set on wanting an epidural. Now, knowing that Wally will likely be taken from delivery, straight to the NICU, and then transported north to DC Children’s Hospital, with me still confined at Mary Washington waiting to get discharged – I want as much control over my body as possible. With his more serious condition, holding and cuddling with Walter after he’s born becomes more unlikely. In fact, my first chance to really see him would be in the NICU, meaning I have to be able to get out of bed, scrub down, and visit him. An epidural won’t allow me that flexibility soon after birth, by which time Walter and Dan could already be on their transport up to DC.

The thought of not seeing my little boy until after undergoing open heart surgery a day or two after he is born rattles me. It is already likely we will be robbed of bonding time immediately after birth (skin to skin, first feeding, and first cuddles), adding separation from my number one support, Dan, and new little man, Wally, for a day or more seems to only heighten our obstacles.

Because of this, we’ll be exploring some other options that may help us logistically. Delivery in DC is a possibility, though it doesn’t truly solve the separation problem – just makes our separation geographically closer. Children’s Hospital of Philadelphia remains the only hospital in the country able to both facilitate delivery (as a part of their Special Delivery Unit) and perform Wally’s full repair, just steps away from where he is delivered. My charge for the next week consists of finding how soon I can arrange a consultation with the Fetal Heart Program at CHOP, and subsequently determine the best option for our little family. Semper Fi!

Dan and me a few weeks ago!

Healthcare in the Military: Standard vs. Prime/ Our Doctors

We have had many questions from both local friends and far away family as to the doctor’s we are seeing and care we are receiving through the military’s health insurance, Tricare. I am very happy to say that our experiences with both have been fantastic and are incredibly thankful for our team of doctors, and financial security which allows us to focus on caring for Walter – not how to finance it. Wally’s special care, hospital stay, and repair could add up to the hundreds of thousands of dollars. Not to worry – that is precisely why we have insurance, and why we’ve made the financial decisions we have chosen so as to ensure our security. Our out of pockets will be relatively minimal.

 

TRICARE PRIME

When I found out I was pregnant, I was on the Tricare “Prime” network. The option is essentially what I dub a military HMO. It directs your care by way of a Primary Care Manager, requires that your initial visits all be on base within the military network, and if necessary, refers you out to designated specialists. Honestly, just getting my pregnancy test was a bit of a hassle – between getting the appointment scheduled, showing up at the Navy Health Clinic, and following up after that, it all felt tedious and bureaucratic. To be fair, the facilities are exceptionally nice/clean, and the staff helpful and friendly. Personally I grew up on a PPO and am not particularly fond of the referral process HMO’s require. Prime does come with the clear benefit of zero out-of-pocket: no co-pays, no fees, so long as you follow the military’s referral process.

PROS: all covered services are covered at 100%, no co-pays, and most care is conveniently located on base.

CONS: You are not directing your own care and wait times between referrals can be frustratingly long – if you get the referral in the first place.

  

TRICARE STANDARD

However, as a working pregnant lady, time is truly gold, and choosing an OBGYN I could count on, I was comfortable with, and who was philosophically on the same page as me regarding care and delivery was important. I took a recommendation from a friend to find my OB, and have been THRILLED with my decision. (I’ll detail specifically about the practice later). Being on Standard allowed me to chose my OB, the hospital where I would deliver, and I can’t help but believe sped up the process with meeting the special doctors we now need for Wally.

In a matter of 24 hours after Walter’s initial anatomy scan, we had reviewed ultrasound findings with the OB, had an echocardiogram with our perinatologist, driven to DC Children’s hospital for an additional echocardiogram/fetal heart monitoring, opted to take part in a research study, and met with our fetal heart team: pediatric cardiologist, pediatric cardiothoracic surgeon, nurse coordinator, and social worker. Though at the point Walter’s ToF was confirmed we would have in all likelihood been referred out of the military network to DC Children’s Hospital – there is no way that paperwork and processing could have occurred in the timely manner it did for us when not waiting on a referral. Also, I can’t help but wonder whether Walter’s ToF would have been detected in the first place, as our OB’s sonographer has her experience in high risk pregnancies with a perinatologist’s office and knew exactly what to look for.

 Now here’s the great part: on Tricare Standard, maternity care is covered at 100% as well. All of these visits and specialists are covered by Tricare Standard without out-of-pocket cost shares from us. So really, there are few reasons to NOT be on Standard for maternity. Granted, any care that is not maternity while on standard will have a co-pay of 5% – 20% depending on whether the provider is part of the (Standard “Extra” network). Still, I don’t have a problem cost sharing in preventative care and including a little bit of an incentive structure to the care I receive. The most comforting aspect of the whole system is that deductible per person (before Tricare kicks in) is $150, and the per family deductible is $300. Even better is that the “catastrophic out-of-pocket cap” is $1000 – meaning that once our cost shares total a thousand dollars as a family, Tricare covers our care at 100%. That is definitely a price I am willing to pay for freedom of provider. Active Duty service members must remain on Prime. It makes sense from a logistical prospective (so their care can be overseen by command), and it does appear that active duty service members receive priority in scheduling and wait times (as they should).

 As for newborns, they are covered for the first 60 days of life by PRIME regardless of whether the mother is Standard or Prime. In Wally’s case, he will not be moved or have doctors changed because of this, and his initial hospital stay will be covered in full. I’m still unclear whether his surgery will fall under total wellness care (100%) or Standard, but either way, footing the bill with the catastrophic cap in place is something we can already set aside for our family’s medical needs. Knowing that the hospital stays and surgeries Wally will require will likely cost in the hundreds of thousands of dollars, we are incredibly humbled and grateful for the health insurance the Marines have provided us.

 PROS: choose your own provider and doctors (most around military bases accept Tricare), seek the doctors/specialists you choose without waiting on your PCM (Primary Care Manager) or paperwork for a referral to process.

• Co-pays are 5% – 20% depending on the provider (Standard Extra, in preferred network will be less)
• Per/person deductible: $150, Per/family deductible: $300
• Max out of pocket per family per year is $1000 (Catastrophic Cap)
• Maternity care is covered at 100%, with the exception of the Maternity hospital stay for delivery which is usually around $25/day
• There is no additional cost to be on Standard from your Service Member’s paycheck

CONS: You will likely spend at least your deductible, and depending on your needs up to $1000/year

• Currently, it appears that service members cannot set up HSA’s (Health Spending Accounts) which allow you to set aside sums of pre-tax dollars for the sole purpose of health care costs (such as that $1000 cap if you know you will likely hit it). Most private companies offer HSA’s so if a spouse works outside of the military he/she can set one up for this purpose. The issue is currently being considered by Congress, but…who knows
• Once you “disenroll” from Prime, you cannot re-enroll for one year

Rx: I want to include that regardless of whether you are covered by Prime or Standard, most prescriptions taken to the Navy Health Clinic are covered at 100% (with super short walk-in wait time). Off base doctors can’t call in prescriptions to the Navy Health Clinic, so you just need to get the signed Rx in hand, take it to the window, and volai! – medicine!

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Our Doctors:

 OBGYN: Elite Women’s Health (located at Mary Washington Hospital)

• Dr. Patel, Dr. Stadulis, Dr. Colon
• All have been wonderful through this process, handle high risk pregnancies, and are readily available, timely, and informative. I never feel rushed at an appointment and they have outstanding bedside member.
• They have repeatedly taken the extra steps to make sure the process is running smoothly for us, even calling at home to check and see “how we’re doing”

Perinatologist: Maternal Fetal Medicine (located at Stafford Hospital)

• Dr. Dhillion is outstanding in all aspects. She has stayed after hours to meet with us, made and taken phone calls at 10 pm to set up specialist appointments, and been delightfully encouraging the entire time. She oversees all of Walter’s growth scans and gave us the initial ToF dx. She takes great care in her work, while not sugar coating the realities Walter’s condition. Definitely recommend for anyone needing to see a peri!

Fetal/Peds Cardiologist: DC Children’s Hospital Fetal Heart Team

• Dr. Donofrio has been as equally outstanding as the rest: coming in on a day off to meet with us, spending time to explain options/procedures, and giving us confidence in Walter’s surgery. The entire team from the research staff to the nurses and social workers are extremely helpful and responsive.

Peds Cardio Thoracic Surgeon: Dr. David Jonas, DC Children’s

• I have only met Dr. Jonas once and very briefly (because he is most often in surgery), but he too helped to explain the anticipated timing of Walter’s surgery, procedure, and outlook. He is, naturally, incredibly qualified and successful in his field, and we are looking forward to meeting with him again after Wally is born to truly detail the exact plan and procedure for Walter’s heart.