Playing Telephone

 I talked with Dr. Ray Donc last night.  Although he admitted surprise at the conclusion, he said that the plan for IMRT looks "pretty darn good" and asked if I were willing to move forward.  So after a lengthy conversation full of probabilities, research stats, percentages, comparisons of apples and oranges and what ifs and survival rates and recurrence and what would you do if you were me and the good, the bad, and the ugly, I gave my consent to move forward with the appeal for IMRT.
     They should know by Friday/Monday what the insurance company's decision is and will call me right away with the outcome.
     So the waiting in suspense should be over soon.

Will it ring faster if I stare at it?

***

     I did ask about my super mobile heart and why that doesn't jive with proton beam therapy.  Given that I am not a doctor (I just play one on this blog) and that Dr. Ray Donc was trying  to explain this to a layperson to the best of his ability, here is what I understand (any factual errors are certainly mine):
     The "allowance" for my heart movement for this therapy was 5 millimeters.  When I was in an agitated state, my heart moved 8 mm and moved a full centimeter when I was in a relaxed state.  Not some whopping amount of movement but enough to be too far out of the allowance.  Too unpredictable. 
     But why does this matter?
     The proton beam, while allowing the doctors to designate a specific depth to which it is delivered, also requires a calibration of tissue mass.  And in my tumor area they had to account for the mass of the heart, the tumor, the lungs, and the empty space as well.  From what I understand, the protons will be attracted to the area with most mass.   And with my heart mass moving that much, what can happen is the heart will "lead" the protons away from my tumor; in theory, I could go through a course of proton therapy and my tumor wouldn't actually receive a therapeutic dose while, at the same time, my heart would receive way too much.  I could go through the therapy and not only derive zero benefit, but I would put myself at a much higher risk for heart damage than I would have otherwise.  And there would be no way for them to know that.  So they deemed it too risky. 

***

     Got a call this morning from the precertification department at Dr. Ray Donc's facility.  Had a nice convo with a lovely Insurance Wrangler.  She told me that she had spoken with our insurance and, although verbally it sounded like they would give authorization, the particular type of authorization is one that she, from experience, knows is a kind of shady authorization that allows the insurance company to deny you at the end of treatment and stick you--surprise--with the bill.  So with a special letter from Dr. Ray Donc, she is putting through the full appeal plan to obtain an actual no-kidding authorization. Who knew there were such sketchy goings on?  I mean, I'm not surprised, but still.