Infections – The Ugly Side Effect of Chemotherapy

triage-cancer-blog-infectionsWe are all familiar with the common cold, flu and ear aches.  These are all infections – either caused by bacteria or viruses.  Sometimes these infections need to be treated with prescription medicines, but often times our body just gets over an infection.  This is because our miraculous bodies have a built in protection called white blood cells.  When we develop an infection, our immune system produces more white blood cells to fight the infection.  This is the process in a typical, healthy person.

Unfortunately if you have cancer, you are not a typical, healthy person.  On top of the cancer itself, the treatment of cancer can make you sick.  Chemotherapy, while it may be saving your life, can also be putting you at risk of contracting an infection.  Chemo is a powerful drug that goes into your body and kills the fastest growing cells in your body – the good and the bad cells.  So the chemo kills your cancer cells, but it also kills your white blood cells.  Remember, white blood cells are the things you need to fight infections.  Generally, you will experience the lowest white blood cell count 7-12 days after your last chemo dose, and it could last for up to a week.  This period of time is called your “nadir,” meaning lowest point.  At this point you are at the greatest risk of getting an infection.  During this time you need to be extra diligent in protecting yourself against, and watching for signs of, an infection. Infections during chemo can be life threatening and may delay your ability to receive your next life-saving chemo treatment.

What are the signs of an infection?

Fever is the number one and most serious sign of an infection.  Take your temperature anytime you feel warm, flush, chilled or generally unwell.  At your nadir you may not be able to fight this infection on your own, so you need to call your doctor if you temperature is 100.4ºF or higher for more than 1 hour, or a one-time temperature of 101ºF or higher.  Seriously, night or day, call your doctor.  Make sure you:

  • Keep a working thermometer near you, and know how to use it.
  • Keep your doctor’s phone number with you at all times. Make sure you know if there is a different number to call when the office is closed.  Do not hold out through the night, waiting for your doctor’s office to open.
  • If you end up going to the emergency room, tell them right away that you are undergoing chemotherapy. You cannot wait around in a germ infested waiting room while your infection is left untreated.

Other signs of infection include:

  • Chills and sweats, with no fever
  • Change in a cough, or a new cough
  • Sore throat, or mouth sore
  • Shortness of breath
  • Nasal congestion
  • Stiff neck
  • Pain when you urinate
  • Unusual vaginal discharge or irritation
  • Increased urination
  • Diarrhea and/or vomiting
  • Redness, soreness or swelling near surgical wounds or ports
  • Pain in the abdomen or rectum

If you experience any of these signs or symptoms you should call your doctor immediately.

Can you reduce your risk of infection?

Every school age child knows that you can avoid a cold or flu by washing your hands.  As a cancer patient receiving chemo, you need to be absolutely obsessive about this.  Good old soap and water are the best choice, but hand sanitizers are a good second choice. You should wash your hands:

  • Before, during, and after cooking food
  • Before you eat
  • After you go to the bathroom
  • After you change a diaper
  • After you touch your pet, or clean up after your pet
  • After touching the trash
  • Before treating any wound

Beyond washing your hands, you should also maintain good oral and body hygiene, use disinfectants to keep your household clean, avoid coming into contact with sick people, and try to avoid getting scraped or cut.  You should also avoid undercooked or raw meat and eggs, avoid unpasteurized or raw products, and wash your fruits and vegetables really well.

Undergoing chemotherapy is uncomfortable enough without getting an infection.  Be overly observant and very, very clean and you can minimize your chances of getting infections.

Working for Yourself, Retiring with Uncle Sam: Social Security for the Self-Employed

triage-cancer-blog-self-employedAnyone who has ever worked for someone else has likely seen the Social Security deduction on their paystub (there are some employees who pay into a private retirement system). This is the tax that is automatically deducted from your pay check each pay period for Social Security retirement benefits. This money (6.2% from your employer and 6.2% from you) goes directly into the Social Security pot. We contribute now and then in retirement we receive a Social Security retirement benefit.  It’s a pretty seamless process.

But what if you’re self-employed?  If you operate a trade, business, or profession either by yourself or with a partner, you may be considered self-employed. Working for yourself can feel quite liberating, but it can be very confusing when it comes to paperwork.  Now that you’re writing the paychecks, you need to report your earnings and pay taxes to the IRS and Social Security Administration.  But how?

The simple answer is that you report your earnings for Social Security when you file your federal income tax return. If your net earnings are $400 or more in a year, you have to report your earnings on Schedule SE, in addition to the other tax forms you have to file.  And now that you’re working for yourself, you have to pay the entire 12.4% tax on up to $118,500 of your net earnings.

Don’t despair!  As a self-employed person, paying into Social Security allows you two income tax deductions.

  1. You can reduce your net earnings from self-employment by half the amount of your total Social Security tax. This means that you can take 6.2% off your net earnings (net earnings are you’re your gross earnings, minus any allowable deductions and depreciation). So if you report net earnings of $100,000, you can take $6,200 off that before you figure your Social Security tax.  This is similar to the way employees are treated under the tax laws, because the employer’s share of the Social Security tax is not considered wages to the employee.
  2. You can also deduct half of your Social Security tax on IRS Form 1040. But the deduction must be taken from your gross income in determining your adjusted gross income.

One of the benefits to paying into the Social Security retirement system in addition to having retirement benefits, is that if you are no longer able to work because of a medical condition, you may qualify for Social Security Disability Insurance.

This is an introduction to a complex topic, so we encourage you to talk to a tax or accounting professional.  You can also visit the Social Security Administration site, where they have a guide on this topic.

Congratulations on being your own boss and best of luck to you!

Are You An Unknowing Beneficiary of a Life Insurance Policy?

Shockingly, there is nearly $1 billion in unclaimed life insurance benefits out there, pexels-photo-187107according to Consumer Reports.  That means that millions of people who were supposed to receive a life insurance benefit didn’t know they were supposed to receive it and did not pursue a claim.  Thankfully, the National Association of Insurance Commissioners (NAIC) are doing something about it.

NAIC recently launched a new online tool called the Life Insurance Policy Locator.  This tool will help consumers search for possible life insurance policy or annuity proceeds anywhere in the nation.  One of the problems consumers had in the past is that they may have suspected they or a family member was the beneficiary of a life insurance policy or annuity, but didn’t have key information like the policy number or the name of the insurance company. With the Life Insurance Policy Locator you can simply start with the person’s name.  Obviously, the more information you can provide is better, but not necessary to submit a request.

This is how it works:

  • Submit a request
    • NAIC will then ask participating companies to search their records to determine whether they have a life insurance policy or annuity contract in the name of the deceased.
    • If you are a beneficiary or authorized to receive information, companies that have policy information for you will respond directly to you.
    • It may take up to 90 business days to be contacted. The insurance company may require additional information from you like a notarized death certificate and documentation of your legal authority to request or obtain information about the deceased.
    • This service is completely free.

If you think that you might be a life insurance beneficiary, it doesn’t hurt to submit a request and see if part of that $1 billion could be yours.

Important News Regarding Changes to Medicare

medicaredotgovThe new year will bring changes to Medicare.  Click here to see what Medicare will cost in 2017.

Also, if you recently became eligible for Medicare, but thought it would be less expensive to keep your Marketplace coverage because you get financial assistance to pay for your Marketplace coverage, then the rest of this message is for you. 

When you became eligible for Medicare Part A (the hospital portion of Medicare that is usually premium-free), you also became ineligible for Marketplace financial assistance. So that means you will be on the hook for the full price of the Marketplace plan. This also means that you probably missed the open enrollment period for Medicare Part B (the other part of Medicare coverage that has a premium). And, it means that if you do try to get Medicare Part B now, you will pay a late enrollment penalty for the rest of your life.  But . . .

For a limited time, you can apply for “equitable relief” that will give you a Special Enrollment Period to enroll in Part B. It also means that they won’t apply a late enrollment penalty, but you must apply by MARCH 31, 2017!

Some of you in this situation may have been notified of this program by mail. But it you weren’t notified, or lost the notice, or even feel you received misinformation about qualifying for financial assistance, you should contact the Social Security Administration (800-772-1213) to apply for the “equitable relief.”

Your application should include:

  • Any information or documentation you have on how you learned that the financial assistance would not apply and/or why you thought you could continue financial assistance.
  • Any letters (including the notice mentioned above), emails, notes from conversations
  • Or any other relevant information

And more good news – you don’t need to show that your confusion was caused by any particular source to qualify for this relief. You can just be confused.  We know health insurance is confusing!

To learn more about Making Sense of the Medicare Mazewatch our recorded webinar.

Gift Ideas for a Cancer Patient

triage-cancer-blog-gift-ideasWhen someone close to you is sick, the instinct is to shower that person with love in the form of chocolate, flowers, and balloons. This is a very kind instinct, but when someone is going through cancer treatment or in the hospital, you may need to rethink these gifts.

Chocolate and flowers each may present a possible problem for a cancer patient.  Depending on the type of cancer they have, they may have dietary restrictions, and sugar can be a forbidden ingredient.  Many hospitals are now banning flowers because of the germs and bugs they may carry. And you may want to stay away from mylar balloons, which pose a risk to power lines and there is a worldwide helium shortage.

So, what should you bring to a cancer patient? Really, anything that will bring comfort to the patient and is allowed in a hospital environment.  Here are a couple of ideas:

  • A cozy set of button-up pajamas, robe or slippers
  • Warm, fuzzy socks
  • A soft blanket
  • A basket of unscented lotions and lip balms
  • A good, funny book
  • A nice journal and pen
  • Magazines
  • Music or relaxation/meditation exercises
  • Movies, a Netflix/Amazon subscription, or an iTunes/Amazon gift card to download their own


You can also give the gift of your time. Besides visiting someone, you could offer to help with daily activities. For example, you could babysit young children. If their parent is in the hospital, you could take them for a walk or out to get something to eat. Pick up their mail, feed a pet, or water plants. You could even offer to help them sort their medical bills and other paperwork.


Use these ideas, or use them to spark your own ideas.  What every cancer patient needs more than anything is love and support, and any gift will be appreciated, because it is the thought that counts!

How to Find Legal Assistance

how-to-find-an-attorneyTriage Cancer tries to give you information to help you navigate the system without an attorney, but sometimes you may need more help.  It can be overwhelming, on top of everything else, to try and figure out where to find a reputable attorney.  Here are some tips to hopefully make things easier!

How do I find an attorney? 

There are quite a few ways, ranging from a recommendation from your Uncle Earl to certified lawyer referral services.

  • Recommendations – If you’re friendly with any lawyers, these lawyers may be able to refer you to other lawyers who have experience with your type of problem. You can also ask your friends, co-workers and employers if they know any lawyers. Business owners and professionals such as bankers, ministers, doctors, social workers and teachers might also be able to give you the name of a lawyer.
  • Certified lawyer referral services – Most state and local bar associations have lawyer referral services. With these services you can typically search by practice area and location to narrow down your options. This type of service refers potential clients to attorneys. After interviewing you, the referral service staff will match you with a lawyer who is experienced in the appropriate area of the law. There is usually a small charge for the initial consultation with a lawyer and this will vary based on service.  However, you should be informed of this fee prior to the consultation.
    • One of the benefits of using this type of service is that they may be able to provide an attorney at a reduced rate. Lawyer referral services are required to make arrangements to serve people with limited means.
    • Another benefit is that they will screen your call to determine whether you in fact have a legal claim — or need some other type of assistance. If you do need another type of assistance, the referral service can refer you to government agencies or other organizations that may be better suited to assist you.

The American Bar Association has complied all of the Lawyer Referral Programs by state. may also be a useful resource.  This website is designed to provide individuals that have lower incomes with referrals to local legal aid and public interest law offices, basic information about legal rights, court forms, self-help information, court information, and links to social service agencies.

How much will an attorney cost?

Each attorney operates different, but generally, for issues like employment discrimination or disability claims, attorney’s work on contingency. This means the attorney will get a percentage of the settlement if you win the case.  If you enter into this sort of agreement, make sure you get it in writing and that it includes, among other things, the agreed-upon percentage.

  • Employment attorneys usually work on a contingency, with no cap.
  • The maximum a disability attorney can charge, by law, is 25% of your past-due benefits for his or her services, up to a maximum of $6,000. Past due benefits is the amount owed to you based on the date the Social Security Administration rules your disability began.  If you lose your claim, the attorney gets nothing except court costs and certain other expenses – out of your pocket.
  • Legal aid agencies – Depending on your income and the nature of your legal problem, you may be able to get free or low-cost legal help in non-criminal cases from a legal services program. Check the Internet or white pages of your telephone book to see if such an organization is located in your area. A State Bar-certified lawyer referral service or local bar association may be able to refer you to a legal services program. A law school clinic may also be able to assist you.

For other types of attorneys make sure you understand what they are going to charge you and when they will expect a payment, before you sign any sort of written contract. Don’t be afraid to ask questions to ensure you understand each charge.

Also, remember that after an initial consultation, you are under no obligation to hire that attorney.  If you don’t feel comfortable with that lawyer or don’t think that they can adequacy represent you, you should keep shopping around!

It may also be the case that the attorney suggests that you first go through a governmental agency, like a state fair employment agency.  In that case, you can find the contact information for those agencies in your state at

Your Year End Tax Planning Starts Now!


Back to share more expert advice is financial planner, Kristi Sullivan! Today she is sharing some practical end of year tax tips for individuals and small business owners.

Think you can wait until December 31st to do tax planning for 2016?  Think again!  Starting your tax to-do’s earlier in the year makes life easier for your CPA, financial advisor, AND you.

Thanks so much to Elizabeth Moore, CPA and Partner at Ryan, Gunsauls & O’Donnell, LLC for these top 5 actions to take NOW.

  • Get your books and records in order for the year (i.e., record all of your cash receipts and disbursements in QuickBooks or the software of your choice, reconcile your bank and credit card accounts, update your mileage logs, gather receipts to document expenses, etc.).
  • If you haven’t met your deductible, get all of those medical and dental appointments out of the way and PAID for by check or credit card prior to year-end.
  • Take inventory of your business fixed assets (i.e. furniture, fixtures, equipment, vehicles, etc.) NOW and determine what you need to buy this year, instead of waiting until 12/31.  Not only must the purchase occur prior to 12/31, it must be placed in service prior to 12/31 to be eligible for depreciation.
  • Start researching the business vehicle of your choice, NOW, instead of on 12/31.  To establish adequate business use (i.e. 50% or more) of a vehicle to get the maximum amount of depreciation deductions, buying well before year-end is a must.
  • Donate to your favorite charity including churches, schools, or other 501(c)(3) public charities.  You can even donate up to $100,000 directly from your IRA to a charity of your choice, which counts toward your Required Minimum Distribution (RMD) for the year and isn’t includable in your adjusted gross income for the year, which is a huge tax benefit.

The post Your Year End Tax Planning Starts Now! first appeared on Sullivan Financial Planning.

3 Steps to Building a Personal Medical Record

by Amy Thompson

A personal medical record is a compilation of all your medical information, including test personal-medical-record-blogresults, treatment reports, and notes written by your health care team. While each office and facility keeps a record of your care, it’s important to have a complete file for your own use, so you can share it with a new doctor, review at home to better understand your treatment, or manage your health insurance claims, taxes, and other legal matters. Here is what to include, how to compile it, and the best ways to organize it and store it for safekeeping.

Step 1. What to Include

A complete personal medical record should include the following information:

  • Your diagnosis, including the specific cancer type and stage
  • Date you were diagnosed
  • Copies of diagnostic test results and pathology reports
  • Complete treatment information, such as chemotherapy drug names and doses, sites and doses of radiation therapy
  • Start and end dates for all treatments
  • Results of treatment and any complications or side effects
  • Information about palliative care, including medications for pain management, nausea, or other side effects
  • A schedule for follow-up care
  • Contact information for the doctors and treatment centers involved in your diagnosis and treatment, as well as others who have cared for you in the past, such as your family doctor
  • Dates and details of other major illnesses, chronic health conditions, and hospitalizations
  • Family medical history
  • Details of past physical exams, including cancer screening tests and immunizations

Step 2. How to Compile Your Personal Medical Record

Keeping track of your medical records might feel like a huge task, but it’s worth it in the long run.  The American Society of Clinical Oncology (ASCO) offers cancer treatment plans and summaries that can help keep track of information about your diagnosis and treatment.

Compiling this information on an ongoing basis will create a complete and easily accessible view of your health. Remember these strategies to help you collect the latest copies of your records:

  • When you have a diagnostic test or procedure, ask for a copy of the results or report
  • At each appointment, ask your doctor or nurse for a copy of anything new that’s been added to your file or electronic medical record
  • If you spent time in the hospital, ask for a copy of your records when you’re discharged
  • Keep copies of your medical bills and insurance claims as they occur
  • Talk to your doctor if you need help figuring out which records to include
  • If collecting this information feels overwhelming, ask your friends or family for help. While you have to sign off on any requests for personal medical information, they can fill out forms or make phone calls for you.

Step 3. Organizing and Storing your Personal Medical Record

There are different ways to organize your medical records. To help figure out what works best for you, talk to other cancer survivors about what they have done, or visit a local office supply store to see what sort of organizers are available. Here are a few options:

  • Use a filing cabinet, 3-ring binder, or desktop divider with individual folders
  • Store files on a computer, where you can scan and save documents or type up notes from an appointment
  • Store records online using an e-health tool; certain online records tools may be accessed, with permission, by doctors or family members
  • Organize your records by date or by categories, such as treatments, tests, doctor appointment, etc.

However you decide to store your personal medical record, be sure to keep them in a secure location, like a safe deposit box, fireproof home safe, or password-protected files. If you decide to use an online service, carefully check the security and confidentiality measures the company uses to protect your information. A family member or friend could also keep a copy in case of emergency.

Get more tips for organizing your medical records.

This post originally appeared at on August 25, 2016. © 2005-2016 American Society of Clinical Oncology (ASCO).

Appealing an Insurance Company’s Decision

triage-cancer-blog-appealsOne of the more frustrating aspects of cancer treatment is dealing with the insurance industry.  We pay our monthly premiums with the expectation that when and if the time comes, we will receive coverage for our medical care.  Sadly, it’s not always as turn-key as that.  Sometimes, claims are denied or we are charged more than we think we should be paying under our policies.  At that point we have to fight for our coverage.  This process is called an appeal (note: some companies call this a grievance).  There is an internal appeals process and an external appeals process.

Internal Appeals

Your insurer must notify you in writing if they deny your claim for coverage:

  • Within 15 days if you are seeking prior authorization for a treatment
  • Within 30 days for medical services already received
  • Within 72 hours for urgent care that you have not yet received

If you disagree with a decision your health plan has made, you have the right to file one of two types of internal appeals:

  1. Expedited Appeal

An expedited, or urgent appeal is filed if you have not received any treatment yet, or if you are in the middle of treatment and you or your doctor believe that your condition could involve imminent or serious threat to your health.  Obviously, this is an urgent matter, so your health plan should respond to your appeal within 72 hours of getting a qualifying appeal.  They will notify you by phone, as well as in writing.

  1. Standard Appeal

If your situation does not meet the standard for an expedited appeal, you still have the right to an appeal.  This process is longer, as your health plan will inform you of their decision, in writing, within 30 calendar days from the date they receive an appeal.

In both cases, your appeal will be reviewed by the appropriate administrative and/or clinical specialist.  These specialists will not have been involved in the initial decision or a subordinate of the person who made the initial decision.

What to Include in Your Appeal?

When preparing your appeal, but sure to include all the necessary information.  This means the member name and ID number, the name of the provider who will or has provided the care, the dates of service, the claim reference number for the specific decision you are appealing, and the precise reason you disagree with the initial decision.  You have the right to include any documents, comments or other materials that are relevant to your appeal.

You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied. If you have an urgent health situation, you can ask for an external appeal at the same time as your internal appeal.

If your insurance company denies your internal appeal, you can file for an external appeal.

External Appeals

Under the Affordable Care Act (ACA) and some state laws, you not only have the right to appeal a decision within your insurance plan, but you also have the right to ask for an external review.  This means that an external, independent, specialist will review your appeal and the insurance plan no longer has final say over whether to pay a claim.  Keep in mind, you can ask for an external review if your internal appeal was denied or was not satisfactorily resolved within the 30 days or 72 hours, in cases of an expedited appeal.

All states are required to participate in an external review process that meets the consumer protection standards of the ACA. Your state may also have an external review process that is more protective. In California, which has some the strongest consumer protections in the county, this means going to  To find out about the external review process in your state, visit:

If your state doesn’t have an external review process that meets the minimum consumer protection standards, the U.S. Department of Health and Human Services (HHS) will oversee your state’s external review process for health insurance companies. If your state relies on an HSA-administered external review, you can begin that process in four ways:

  1. Call 1-888-866-6205 to request an external review request form. Then fax an external review request to: 1-888-866-6190.
  2. Mail an external review request form to: MAXIMUS Federal Services 3750 Monroe Avenue, Suite 705 Pittsford, NY 14534
  3. Submit a request via email: is
  4. At some point in the near future you will be able to request an external review online at

Ideally, you will not need any of this information.  However, if you do, take heart.  Thanks to the ACA, there are strong consumer protections available in every state and we see an average of approximately 50% of external appeals of denials get successfully overturned.

How to Support Someone with Cancer

Do you have a family member or a friend who has been diagnosed with cancer?

Have you been wondering how you might be able to provide support or do anything to help?

Often we don’t know what to say other than, “Let me know if there is anything that I can Triage Cancer Blog Supporting a Friend with Cancerdo.” While well-intentioned, an open-ended offer of support is unlikely to be followed up on. It can be more helpful to offer to do specific things for your family member or friend.

There are a number of helpful lists of suggestions available in the resources listed below, and we offer a few additional ways to offer practical help, here:

  • Practical help
    • Attend medical appointments and take notes
    • Sort mail
    • Sort medical bills, insurance company paperwork, and medical records
    • Make follow up calls to providers and insurance companies
    • Complete appeals paperwork
    • Apply for financial assistance programs
    • Pay bills
    • Create a spreadsheet of tax deductible medical and dental expenses ( to make tax time easier
    • Research clinical trials or treatment options
    • Schedule appointments
  • Errands
    • Provide transportation to medical appointments
    • Go grocery shopping
    • Drop off prepared meals
    • Pick up prescriptions
    • Pick up/send mail/buy stamps
    • Pick up dry cleaning
    • Pick up thank you cards (for your loved one to send to others who have helped)
  • Babysit
    • Pick up children from school
    • Take them to extracurricular activities
  • Household chores
    • Cook
    • Wash dishes
    • Do laundry
    • Vacuum
    • Dust
    • Change bedsheets
    • Change lightbulbs
    • Organize a closet
    • Rake leaves
    • Mow the law
    • Water plants
    • Feed/take care of pets


Supporting a Friend Who Has Cancer:

Helping a Loved One with Cancer Long Distance:

These websites also have tips on how to help family members and friends and have great tools like calendars to schedule meal delivery, transportation to treatment, and more:

Don’t be hurt or offended if your friend or family member doesn’t ask for your help or declines your help when you offer. Even if your friend or family member doesn’t need help, your willingness to be supportive will be appreciated.