JaneMD passes out from exhaustion

(Passed out from exhaustion - from sodahead.com)

As everyone has noticed, the spacing between my posts have gotten further and further apart. Several things have happened. The biggest issues are probably related to my second job and some recent health set backs. On top of my new 65 hour work week, I have had to schedule surgery, weekly doctor's appointments and have regular physical therapy. Post surgery, I was laid up for some time and my poor children were very concerned about their mommy. Child2 spent the past week following me around and being carried because I was finally mobile again. It has been expensive as well - but I'll be getting able to deduct my health expenses this year since we'll be above the 7.5% threshold. 

To complicate the matter, there was a whole spate of Jewish holidays, so every day that wasn't a Jewish holiday, I was working. If I was working, that meant HubbyJD was working shorter hours to collect Child1 and Child2 from daycare and he had the Jewish holidays off too. I occasionally have downtime at work to write a little, but since blogger is blocked anyway, it doesn't help much. My netbook stopped going online because of a storm frying our modem, so I'm using a different computer. I have a professional publication under my RL name in the works which is cutting into my time too.

While I know everyone has lots of personal stuff going on, internet posting has taken a backburner to everything else. I probably only visited Mr. MoneyM once in the past month and didn't post. I still am keeping my budget update - with a new column dedicated to medical expenses, but I am just to tired to post. Especially when there are so many other people doing it much better than I - if you want science, I love Phil Platt on Slate with his pro-research and pro-science discussion. You already know I like MMM and NoMoreHarvardDebt.

My apologies to everyone who was hoping for an enlightening post, but this doctor is going to go take a nap. After I do all the laundry, take out all the trash, drop off stuff at the thrift store, and go pick up the kiddos from daycare. 

Okay, so no nap.

Jane relies on someone else to discuss chemicals in food

Did you read that buzzfeed article about '8 toxic foods!?' Notice how I didn't link to the article because it

is fear-mongering bull? Scare tactic after scare tactic of horribly researched drivel. (Lieutenant Data totally would have warned you off this course of action, buzzfeed.)

Fortunately, instead of writing and researching a rebuttal, an organic chemist did it for me. Here it is "Eight Toxic Foods: A Little Chemical Education."  This is why people go to college and get science degrees. :) Thank you facebook friends for linking me up with this article. This awesomeness will not be forgotten as it is almost as cool as "Voices for Vaccines."

I haven't had time for many posts with my training for the second job and the fabulous, famous annual June/July resident/physician Shuffle. Rest assured, there will be an update on the biking, the diet, the finances once things get settled down.

Follow-up on Potty Training

I just wanted to share a link to an article written by Steve Hodges, a urologist, discussing some of the topics I touched on in my last blog post. He argues AGAINST pushing your child to potty train early and discusses how pooping really affects your child's ability to successfully potty train. Read it here.

"No Potty MOMMY!"

Daycare asked me about potty-training Child1 who is 2 years old. Another older child is working on potty training and they were planning on introducing the potty to Child1. I gave my indifferent blessing on this and shared some of my reservations. (Beware, I'll be using 'poop' versus stool/bowel movement and so forth)

1) Boys potty train later than girls, statistically. Many boys get potty trained around the age of 3, not so close to the age of 2. I know a 22 month girl who poops on the potty, but I don't think Child1 is all that interested.

2) Firstborns don't have an example to follow. That 22 month old girl I just mentioned has a 4 year old sister who is very proud of her potty skills. Consequently, the 22 month old is super motivated. It took the 4 year-old quite a bit longer though.

3) Parental commitment is lacking. Neither myself or HubbyJD are hardcore 'potty train NOW.' If they do it at daycare, and not at home, then you won't get far.

Daycare understood and hadn't really intended on doing very much. They wanted to let Child1 work on sitting on the potty after meals and seeing if he did poop there, making sure he didn't get afraid of the potty, and learning the idea of wiping and flushing. It will probably be several months until Child1 is actually in a better state of readiness.

Other pieces of advice from JaneMD on this subject. Make sure your child isn't constipated. Miralax is fiber, not a drug, so don't feel like a failure if your child ends up on it. Painful stools tend to make children have stool withholding (trying not to poop) behavior which encourages more painful stools. It becomes very difficult to potty train in those cases.

Try to use the child's natural physiology. The best time to go potty is after eating a meal because the gastrocolic reflex is working then. Gastrocolic reflex is why you feel the urge to go to the bathroom during your meal or right after. 

Don't spend a ton of money on the 'magical singing self flushing potty.' You didn't train on an electronic potty. The more the potty seems like a toy; the more it will be treated that way. Books, however, are perfectly welcome as a method of relaxing. It works on adults, too.

Say it with me, 'potty training is WAY more important to the parent than the child.' Your child, while not enjoying being wet and poopy, is only motivated to change because YOU care. Your child doesn't know any different so why would he/she spend energy on it? If you want an amusing potty training story about motivations, read Parenteconomics. The dad tries numerous ways to motivate his kids to potty train - and most of them backfire - until he outsources the problem to daycare by his third child. I personally have trouble keeping Child1 on the toilet to relax long enough to poop because Child2 is wandering the house while I supervise potty time.

So keep your cool and remember that almost every healthy child will be potty trained before 4 years old and it is not a reflection of you if your kiddo takes his/her time. When your child is doing an exclusive interview twenty years from now for inventing warp drive, she/he will not be recounting triumph over adversity because you didn't buy the most expensive potty. He/she will be recounting your attitude if you become a toilet-training tyrant.

 

(P.S. Alot of naked toddlers come up when you use goodsearch to look for 'potty.' Don't let it be your kid!)

New job, new bike

So two little kids, a full time job, some medical issues, and a NEW JOB have led to a delay in updates. For the five people actively checking in, thanks!

Okay, where we last left off, Jane had some horrible trip on Airtran during Passover and will never be traveling like that again. I applied for a second job and got it, which has required more training and additional hours. I am still going to be working full-time at my current job, but once or twice a month I'll be working in a pediatric urgent care. HubbyJD supported my additional employment (he, jokingly, claims he made me get a second job because I wasn't working hard enough). A good part about this job is that I can bike to it since its about 1 mile from my apartment. A bad part is that I'll be doing it on weekends around midnight.

With this in mind, I started actually biking on our fold-up Schwinn and bought a Nashbar Kid Karriage, which was on sale with fresh shipping for under $100 with tax. I have now biked two four mile round trips to the gym, once alone and once with the kids. My legs are killing me, but I'm sure this will get better with time. I may eventually invest in an actual bicycle with gears since HubbyJD thinks we can all go biking together now .

What has our budget been doing? Subtracting medical expenses and getting hit TWICE by uninsured drivers (we had to pay the deductible), we are around $5,500 a month. There was a tax error on my part as well that resulted in us owing money. When I filled out my initial W-4 form in 2011, I worked half a year as a low paid resident, half as an attending, and HubbyJD only worked 5 months of the year. For 2012 we both worked the full year and, despite having an additional child, made too much money to get the student loan interest deduction or the loss on our rental house. Add in that I had not updated my W-4, my failure to take out enough money resulted in owing. (Fortunately, my bi-monthly housekeeper is a CPA student, filed our taxes for free, and is helping fix the W-4 issue, especially since we know have to project the income from my new job.)

On the plus side, our lease ended and we bought our car at the end. We anticipate selling one or two of our cars and buying older four-door stick shift models. We FINALLY completed the refinance of our out-of-state rental which resulted in a slightly decreased monthly payment - $60 so at least that frees up $250 in the budget. Let's see if my potentially new biking habit can shrink our gas budget some too. My bike investment so far was $35 for 2 children's helmets and $100 for the trailer - minus $75 in giftcards = $60, which we now are referring to as my mothers day present.

Stop the AntiVaccination Billboards!

I have to say, since I read Slate, I am loving the science guy Phil Platt, so far. He pointed this out today on Slate. He said it much better than I am going to today. The crux of the issue is that the vaccine-hating "National Vaccination (mis)Information Center" is putting up these horrible antivaccine billboards. They show a cute baby and say "Vaccinations? Know the risks and failures."

It makes me want to hurl, literally and figuratively. Want to watch an infant die of pertussis? Mumps outbreak in New York brought on by an unvaccinated kid from Britain? Hib deaths in Minnesota in 2008? I was counting the seconds until Child 1 and Child 2 were vaccinated.

What can you do? Contact Clear Channel. Here is what I wrote - on the fly.

I am highly concerned about your decision to allow extremely flawed and dangerous billboard warning people off vaccines to be set up in your facilities. Are you aware we are having a huge pertussis outbreak? We haven't had an outbreak like this since before 1970. Infants, like the one in the picture on the billboard, are at huge risk of DEATH from pertussis since it stops their breathing. I doubt you would allow billboard that encouraged people to drink and drive even if its someone's 'opinion and money' that it is okay. Please take down this horrible dangerous billboards.

I also joined the 'Voices for Vaccines' facebook group. And I totally, shamelessly stole the billboard from the Slate page linking to 'Every Child by Two.' I did not place a link to the evil billboards so no one mistakes what I'm about.

Every Child By Two

 

Really, someday soon I will be posting more financial stuff. Really. Occasionally I just am really hit by something I read online, but that is what blogs are for.

Jane, antibiotics, and CRE

While I often alternate between finance and medical posts, based on some recent news, I went for a medical post.

Perhaps you have been reading the scary articles about CRE (carbapenem-resistant Enterobacteriaceae)? If you haven't, just search 'CRE superbug' and hear the doom and gloom for yourself. Basically, these awful suckers are found in hospital. They have been stealing resistence coding genes from other bacteria previously treated with antibiotics and are now resistant to our last line of defense antibiotics - carbapenems. The antibiotics also kill off the non-resistent competing bacteria giving these bad guys free reign in a patient. Half of the patients who get the infections will die because no antibiotics can treat them.  The bacteria are currently found exclusively in healthcare facilities . . . for now. . .

Freaked out? Wondering what you can do to protect yourself?

• Wash your hands constantly while visiting a hospital. Touch something, cough on something, get coughed on - wash your hands. Try to keep from bringing as few germs as possible home from the hospital. Make sure everyone, including your doctor, nurse, tech, and housekeeping staff do the same.

• Minimize your use of antibiotics. You probably don't have CRE, but the more 'normal' bacteria you keep around, the less resistant bacteria you are carrying. Many illnesses are actually viral and antibiotics will do nothing except kill of the innocent bystander bacteria.

• Avoid visiting immunocompromised/elderly people while you are sick. They are the most vulnerable and constantly exposed to more antibiotics and germs. If a patient on chemotherapy gets a cold and fever, they may get treated with antibiotics. Even if it's probably just a virus, they can't take the chance it could be bacterial. An untreated bacterial infection in a patient with no white blood cells to fight it is almost always fatal.

There are plenty of times you will need antibiotics, but give all things time to show virus versus bacterial. Colds actually last 2 weeks, not 1 like people think they will. Antibiotics don't benefit people who have the flu virus. (Techinically, the flu virus softens people up for secondary bacterial pneumonia which is typically treated with antibiotics - in the ICU, on a ventilator, not the majority of flu cases)

Don't worry, in the future, I'll be writing a post on how I cope as a doctor knowing about all the killer germs out there. Hint - my kids eat dirt at non-hospital places.

A little discussion of the flu vaccine

Congrats all, this year's flu season is almost over. I hope you got your flu shot. I did, the kids did, and HubbyJD tried to get his several times. He missed flu shot at the office day and the Rite Aide, Walgreens, and Hospital Pharmacy were out each time we visited.

I was going to give a few words about common misconceptions or you can read the CDC website here.

1) The flu isn't serious. 
The flu is very serious. Averaged over 30 years, 30,000 people die in the US per year from the flu and 200,000 people get hospitalized. A good half of the 150 kids who die of it yearly are under 5 and don't have any other medical problems. Mathematically, that would be a worse than 1/10 chance of dying if you get hospitalized from the flu.

2) The flu vaccine gave you the flu.
No, it didn't. If you got an injection, the flu virus is DEAD. A known side effect of the flu vaccine is cough, mild chills, and low fever. The live virus - nasal version - is could theoretically (and has never been demonstrated to do so) give you the flu. Just in case, certain populations like cancer patients and the immunocompromised are never given the nasal flu vaccine. If you aren't passed out on your couch for days having people feed you soup, you didn't get the flu.

3) The flu vaccine paralyzes people.
People fear getting Guillian-Barre Syndrome from the flu vaccine. The rate of GBS in the normal population is 1 in 100,000. The rate of GBS in the flu vaccinated population is 1 in 100,000. Before molecular chemistry, PCR, and multiple other medical techniques were in use, the 1976 Swine Flu vaccine increased the rate of GBS to 2 in 100,000. I think they were still using vinyl records back then too, so I don't find that comparable to my current MP3 player.

4) I don't have to get it every year.
The flu virus is constantly mutation/experiencing 'genetic drift' so the vaccine is updated every year. They make their best guess when they manufacture the vaccine and protection is typically in the 60-80% range, sometimes as high as 90%. Occasionally a strain will show up late and they have to scramble to make a new vaccine, like the Swine flu of 2009-2010.

5) My doctor will be able to give me some meds if I get it.
Not really. The flu is a virus. Our virus fighting abilities are AWFUL. Tamiflu and Relenza are most effective if used for flu prevention or possibly intervening in the first two days of the flu. We use these medications more often if you have additional medical conditions in the hope they will keep you from getting hospitalized. We treat people in the hospital with them, but really, it comes down to supportive care (oxygen, fluids, managing blood pressure, etc), treating secondary infections (pneumonia on top of the flu), and hoping your body will fight it off. We had 20 cystic fibrosis patients on oxygen trapped in the hospital for a month during the swine flu and a full ICU . . .

6) The flu vaccine causes autism.
The research falsified by Timothy Wakefield was only about the MMR vaccine - which didn't cause autism either. Mercury also doesn't cause autism, and some flu vaccines contain a tiny amount. The original mercury argument was that the cumulative exposure of mercury across all vaccines in the first 6 months caused autism was disproved, but to keep people from refusing vaccines, almost all vaccines are mercury-free. (Besides, if mercury caused autism and we took the mercury out of vaccines - why are autism rates going up? Was the mercury actually protecting kids from autism?)

I could write a long time about vaccine misconceptions, and I will eventually in greater detail discuss autism on this blog, but that topic deserves a MUCH longer series of posts. Keep safe and if you didn't get vaccinated this year, make sure you get vaccinated early next year - HubbyJD will be!

Jane is NOT above recycled presents

My presents did NOT look like this!

Happy Holidays to all. We just celebrated Chanukah over here and once again used a low low bar for purchasing presents. As the Mommy, I, Jane, was responsible for purchasing all of the gifts for our family except myself. I financed some of our purchases with freebie gift cards, outlet shopping, and online deals. As the Daddy, HubbyJD was given a list of books that I wanted, a loaded gift card, and specific instructions on when and where to purchase my presents from that list.

Ideally at our house, we give one present each night, hopefully under $10 for 7 of the 8 days. On the 8th night we typically give each a $20-30 gift. We have yet to engage in the contest for the lowest priced gift, though that day may be coming. This year I made some one-time more expensive purchases for HubbyJD's office - professionally framing his some of his certificates. Other presents were $3 picture frames with our pictures in them and sweatpants. I got, as expected, books and my requested DVD of Firefly the Series.

Child1 and Child2 got a different tack. One of my friends wanted to get rid of some of her barely used toys and gave me three times the number of toys I could possibly use. Some of the items I donated onto my synagogue's playroom, but other ones I sorted, cleaned up, and gave the boys. Eventually I did buy a few specific trifles. In all I don't think I spent more than $40 on all of their presents. We lit our candles, ate a doughnut, and opened presents. They eventually played with their presents - blocks by far are the most popular thus far - but the sheer novelty of ripping off the paper was more exciting.

Maybe one day my children will go to a huge birthday party and realize some of the other kids get big new expensive toys. However, at this point, they don't care - and even if they did - in 10 minutes a new toy becomes a used toy. A set of blocks is a set of blocks as far I'm concerned.

(If you were wondering how I wrapped blocks without a box, I can fill you in. When we moved, I bought curtains that came in zippered clear vinyl bags. Those saved bags made great containers to stack the blocks inside and then wrap. The blocks got moved to a big plastic container and the zippered bags now store other toys.)

Pediatricians and Guns

As one of the many people stunned and saddened by the horrible events in Newtown, I wanted to take a minute to discuss where the American Academy of Pediatrics stands on guns. I am deliberately not addressing more about the tragedy because there is so much that could be said, but this blog is where you visit for medical/finance posts.

AAP Statement on Firearm Related Injuries Affecting the Pediatric Population October 18, 2012. "The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents. Adolescent suicide risk is strongly associated with firearm availability. Safe gun storage (guns unloaded and locked, ammunition locked separately) reduces children’s risk of injury. Physician counseling of parents about firearm safety appears to be effective, but firearm safety education programs directed at children are ineffective. The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use."

Essentially, your pediatrician will counsel you that firearms are dangerous and should be stored unloaded and the ammo stored elsewhere - both of which are locked. We're serious about this because 3,100 children a year will injure themselves with a firearm - 120 of those injuries will be fatal. This does not include the number of teenagers who will commit suicide with firearms -over 1500 per year as firearms are used in 90% of successful suicides. So that is 1600 kids per year who die in what is considered 'preventable' deaths.

I recognize there are many legitimate reasons to own a gun. One of my friends did her residency in a military town, and EVERYONE owned a gun. I'm not a pacifist; I have a healthy respect for firearms.  I have been to the gun range, I grew up taking riflery at camp, and my entire family in Israel are/were members of the IDF. However, my job is to counsel a parent on the dangers of owning a gun with children in the home, the same as I would a swimming pool, a trampoline, and a bicycle. (Unless I'm in Florida where the fight over the ridiculous law preventing doctors from asking about guns in the home is still being fought.)  Owning a firearm is neither good or bad, but if you own one, respect its power and store it properly.

The AAP has a good resource page about talking to your children about disasters. I am lucky that my children are too young to know what happened, but it won't always be that way. May all those affected be held in our thoughts and prayers.

Formula Fact Vs Fiction - Part 2

We're about a week out, and Child2 is doing great with his surgery. Now I have time to return to the questions that I regularly get asked about formula.

What about Soy?
Nutrionially speaking, soy formula is pretty much the equivalent milk based formulas. People used to switch to soy if their infant is spitting up alot or they were concerned about milk protein allergy - which can result in cranky babies with blood in their poop. An allergic baby is reacting to the milk proteins which can come from the formula or via breastmilk if mom eats dairy. If the child didn't have milk protein allergy while breastfeeding, she/he doesn't need soy. Also, milk protein allergy often is cross reactive with soy so you aren't helped at all by switching to soy. I have met some hardcore breastfeeders who cut dairy and soy of of their diet for months with the hope their child would outgrow the allergy. (which they often do)


What about medicinal use of soy formula?
Soy absolutely has a place for certain medical conditions like a rare disorder called galactosemia - can't digest galactose - or parents who have ethical concerns with using animal derived products. On the flip side, premature babies are NEVER fed standard soy formula because it can prevent absorption of calcium and phosphorous - giving a child ricketts!


Should I switch formulas because my newborn is lactose intolerant?
No. Your infant is NOT lactose intolerant. Infants cannot be lactose intolerant; all infants are born with enzymes to break down lactose because it is a main component of breastmilk. Lactose intolerance refers to the loss of that lactose breaking up enzyme which occurs at about about a year of age. Many Caucasian populations keep a much higher concentration of that enzyme after 1 year old. Other ethnic groups do not keep so much. Truthfully, most lactose intolerant people have enough of the enzymes remaining that they can eat small amounts of dairy. If this describes you, four pieces of extra-cheese pizza or an extra large Dairy Queen Blizzard are not good options without enzyme replacement (lactaid) - though one small piece or a small cone may be doable.

What about Gentle/Sensitive/Low iron?
Welcome to another marketing ploy. This plays on parents belief that their child is lactose intolerant and the gentle formulas are 'lactose free.' As already discussed, not really the issue. It may give a parent a sense of control that they are trading formulas, but their child's spitting up/irritability will probably improve with time and or technique. These formulas still contain milk protein so if the child has milk protein allergy it won't make a difference.

Most pediatricians will roll their eyes outside of the exam room and let people change formulas because if the parent perceives something relatively harmless to be true, it's not worth the battle. For example, refusing vaccines is very harmful and needs to have time spent on that issue. Changing from a nutritionally sound standard formula to a nutritionally sound 'senstive' formula is safe and fighting it is generally not a good use of time for the doctor.

Low iron formula is not marketed in the US because it is DANGEROUS! The best iron bioavailability (gut absorbing) food is human milk. Human milk has a fraction of the amount of iron in commercial formula, but it is absorbed so well iron supplementation is not necessary unless there is an additional health problem. Commercial formula's iron is not absorbed as well and must have more iron in it to let babies reach a safe level. If you have located low iron formula, it was manufactured in a foreign country, and you are facing a HUGE danger of feeding your child a questionable, potentially non-safety controlled substance that could easily lead your infant to becoming severely anemic.

What about Nutramigen/Alimentum/Elecare/Neocate?
These formulas fall into the 'elemental/amino acid' based formulas. Each of these is an expensive, semi-digested formula for infants with major health issues that cannot safely digest normal formula or breastmilk. They actually smell like they are partially digested and taste horrible too. The closer you get to elemental (Neocate) the nastier it tastes/smells. No one should be using these formulas without the blessing of their doctor. Some of the things that would make a physican consider these formulas include severe reflux, consistent weight loss, failure to thrive, genetic disorders, digestive surgery, and cancer treatments.



My baby was premature - what about him/her?
It's standard practice in the United States to give infants with normal digestive systems milk-based higher nutrient higher calorie formula. Normal formula/breast milk is 20 calories per ounce. Neosure/Enfasure 22 are 22 calorie formulas with a different protein/iron/fat ratio than standard formulas because premature infants have different needs for growth and weight gain. The powdered formula can also be added to pumped breastmilk to increase the calories content to 22 calories. Preterm infants generally stay on these formulas at least six months with some adjustments for weight gain and gestational age. Infants with severe digestive system problems/surgeries will be put on special specific formula diets with consultation of pediatric gastroenterology.

Long story short, it is totally fine to buy generic formula because it is almost identical to name brands. Your child only needs formula till one year of age and the various stages and additives are generally marketing ploys.

Saving health dollars with paperwork

Just to follow up on my bill paying section, I wanted to give a little advice about dealing with insurance companies since Child2 is about to have outpatient surgery this week. (That belly button thing I posted about a while ago)

1) Get a referral: If you go to your primary care physician (PCP) for anything and you anticipate the need to see a specialist, ask for a referral AND get a copy of it. So if you are visiting your PCP to get a blood pressure check and you were thinking about seeing a dermatologist for a skin check sometime, physical therapy for nagging back pain, or plastic surgeon for skin tag removal, etc - ASK FOR A REFERRAL. It costs the doctor nothing except a piece of paper. It's great if you have a specific physician in mind, but if not, just get it on a prescription pad and take it with you.

2) Touch base with your insurance company: patiently wait on the phone to talk to a human being and ask if they cover X service and what the copay will be. Ask if there are limits to how much they cover and if you will be charged separately for hospital, lab, and office charges. Mention that you have a referral, even if you don't officially need one. Be nice; we'll discuss that in a minute.

3) Confirm your appointment and referral: When you set up your appointment with a specialist, make sure they have your referral on file. If they don't, give them your PCP's office information and bring your copy of the referral to the appointment. Everyone's office is interested in getting paid.

4) Review your bill and your insurance statements: If you get approved for a specialist or procedure, you should receive notice that you can see specialist Z for X number of visits. When you get your bill from the physician/hospital/lab (or all 3 separate bills), make sure insurance covered your visit. If you need to, ask for an itemized bill. Then call your insurance company and discuss what they did and did not cover. BE NICE. They get yelled at all day by irate people. If you are nice, they will be willing to refile claims for you, resubmit them, contact the doctor's office, or take it up with their supervisor.

5) Record name, date, and activity: Get the name and number of every person you talk to. Write it directly on the bill, '11/20/12 Talked to Sherry in customer services, will forward info to her supervisor and hear back in 30 days. 777-664-9041' Insurance companies and doctors office employees know each other and can confirm that type of information. Insurance companies generally will have an electronic record of this type of correspondence and will look toward that date you tell them in followup. It will also keep them from turning your over to collections.

6) Keep your records together: Come up with some type of filing system that keeps your medical bills in once place. I personally have a file on top of my desk that I keep the current projects in. I put sticky notes that say 'pending' on the ones that are in process. I move them to our general file system the main portions once they are resolved and shred the ones that were minor correspondence or extra copies.

Now for my true story. I was able to save somewhere in the range of $700 for medical bills during my pregnancy by calling and talking to hospitals, insurance offices, and doctors offices. I was in a car accident and had to be seen in the ER. Since I was pregnant, once they all agreed I didn't have a broken neck, they sent me up to OB floor. I was later asked to pay for the copay for the ER and then 'out of network' OB office costs because that was how the hospital charged for OB services. I was able to successfully get my out of network fees waived because it was an emergency visit and I didn't get to 'select' which OB was on call.

Furthermore, I had some bleeding at the start of my pregnancy and was referred to the high risk specialists. I was also going to VBAC, so when everything was okay, the high risk specialists kept me on as a patient even though I was not high risk at that point. I was just receiving normal care from their office. My insurance company would usually pay $6,000 for my entire pregnancy care and I'd be responsible for $300 as a bulk payment. However, since I kept seeing the specialists, I was getting extra bills for $50 after every visit. It took a bunch of phone calls, but I got the office to re-code for almost all of the visits and I only paid an extra $25.

Keep in mind, there was alot of waiting on the phone to get all of this done over a period of weeks, but it was WAY cheaper than actually paying all of those bills.

Better Bill Pay in 5 steps

We just had a bit of a financially harrowing incident over a bill which has led me to create "Better Bill Pay in 5 Steps" so it won't happen to you. Anyone can accomplish this with 1 or 2 hours of work.

1) Electronic bill pay: Examine all the bills you're paying via checks or mail. Can it be faxed? Can it be paid electronically? Can you place it on autopay, and your bank mails the check for free? Are your student loans on autopay? You should get a 0.25% interest rate discount if you place them on automatic electronic payment for government loans. 250K loans at 6.8% over 30 years with a monthly $1630 payment comes to a total savings $40,000 and 27 fewer months.

2) Personal bill pay: Are there any bills that you can pay in person? This is much more likely to be effective at a local organization like a church, synagogue, landlord, or small doctor/dentist office than a larger organization that has its billing off-site/out of state. Combine it with a grocery trip and stop buying stamps.

3) Confirm your address: Make sure that any correspondence that needs to reach you has an appropriate forwarding address available. Bizarrely, the post office charges to do address changes online so ask for the paper forms. Then fill them out for any address you have moved for the last 5 years. Mail forwarding only works for one year and then needs to be renewed.

4) Consolidate/phase out your email accounts: If you have moved jobs/graduated school, it is very possible that your email address is still receiving mail. I recommend getting a dignified name of some type on gmail and filtering all your email into that. Whatever you do; if an email is going to be shut down or essentially unused, set up the auto-email informing mailers of your new contact information.

5) Know how to access all of your accounts electronically and check them weekly: This way you will know if any strange chargers appear or if your scheduled electronic payment suddenly stops. Even better, be familiar with when your electronic payments are scheduled versus when you get paid to know when you can put aside extra money or make the extra payment.
____________________________________________________________________________

Now onto our story. Our out-of-state condo is undergoing a re-finance that will remove that pesky first-time homebuyer residency requirement. Our renter pays into the local account and the mortgage and condo association dues came out of that account on autopayment. Unfortunately, the condo association moved to a new management company last year, but we were never informed because they sent that information to the condo itself (haven't lived there in 4 years) and HubbyJD's law school email account. The old management company forwarded our checks to the new company every once in a while, when they felt like it. Then they just stopped and the checks expired so the money was credited back to our account. HubbyJD finally checked that account and noticed the credits.

He immediately followed up on the electronic trail in his old email and found we about to have a lien placed on the condo we were trying to re-fi! I had also made an extra $1.8K loan payment THE DAY BEFORE. He contacted the mortgage companies lawyer and straightened things out - provided we pay everything immediately. Fortunately I knew exactly where we were in our monthly banking cycle to come up with an extra $1.5K that afternoon. Since I run the household finances, I immediately enacted steps 1-5.

Formula Facts Versus Fiction - Part 1

As you know, JaneMD loves Part 1 and 2's. So here comes another one on formula . . . particularly since some people have expressed some interest in more about newborn care/prices

Real conversation in the outpatient office:

Patient's Mom: My baby spit up alot since I changed to step 1 formula at 2 months. So we tried the sensitive formula; she was still gassy. I tried soy for a few weeks and she seemed better, but after she had a big spit up, I went out and bought some Alimentum now that she's five months.  She doesn't like it very much, but she's stopped spitting up. I know she's lactose intolerant.
Me: How many ounces were you feeding her at a time when she was 2 months old?
Patient's Mom: Eight
Me: How many ounces does she take now at a time?
Patient's Mom: Six or seven

This mom has fallen into a trap that I think of as 'The Great Formula Lie.' This mom had no idea she was taken in by advertising and false claims. She spent alot of money and time switching formulas for spitting up when if she had not overfed her two month old, took some precautions like sitting her baby upright after feeding, or asked her doctor, she very likely would have it avoided completely. 

So in this two parter, I will discuss major lies - I mean 'selling points' that marketing trying to use on you.

#1 - Stepwise formula:
Ah, Enfamil. Even though I was a solid breastfeeding mother for the first 7 months of life, you continued to send me formula samples. Your advertisements said things like 'I am not a baby, I am an infant.' All ridiculous lies. I appreciate that you sent me a sample of Newborn and Step 1 once a month, though because it was free.

I once set those Newborn and Step 1 cans next to each other and examined the ingrediates and nutrients. Essentially exactly identical. The ONLY difference was Newborn had 75 units of Vitamin D and Step 1 had 60 units per 5 ounces. That is all. The entire difference. Both claimed to have prebiotics, both claimed to have DHA and ARA. 

Well, Vitamin D must make a difference, right? Not really. Your child is recommended after the age of 3 months, if breastfeeding, to get 400 IU of Vitamin D daily. Step 1 formula would require drinking of 33 ounces and Newborn formula would require 27 ounces a day. The newborn formula claims to be used 0-3 months, and the step 1 is 0-12 months. Except you don't need vitamin D supplement until 3 months of age and then you don't really need the newborn formula, or you could buy all newborn formula since the difference is so small.

I grabbed Walmart formula and guess what - it is completely identical to Step 1 Enfamil! Everything is the same - including its claims for DHA, ARA, and prebiotics. This is because the US FDA controls what is in formula and it must meet a certain requirement so all formulas, Enfamil, Similac, any generic are nutritionally, for all intents and purposes, the SAME. In fact, there are no studies that show outcome (IQ, growth, and so forth) over any type of formula in a normal child. These claims are like stating that using a 'Graco' carseat over a 'Costco' carseat will make your child more likely to graduate college.

Enfamil also started sending us 'Enfagrow' stage 2 powder for kids older than 1 year old. However, there is no reason to be giving formula to a normal child after he/she turns 1. The label claims to be much better than whole milk - though hilariously the first ingredient is whole milk. If you are still feeding your child formula at a year, you are failing introducting new foods.  Your child should be taking up to 24 ounces of milk a day and all the rest of his/her nutrition should be from FOOD. Not formula! For much cheaper, feel free to feed your child whole milk and give them a chewable vitamin with iron once a day. Many kids can be picky eaters, and this is just to bolster any nutritient they may be missing.

#2 - Marketing through fear:
The label on the advertisement for Enfagrow reads "Enfagrow Preminum Toddler or Milk? **You decide**" (It really said that.)
Translation: You are failing your child if you do not buy this formula. Even better, they have a random well groomed woman in a white coat holding her glasses. I assume, since she is unlabeled, not wearing an ID, and testifying her love of Enfamil, she is a model portraying your friendly pediatrician. (Similac is has similar ads; I just happen have the advertisement on hand)

Look at the claims on a typical can of formula. You'll see they claim improved brain growth, size increase, and all sorts of other things. As I said, since formula is controlled through the FDA, all of the differences between the standard formulas are going to be minimal. You can't fail on any of them. We did all Walmart formula for the first child and are currently using Enfamil because I get it free as a hospital employee.

Don't be confused - there is nothing wrong with using formula. Not everyone wants or needs to breastfeed and that is OK. Just don't fall for the marketing that tries to convince you one is better than the other.

To be continued in Part 2 next week where I'll discuss various types of formula that are out there.

Glorious resident lifestyle continued

It took a little longer than planned to get my post up because of the Jewish Holidays. The High Holidays were upon us and had all sorts of no computer rules. In order - Rosh Hashana: repent, eat big meals, Yom Kippor: repent, don't eat at all, and Sukkot: celebrate by eating all meals in a hut with no roof for a week - hence today's photo of 'hospital sukkah'.

Returning to the actual planned content of my post: In Glorious Resident Lifestyle part 1, I established that I worked hard and was paid badly as a resident. So what exactly did I do during my 30 hours of call?

My typical call day as a 1st year pediatric resident:
6am: arrive and get sign out about events that happened on my patients overnight.
6:30-8am: examine and talk to each patient. Update patient record (daily notes) on 3-10 patients depending on census
8am-9a: attend educational conference if possible, continue to write patient notes.
9a-12noon: round on all patients with whole team - 12 to 30 patients. Leave group to perform procedures - deliveries/lumbar punctures/cpr/central lines
12noon-1pm: educational lecture. take sign-out from person who was just awake 30 hours.
1pm - 5pm: complete patient work, perform procedures, admit new patients, sign out all other team members
5pm-6am: continue patient work for 12-30+ patients, perform procedures, admit new patients, 10pm nursing/patient check. Possibly sleep in call room if kids stable. Possibly sleep at desk outside of unstable kids room. Possibly sleep not at all.
6am: sign out other patients to rest of team.
6:30am-8am: see all patients, write all notes
8am: educational lecture, try to stay awake
9am-noon: round on patients again, try to finish all work to sign out by noon at 30 hour limit.
noon - 6pm: sleep
6pm: HubbyLawStudent arrives home. Based on business of call night and cleanliness of apartment,  may or may not have an arguement.
9-10pm: go to bed because it starts again at 6am

Staying awake for 30 hours was the worst and hardest part. I was usually pretty good until about hour 20-22, and then my productivity died horribly. Sure, I had a call room that I could possibly have slept, in theory. Winter is the worst because of RSV season leads to a huge number of hypoxic - not getting enough oxygen - infants. July is hard because the new interns need alot of attention and guidance. June is probably the least busy pediatric month, everyone has the most experience and kids are out of school avoiding germs.

That was as an intern. As a senior resident, you got to do 12 hour shifts instead of calls - except you would be scheduled for 13 shifts in a row with 12 hours off in between each one. With the new 60 hour work week, that averages out to 5 x 12 hour shifts per week. Nurses, btw, work 15 x 12 hour shifts over a full month which is like 3.5 per week. They would also get paid overtime or night-shift differential, which residents do not.

If you thought that sounded rough, imagine being a surgical resident. They have schedules like that for 5 or 6 years. You can pretty much cut out my lunch or rounding time and replace it with 'surgery' for hours on end. OB? Replace lunch or lecture with 'wait for babies to be born/c-sections' which they do for 4 years. Pediatrics, family medicine, ER, and internal medicine (among others) are considered pampered lightweights.

 This says nothing about what it was like emotionally to be a resident. You were exhausted, you were in charge of training the other interns and medical students. You had to achieve a certain number of procedures to graduate and pass various national exams. You had to deal with blood, puke, pee, poop, and pus. You were sometimes belittled or yelled at by attendings, nurses, other residents, fellows, and parents. Whole blogs are dedicated to how alone and powerless you often felt. It's not a suprise that arguing with my spouse got mentioned as part of my post call ritual.

As an attending hospitalist, I have a WAY better schedule. I work around 50 hours a week, with some call at a lower risk facility. I also get paid twice as much as a resident, which is still considered pretty low, even for a lower paid specialty like pediatrics. I could have added 20K to my starting salary if I had joined a group practice or wanted to work more.

(I'm lucky because pediatric subspecialists are generally overworked and understaffed because they take 3 more years to educate after residency. There are whole metropolitan areas where there is ONE pediatric geneticist for 2 million people. That means they are on call 365.25 days/year, can't take vacations because if a kid with adrenoleukodystrophy gets a stomach virus, they have to be available to manage the correct fluids and treatment.)

If you want a TV representation of what residency is like, I would recommend Scrubs as your look into our lives.

To end on a funny Scrubs-esque note, here are 10 Things that I actually heard during Sign-out.
Be warned - partially funny and partially cynical. Remember, these are from people who were awake for 30 hours.

1. That asthmatic patient, did you forget to tell me he was missing two limbs?
2. To the Jewish doctor - This Orthodox Jewish family has all these weird rules on Saturdays. Do I need a social work consult? (No)
3. We'll just say this family is pretty 'concrete.'
4. This patient weighs about three Kentucky Fried Units.  (450 pounds)
5. Her/his mom handed me a book on the vegan/gluten/dairy/sugar/preservative-free/all natural/organic diet she uses on her child.  We're treating him/her for malnutrition.
6. We had a Soap opera baby today. The woman didn't actually have a child but have been lying about it for three years and now theoretical father wanted to see imaginary child.
7. I could tell you all twenty meds the specialist put them on, but they haven't taken any for three years.
8. Child is fine; mom left to go use cocaine. CPS is waiting for her when she gets back.
9. This child was stabbed in the vagina by a rhino. Not a real rhino, a rhino statue at the museum.
10. Don't open the security bed, even if the delusional psychotic teenager seems better. He just beat the cr@p out of his mom, and it took 4 security guards to tackle him on his last escape attempt.

Glorious resident lifestyle of the not rich or famous

You are sitting in the pediatric ER with your child that may or may not have appendicitis. First, you saw the medical student who talked to you for 30 minutes. Then you saw a tired looking pediatric resident who talked to you about the exact same thing for 15 minutes. Then you saw a much more awake pediatric ER attending physician who talked to you for five minutes, agreed to admit your child, and get a surgical consult. 30 minutes later, the surgery resident sleepwalks in, presses on your child's belly and mumbles that he's getting a CT of the abdomen with a blood draw, and wanders away.

D@mn, you've been here 3 hours and what the heck? Why did those residents look so tired and am I seriously expected to leave them in charge of my child?

Before discussing the actual resident lifestyle, let's lead with resident compensation. The federal government pays teaching hospitals $200,000 to train each resident per year. The resident is actually paid, pre tax, in the $40-50K range. Med students pay $40-50K for the privilege of training.

During my residency, I had an 80 hour work week and no call lasting more than 30 hours. New regulations recently moved the limit to a 60 hour work week, no first year call over 18 hours, and no later year calls more than 24 hours per the schedule. Some leeway is given for emergencies and unstable patients.

How did that translate into actual money and hours? Well, I made $40k my intern year. I worked 80 hours a week while on service, did not have any holidays off, got three weeks of call free vacation and one call free month. That averaged out to 70 hours a week for 49 weeks - 3430 hours a year. Taxes/insurance took about 20% of my salary, no 401K for such lowly peons. That led to $32K over 3420 hours - $9.35/hour. That is similar to a McDonald's manager, except a typical resident is 27 and already completed 4 years of college and 4 years of medical school.

Oh, I got two $5 coupons for hospital cafeteria food for each call night. An 80 hour work week required call every 4th night, which I got to do for 45 weeks of the year. 45weeks x 7 days/4 days is 79 calls x $10 = $790 in 'food' perks. Yes, just like the McDonald's manager.

How anyone can pay off their $150K+ in loans on a salary of $9.35/hr and $80/month in 'food' perks just boggles the mind. Does anyone have that much self control when working 80 hours a week? If you were wondering, the 60 hour work week essentially will remove call free months for everyone, so do the same calculation with 60 hours - $10.88/hr with less food perks.

So what was my personal resident financial lifestyle like? I lived across from the hospital, so I didn't ahve a car. I was supporting first 2, then 2.5, and then 3 people on my salary alone. (Remember HubbyJD was originally HubbyLawStudent?). I packed my own lunches and used my cafeteria cards to buy food that I took home. Keeping kosher, I was able to take milk, cereal, fruit, hot chocolate home with the plastic silverware in $5 increments every 4 days.

Stay tuned for more glorious residency lifestyle next week . . .

BJ's and I agreed to see other people

If you didn't know, BJ's offered their 3 month trial membership this summer. With my family of 4, I was not certain I would shop there often enough to make it worthwhile to buy a membership. I assumed that the 19 Kids and counting people used BJ's . . .

In my 3 month trial, I went to BJ's 4 times. The first two times I bought the objects I was scouting to see if I'd like them in bulk. On my 3rd visit, like a good scientist, I took my shopping list from Walmart to BJ's, recorded all the prices on similar brands, and then put it in a spreadsheet to compare my savings. I also examined which items and brands BJ's vs Walmart vs specialty grocery store carried. The last visit was the big purchase when I spent $350.

The good: I was able to buy challah (Jewish bread), kosher salami, and stuffed grape leaves for rock bottom prices I could not find anywhere else. I went a little wild and bought ALL of their two loaves of challah for $5 compared to my local grocery stores $7 per loaf. Similar issue with the salami - I bought all of it they had in stock and put 20 loaves of bread and 30 12oz salami in my fridge. I bought bulk plasticware, nuts, cups, and nice paper plates. I had enough storage space that I may not have to do that again for another year.

The so-so: I was able to find peanut butter $0.50 cheaper per container than Walmart. Not too exciting. I was underwhelmed by their bulk oreos, frozen vegetables, and Mrs. T's Pierogies. I found deodarant cheaper by $0.25 a container, if I didn't care about the brand. Morning Star Farms products cost almost exactly the same since Walmart started selling the 8 pack burgers.

The bad: CFLs were $0.60 more expensive per bulb than at Walmart! BJ's bulk diapers were more expensive than Walmart bulk diapers. Black beans, chick peas, and lima beans were $0.10 per can more expensive than Walmart-even though they come in six packs. Bagged sandwich bread was not cheaper than Walmart. Bulk fresh fruit - apples, oranges - were all cheaper at Walmart. Whole wheat nutrigrain waffles and egg beaters were the exact same price. Walmart brand protein bars were cheaper than the namebrand ones sold at BJs. They had very narrow brand selection and few whole-grain choices.

I also noticed how tempting it was to 'overbuy' things. Look, paper towels in bulk! I should buy those . . . except we use rags instead of paper towels and just wash them. There were tons of products I almost bought and then remembered that I did not miss the object before I saw it at BJs and it didn't have a place in my house. I think having so much on hand would tempt me to make larger meals and consume more items. For example, you make a tray of brownies for dessert on Monday (bought in the Duncan Hines brownie mix 4 pack) and have half left over - which you end up snacking on all week and put on some weight. Or you can use spend cut the recipe in half of the 5-minute Chocolate Mug Cake, even cheaper.

Quick, buy 30lbs of whole wheat flour . . . nevermind, don't need flour now that I froze all that bread . . .

Once I stocked up on my specialty kosher items, the difference in cost between what I regularly buy at Walmart and BJ's wasn't worth the temptation to overbuy. I am hoping that the next few months grocery bills will be lower because of this, but that remains to be seen. Should I ever need bulk purchasing of those items, I have some friends who shop there regularly and are happy to buy for me.

Buyer Beware parenting/health magazines

It's been busy with my little anklebiters, but I know I haven't done any frugual-health posts recently. While perusing various topics, one found me in the mail.

Cosmo 2 years for 15 dollars!  Health 2 years for 13 dollars! FREE GIFT! It was a DEAL. And FUN! And per Cosmo - SEX!.

It appeared that my subscription the Fitness is a great opportunity for Hearst to advertise the rest of its line to me. Considering how much the magazines cost as an impulse buy at the grocery store, I could just write a check and get a DEAL FUN SEXY GIFT. However, my better sense prevailed because of a few facts. First of all, I am no longer in Cosmo's target market. I'm married with kids - I don't need monthly advice on figuring out what his posture tells me about his commitment.

Health had a different challenge. I have read the magazine and it's heavy on the gimmicks, light on the actual science. Many people do not realize that the lay press vastly over reports on studies and likes to make wide sweeping statements from very little understanding of research. One study that made the news last year was on how many years apart having your children affected their autism risk showed a very small increase of risk if your children were under a year apart - except that they did not control for multiple factors. Every pediatric autism specialist and neurologist rolls their eyes each time they hear about it.

Here is how the laypress reported it along the lines of "Autism risk doubles for children less than a year apart." (I will go on at length in some future post about what their data reallys says - but if you are wondering if the risk of autism is 1% in each child, they found that under 12 months could possibly increase the odds to 3% - in California from 1992-2002 during the same time they widened who they accepted for autism)

This leads me to children's magazines like American Baby and Parenting. Not only do they report headlines like that, they also have articles titled like 'unlock your infant's genius level gifts/telepathy' They recommend expensive products as if they will give your child an advantage. They regularly report or distort things into pseudoscience. they'll quote a pediatrician and then a naturopathy 'expert' or personal trainer in the same article as they had some type of group consensus, when in actuallity most of it was taken out of context.

Hilariously, midway through a particularly painful reading with some ridiculous quote in American Baby from a physician, I was thinking to myself 'what kinda of yahoos do they interview for these things?' I turned to the next article and saw my own boss quoted.

Next, I turned the pages past the 'serious' story that quoted my boss, and the next three pages were about purchasing the best new family car/van. Not a single vehicle was priced under $20,000 and there were no suggestions for good used vehicles. Truthfully, the article implied that you were doing your child a disservice if you didn't buy this years model - even though there is VERY little difference between a 2010, 2011, and 2012 Honda Odysessy minivan.

Have no fear, the next article was about breastfeeding success and some of the objects you should be purchasing to maximize your success. First, Dr. Sears complained that women weren't practicing 'natural' breastfeeding and reaching his minimum goal of 1 year of breastfeeding. (The AAP itself recommends  4-6 months, the AAP counsel on Breastfeeding recommends 6-12 months if possible) He implied that if you really focused, you could be Super-mom and make it a year and everyone was just weakwilled wimps. (I shouldn't be surprised by the anti-vaccine star of 'The Doctors.') The following pages featured some fabulous objects aforementioned Super-moms should run out and buy to achieve 'natural breastfeeding' - a $150 nursing pillow, a $65 'modesty' breastfeeding cover, $30 per bottle BPA free, organic, 'doctor recommended' bottles.

HubbyJD found it hilarious that the next page of featured products had a sidebar column entitled 'How to save money when you welcome your new baby.'



So my best advice about magazines related to 'health' or child-rearing is to avoid them. The health and advice tends to be sensationalized and made into soundbites. Practice critical reading and thinking about what the various claims are recommending. Remember that the magazine is also interested in selling the 'featured' products, even on pages that aren't specificaly identified as ads. You don't need most of the products they are selling and lots of the advice is not helpful or well researched. Your pediatrician can probably recommend you to a few worthwhile books that should be more unbiased.**

Also public service announcement, Pertussis outbreak is ongoing over 16,000 cases in 2012 in the United States. Pertussis seems like a cold to an adult but can cause huge problems for infants and children - 20 babies in California died last year. Please get vaccinated, particularly adults who have contact with children. 



*** Disclaimer: I read this book in residency and am not one of the authors. They both have children and attempt to address common questions like bottles/pacifiers/poop/traveling on an airplane.

Reworking the budget

So I severely undershot the budget in a few ways. Before Child 2, I was making 5.1K and we were paying about 4.6K in expenses. I imagined I would have enough money to just add Child2's daycare to take up the rest of that $500-600 and then add $300-400 on in new rent. I sat down and recrunched all the numbers - which I had been too busy to do for a few months. It was scary.


Instead of our $5,400 I imagined, we were spending $6,400!

Salary $9,500/month - $6,400/month expenses = $3,100 - $1,600 minimum loan payment - $1,300 savings = $200.***


At that rate it would take us 16 years to pay off the loans. (20 years without the extra $200 a month in payments) It would also cost another $150,000 in interest.

*** I ignore our FSA reimbursements in these calculations because we weren't filing them regularly and two months we spent over $7,000.

Where did the budget go so wrong? Even though we spent less than $30 a month eating out, we were still spending $920 on tolietries and food. I even estimated a little down on this number since alot of the moving expenses were included in this. Also, the personal expenses included clothes, hair, car, and dog expenses. We spent at good $100-200 dollars/month on the dogs alone between end of life care and dog sitting. I splurged right before Child2's birth and got my hair colored -$150. We spent alot on 'onetime' wedding expenses $450, which some people would put as part of 'entertainment.' We ended up on some charity mailing list and ended up giving away $450 in charity a month.

So I did some more number crunching. Our income went down from $10K because of our FSA's. We should get about $500 back per month. The dog expenses are gone which will decrease our personal expenses. While we aren't buying more apartment equipment anytime soon, I know something would certainly always come up and plan accordingly. (Look, our microwave just burned out, $50 at Walmart!) I recognized I needed to set aside money for holiday and birthday presents for the year - that is $900 of our monthly new onetime expense budget of $300/month.

Here's how things look now.

Previous Monthly Budget (JaneMD salary 5.1K)	Actual Monthly expenses	New Monthly Budget (JaneMD salary 4.9k )
Rent + gym + housecleaning $1188	$1700	$1700
Cellphone + internet $160	$160	$150
Car lease $190	$190	$190
Home/car insurance $125	$125	$125
Daycare $670-770	$1365	$1365
Utilities $160	$150	$150
Car Gas $150	$150	$135
Groceries/Toiletries $800-1000	$920	$770
Personal expenses $500	$700	$350
Charities/religious $400	$450	$400
Onetime expenses $300	$450	$300
Bank autosave feature $42	$45	$45
Total budgeted monthly expenses $4685	Actual spending $6405	New budget $5680

Our new budget decreased by $750 from actual expenses. Little things have changed. I got an employer discount on our internet. Our phones will be someday paid off, dropping that expense by $25. I watch our grocery bill like a hawk and move things into appropriate categories, like the microwave. We have an upcoming vacation to see our families, which is already budgeted for ($500), but I'll be coloring my hair with my mother (savings of $140). I also made our FSA reimbursements a major part of our budget, thus making sure they always get filed.

Salary $9,500/month + FSA $500/month - $5,650/month expenses = $4,350 - $1,600 minimum loan payment - $1,300 savings = $1450. 


At that rate it would take us under 8 years to pay off the loans and save $60,000 in interest.


A message from HubbyJD: I appreciate my wife, JaneMD, and all of her hard work at our budget and finances, especially since she does my accounting for free. I want to be financial independent and get all our loans paid off. I do draw the line at the beer austerity measures that she has recently enacted. Someone please tell her I can buy 2 twelve packs a month of Guinness.