Archive for the ‘Health Care’ Category

If you see something, say something: just few random thoughts on Robin Willams

August 12, 2014

At the cube farm today a few people passed judgement on Robin Williams and suicide. For various reasons (ok, mostly one), I didn’t bother to speak up about the lack of maturity. I chewed on my lip and thought how lucky they were.

Yeah, you read that right. Lucky.

Only somebody who has never watched another struggle with major depression would say something that stupid.
Only somebody who has not felt the smothering lack of energy where even brushing teeth seems like a monumental task would say something like that.
Only somebody who has not curled up looking for a sliver or a moonbeam to cling to would say something like that.

The absolute tragedy, is, of course, that yesterday thousands of people yesterday killed themselves. One person’s death filled social media spaces. We do a lousy job about talking about mental health. We talk about it after a tragedy for a few weeks and clamor for more funding and less stigmatization. Nothing happens.

Probably because we don’t want to admit it’s us.

We don’t want to admit we are the ones who have fought demons with the help of medication and professionals.
We don’t want to admit that there are times (still) when the mountain seems to be without a trail.
We don’t want to admit how hard the battle was because there is still shame in the battle.
We don’t want to admit that we know it could have been us.

I don’t know what drove Robin Williams to suicide. I know what its like to sit in that darkness and not feel. I only hope he has found his peace.

A new record on the way to the #PhiladelphiaMarathon

September 22, 2013

Less than sixty days to the insanity!  I am becoming excited about walking the Philadelphia Half Marathon for OAR (shameless fundraising plug).  In an effort to not become injured, I’ve started to cross train at the gym.  Between kicking, swimming, stationary biking and (ugh) weight lifting, I was injury free until I dropped a bed on my foot.  Yup, you read that right.  I dropped a bed on my foot.  I was attempting to rescue pink mouse (REALLY? AGAIN?) and blue rat (new cat, same issue) and the board came crashing down.  After few A lot of curse words, I realized my foot was not broken just going to have a massive bruise. Right across the top of my foot.  It healed.  And I was ready to resume walking.

Today, I started on my Sunday morning trek with the goal of “hit seven miles”.  7.4 miles later, I unlocked the key to the front door.  Really.  Ok, the time wasn’t great but it was done.  I skipped a ready-made excuse of the pouring rain thinking WWTD*?  Yeah, if it’s raining that day, I’d go. . . better get used to walking in the rain (although when it hit downpour level I did wait it out under the entry to some local business).

Somewhere between mile five and six, I found myself aware of how I was pushing my body. I see why runners run.  There is a point where it’s the next step, the air in your face and a feeling that is so completely different than anything else I’ve felt.  I can’t remember the last time I walked seven miles (maybe never).  As I walked through the office park on my path, I saw a dead snake (ew, but grateful for his/her demise), saw two deer romp along the front of an office building and realized the town next to me has an intersection of Bartlett and Lyman.

Two hours after coming home, I’m not hobbled in pain.  And I’m thinking this is the best impulsive idea I’ve had in a long time.

 

Move the bed, get my toy human!

Move the bed, get my toy human!

 

 

*WWTD in no way shape or form resembles a popular religious acronym.  The fact that the third letter refers to a person with wildly long hair and a strange cult like following is purely coincidental.  Pretty sure the other guy ate pie.

The insanity of attempting to use your #fsa and #insurance plans. #mangledcare

May 13, 2013

The flexible spending accounts (FSA) are one of the more under utilized benefits by many of my co-workers.  The net is that you can legally allocated up to $2500 (as a single person) designated from pre-tax dollars to pay for prescription medications, physical therapy, medical co-pays, etc.  Usually (keyword) it works like a charm; you go to the pharmacy to pay with the debit card and it’s done.

Until one day, you receive in the mail letter stating that they company managing the FSA system (in my case PayFlex) sends you a letter stating they need “an itemized receipt for the treatment received”.  It’s a Dante worthy ring of hell adventure just this side of having to be the unfortunate soul to cuts Donald Trump’s hair. Really.

Being a proper Gen Xer, I first tried to solve this issue on-line.  Being a total type A, save documentation you probably don’t need person, I pulled out the “Welcome to PayFlex” guide.  Any reasonable, logical, sane person would have waited until Monday to handle this over the phone.  After spending a few hours playing with the web site, I gave up and called.

I swear on Jackson’s life that the reason why costs care are what they are is because of the sheer ineptitude of the industry to become seamless.  It would save them money (increase profits), probably decrease secondary illnesses related to things like increased stress from dealing WITH insurance companies.  The reality is that none of these the issues I’m have their roots in the currently being enacted Health Care Reform Act/Obamacare.  My hope is that the new act will only LESSEN the frustrations.  I don’t have hope because the system is so entrenched.

So back to the attempt to use my FSA account. . . .

I mailed back the detailed receipt as requested.

They denied the claim.

I called.  Why was this denied? You didn’t use our form.  Uh, great but it doesn’t say to send a claim.  I read her the letter (really) and it didn’t mention a claim form.  A few transfers letter, they’ve agreed to re-review bill without the form since, you know, they don’t require it.

Back and forth, they ask if they can fax me something (no, I don’t have a fax number).  They are stunned.  I’m stunned.  I ask them to send me the form in the mail (true story: my printer broke and since I can use the printer at work? Why bother: most of my life is paperless) since I don’t have a printer.

Back on hold; they aren’t sure if they can mail me the form since it’s on-line.

More conversation, she keeps suggesting to me to use the online feature(s).  I wholly agree but I point out to her that since I am using my iPad, there is an encryption mismatch.  I agree to use my notebook to register for the services.  Turns out, my employee ID number wasn’t long enough: I needed 2 leading zeros. Turns out the zip code that I’m supposed to use is not mine but my employers (not in the information).  Log in.

Very first line? “New mobile applications for iPhones, iPads, Andriod and Blackberry.”

Somebody just send me Bully Boy Vodka.

 

Grey’s Anatomy the Evening Before Easter

April 7, 2012

I think I’m one of a dozen people who has watched Grey’s Anatomy. I’m not sure HOW I missed it when if first came out (thank you Netflix) but I caught the first 3 episodes today.

If you surf back in my blog, I think there is an entry about Maude Thursday and Holy Week from last year complete with an edited version of what happened. This week was the opposite. I’m not sure where I stand about my role in the church, that’s a different battle for a different day. I know now I feel safe (emotionally) where I worship which is a far cry from last year.

One of the early episodes of Grey’s dealt with organ donation and the resident reminding the intern that it wasn’t “skin”, “eyes” when speaking to the family, it was the person’s skin that could help others. I’ve sat in these meetings, I’ve heard the surgeons try to explain what would happen, the stunned families still trying to process the death of a loved one being asked to give parts so another person may live. Nobody likes these conversations. The doctors try to be clinical, afterwards some are lost in thought, others are snarky – no matter the outcome. The families grapple with the decision because in essence, the grief process is condensed to the finality of yes, my loved one is gone. And the social workers/chaplains won’t ever say it aloud but are silently cursing over what was probably a senseless death and trying to gather enough about the person to speak to the family afterwards.

I’ve been on the receiving side. It’s strange. Each time the redo one of my hips they put in more bone grafts. I was watching Grey’s, and the wife of the organ donor said something along the lines of how do I hold a funeral when my husband doesn’t have any skin? (reality, they take the skin from the back and thighs but that is an aside). I thought about the dozen families who wondered and still gave the bones for my grafts. It is hard to receive that gift: knowing it was because of a death. I rarely think about the giving (ok, I rarely think about it period, it’s not exactly laced with happy memories, just a lot of scars of varying sorts) and the courage it takes to let a part of a loved one live even when s/he is no longer with his/her family.

Many of us owe a lot to strangers who in a period of great darkness and sorrow, found the compassion and strength to give. As I sit the night before Easter, I can’t help but give thanks.

Resolutions and other nonsense

December 29, 2011

I’m not into New Year’s Resolutions – mostly because there seems to be a lack of creativity “I’m going to go to the gym every day” or “I’m going to quit smoking”.  A blog post circulated today about the UU church working on a wider justice, spiritual formation, more inclusive in its cohesiveness in the discipline of discussion.  Look, if I go to the gym every day, maybe it will help other members of my health insurance company (I mean, I’d probably be healthier and not spend as many health care dollars and all).  And no, I don’t smoke.  But, for me, many of the New Year’s Resolutions (like giving up things for Lent) have a self-serving motive.

The past year has, to me anyway, seemed to further create an us versus them divide.  99% vs 1%, Congress versus each other versus the American people, a complete and total increase in rising tensions: if you have a job, the insane competitiveness to prove why you should keep it, over and over.  It’s draining.  Maybe that has always been adulthood (how the hell would I know? I do know we have an amazing ability to glamorize and romanticize the past).

I think somewhere in the back of my head, I’ve always had this notion that people create resolutions on New Year’s Day after making a promise their higher power to never do anything like that again as long as they live.  Ok, that is probably my twisted humor after spending a few too many semesters at the overly politically correct institute of graduate theological education.  That and I’m a jackass.

This year, I decided to make a bucket list of some strange goals, some normal goals and a few I really have little control over.  If it happens, it happens. If it doesn’t and I tried, well, ok.  I’m not going to involve going to the gym in this list.

1) Purchase as many items as I can from locally sourced suppliers.  Some things are out: cat food! Jackson only eats one type and I’m not about to go through changing the food of a 14-year-old fur beast.

2) Less trash tv; more books.  Ideally, I’d like to read 3 books a week.  Some fun, some more thought-provoking.

3) Have a job with benefits.  While I’m grateful for my temp job for the past 7 months, I’d really like to drop the 100% payment of my health insurance.

4) Write actual letters to my friends.  You know, the types with stamps.

5) Be more creative in my cooking.  I can make a killer potato soup but maybe expand out my culinary skills.

6) Give up on the fact that on opening day, I am 100% convinced the Cubs will not make the World Series.  I’m trying reverse karmic psychology on this: work with me.

7) Plug my ears and shout la-la-la-la when anybody equates my dislike of President Obama as being racist.  I don’t like how he has governed: I’m sure he’s a nice guy for a south sider but I’ve not been impressed with his presidency.  I think he was set up from the start as many thought he was the second coming of Kennedy or Christ depending on who you spoke to about the topic.  I didn’t like him in the primary, still don’t.  Of course, my standard for POTUS is either LBJ or Andrew Jackson depending on my mood.

8) Make the decision to redo the condo or sell.

9) Buy new storm windows.

10) Buy a hair dryer. It’s been on my to do list for 5 years. I only remember it the first really cold snap.

11) Go to NOLA this year.

12) Resist all temptations to dress up Laffite as clown for Halloween.

And while you are waiting you can get a (not so healthy) bite to eat

October 29, 2011

A few weeks ago I had to have some diagnostic testing done.  Nothing major – but there was a wait time involved and the tech said to me I could grab a bite to eat while I waited.  Since I actually was hungry (and had lost the paper that said if I could eat before or not…), I went to grab something at the Souper Salad located at my favorite HUB area teaching hospital.  I don’t know if it’s a city law (or state – things I don’t pay attention to in this area) but the calorie counts were posted and a full nutritional disclosure was available.  From their website, the restaurant claims  “Since 1976, Souper Salad has been satisfying Boston’s appetite with a healthy and delicious menu  filled with the freshest Soups, Salads, Sandwiches, Wraps, Pita Pizzas and our signature Walkabouts.”  Healthy? As in Carol Brady healthy.  I was stunned.  Normally this isn’t a blog worthy event: although I’ll admit being a bit surprised that all of the breakfast options had over 25 grams of fat and the sodium count is out of this world (I mean, we are IN a hospital people! In all fairness the other option is Starbucks which isn’t much better and is a privately owned chain.).  Thankfully, I found a Luna bar at the bottom of my bag and grabbed an over priced bottle of water.

I was thinking this was some wacko anomaly until I ran across the following post on Fooducate.  3 major children’s hospitals in this country have a McDonald’s on site.  Yup, you read that right: Children’s of San Diego, Children’s of Los Angeles and Texas Children’s.  According to Fooducate, the one at CHOP closed because of space needs.  Ok, let me think this through: you have a child at a major teaching center, chances are it’s not for putting in ear tubes.  S/he has some thing seriously wrong or (let’s face it) because of the teaching status of the hospitals, you might be on some form of Medicare/Medicaid.  What does it say about the hospital to rent out the space to a known purveyor of garbage? junk food as one of the options?  How do doctors/nurses/dietitians look patients in the face and provide advise on overcoming obesity, eating healthy with limited resources, and providing tips on foods that are better choices than fast food when down the hall sits the golden arches?

Look, I’m the first to say hospital food (for the most part) sucks.  But the one thing hospital foods (and eateries in a hospital should be) is nutritious.  Perhaps as part of their well needed awareness on the food choices people make, the medical community should examine the food available within the four walls of their institutions.  In times of need, stress many people will eat: perhaps not encouraging bad nutrition by what is available would be a good first step.

A snarky start to the week.

August 2, 2011

Ugh. What a Monday.  The only good thing in my book was watching Rep. Giffords return to the House floor.  Who’d have thought it?

On the half full side … I did manage to remember to bring my lunch to work (yeah!), where I discovered I had a bag of oh so precious Resse’s Peanut Butter cups (score, solves the chocolate problem).  Unfortunately, by 8:30, my day had pretty much been tanked.

Granted, Monday and I are not the best of friends, but yesterday, I had a 7:15 physical therapy appointment.  Already feeling snarky over not getting to see my PT, and because of this whack-a-doodle contract I’m working, I was forced to use a location close to my temporary office that has hours from 7-7 and is affiliated with a major teaching hospital.  15 minutes into the evaluation with the new PT, I made the decision I’d ride out this prescription with her and not return.  Yup, it was that bad.  My number one pet peeve of anybody (but especially those working in the health care professions) is not listening/not reading the chart.  She didn’t do either.

Your doctor writes a prescription for physical therapy.  Most scripts are simply the impacted joint with treat/eval.  My ortho wrote a detailed script: I have a complicated ortho history (usually 28 ortho surgeries indicate that …) and he wanted specific modalities as well as more extensive treatment than a simple ankle/knee one.  At one point, out of sheer exasperation, I said, uh, it’s on the script.  She asked me what I was doing to alleviate some of the symptoms: I went through a detailed list of PT excercises that I do daily.  She then printed off the same exercises substituting a tennis ball for a racquetball for the plantar  and told me I needed to loose weight (thanks).  I was mildly irked: first appointment, yet to check range of motion, strength, laxity and she is giving me (the same) exercises as homework.  I had yet to take off my shoes.

Part of me was just laughing: the other part was livid.  She then told me I was sitting wrong.  My hip was flexed past 90 degrees.  I said, truthfully, my surgeon has seen me sit like that and he is ok with it.  She pulls out her measuring device (don’t ask me to spell goniometer) and says see, you are past 90 degrees. I was at 91.  I still had my shoes on.  35 minutes into this painfully slow ordeal that made me wish for even a student (and I checked – she has been at this facility since ’89), she finally gets around to examining me, you know, seeing what is wrong.  (Note: patients really don’t like FILLING out forms only to have you not read them).  I heard I had my last hip revision done at the wrong hospital (Hi, you don’t know *who* did the surgery, and he is one of the top 10 in the country), that I didn’t have plantar fasiciitis (um, ok, 2 mri’s noted it, plus the huge tightness on the ball of my foot, I have a high pain tolerance and the point of tenderness is in an atypical place), and why did I have knee surgery (read the surgical history: you’d see ACL repair).

Finally, I was asked what was bothering me: Tightness from the bottom of my hamstring to the ball of my foot because I can’t get my right leg into full extension.  My two orthos agree this is an issue: that probably isn’t skeletal but muscular and the best course it to try intensive PT before doing releases of tendons/muscles.  She looks at me and says “there isn’t a different in your leg length, your pelvis is even”.  Head:desk.  I demonstrated.

After more back and forth she asks about my insurance: I tell her.  She says “oh, I can’t treat you.” For real? I have 45 visits a year left (I used 15 when I strained my shoulder).  Apparently she needs to get authorization and why didn’t I tell them this when I called.  At my limit (which actually takes a bit with health care providers), I said “Nobody asked.”  She launches into a tirade of now she would have to do work to get authorizations.  Ok, look, I get medicine has become a paperwork nirvana.  I also know that a well written (probably an issue) evaluation will generate approvals.  I also know that because of the screwed up system, I can’t take my prescription back and get a new PT because it’s a double evaluation.

My hope is that she is a better practitioner than evaluator.  But after finding where she wrote on my heel cord with green ink? I’m not so sure.

I know I’m picky about my health care. I know that I have a complicated history.  It’s why I’ve found away to pay close to 6K a year for my health insurance.  I know there are a ton of good health care providers out there: and for all I know, she might be an excellent PT.  But I also know that if a provider doesn’t appear to be paying attention, I question his/her ability to practice.  And I also know, that telling somebody she can’t be treated is not the best way to start a relationship.  For all she knew, I could have paid out-of-pocket.  I also know, I’m not interested in hearing about the stresses of your job: I’ve got my own and we aren’t friends.  And it would have also been nice for you to ask my name.

(off soap box)

Taking a month of …. for now. The No Grocery Challenge

July 30, 2011

So, a friend of mine posted this blog a few weeks ago on Facebook (seriously, how did I live before smart phones and social networking!).  I chased a few links and found what might be one of the original blogs.  (Eh, who knows …).  The rules are pretty basic: don’t go to the grocery store except for what cannot be sourced otherwise.  There are few challenges floating about in the locavore world.  I was immediately interested and agreed to this mad cap challenge. Hey, it’s just me, right? I mean, aside from the sous chef and the prince.  And then I decided to step it up a bit.  I am keeping the basic challenge: buying everything at farmer’s markets, stands with a short exception list (below) and then only $30.  And no, I didn’t stock up on Coke Zero or ice cream!

A lot of the people involved have kids.  I can hear some people in my life now “of course it would be easy for you, you’re single.” (uh, yeah, i also have an hour commute and work roughly 50 hours a week but that is a different blog).  Yup, I live the life of a singleton.  That also means, that if I worked 12 hours that day, there is nobody I can call to say “hey, can you toss on some pasta for me” (well, that and being gluten-free also).  I’m also working for a company that is facing an audit probably in August.  ACK!  So, I know August will be insane.  So why not kick it up a step?

For August, I will not only avoid the grocery store (except the list below), I’m also skipping caffination stations.  Not giving UP caffeine (that would be a danger to others) but avoiding the fast food life style of the mornings and sometimes evenings that have fueled me during early morning commutes or late nights because I’m too lazy to cook something.  I realized how horrific my eating habits (despite some canning adventures) had become when I realized that one day I consumed (seriously) a package of pop tarts from a vending machine, some carrots and a tomato (probably a few thousand miles on those), ice cream with strawberry jam (ok, I made the jam) and 2 dill pickles. Why? It’s what I had either in the house to eat without cooking or had for the vending machine. Seriously.

When the challenge was posted, I realized hmmm. It would probably be good FOR me to do this: I despise chain stores, I try to be a locavore (but let’s face it … some mornings hash browns and coffee from Dunkin Donuts do hit the spot), I believe in local businesses well and the entire menu I listed earlier.  The thing is, to some extent this will already be easier for me than many: I buy my meat from the fantastic 8 O’clock Ranch (which probably means I’m not a locavore FOR meat but since they are a small ranch in upstate NY … I’ll stick with them), I get most of my fruits and veggies from Old Nourse Farm’s CSA.  My issue is more that while I’ll can/freeze food, I forget to USE that food in my I-must-eat-now mode (that and I don’t own a microwave).  So with a bit of planning, I’m going to go free from caffination stations, grocery stores, chains . . . what I do need to buy I will buy from family owned groceries.  This will be interesting.  I’m sure I won’t save money (one of the original bloggers is in Hungary. $2 wine? Ha.) The obvious benefit is breaking myself of this pop-tart diet I seem to be on!

So, with that … my August grocery list is limited to: vinegar, yoghurt (don’t tell me I can make it … epic fail), half&half, cat food (they do like to eat), salt, sugar and olive oil.  The greater adventure … figuring out what I’m going to eat for breakfast, lunch and dinner now that I’m avoiding chains and the cafe at the office. If you see me, and you love me? Please hand me Diet Coke.  I’m sure I’ll need it by mid-August.

Cracked, broken and a little disappointed

May 11, 2011

Today I did an ‘adult’ thing: I took care of me.  Ok, most days we all do this without thought.  Today, this action involved thought.  I have been working a series of temporary jobs on quite frankly a battered and broken body.  I had accepted an assignment with the following description:

*matching invoices

*organizing slips/paperwork

*pulling paperwork, entering data

 I’ve worked for this company before: it is a fantastic, proactive corporation that is forward thinking.  The reality is that the job involved standing in a non-temperature controlled warehouse pulling invoices out of boxes.  I know my limitations; I’ve painfully become aware of them.

 The company I’m working for and I looked at job modifications: there was one critical element that could not be modified.  I am grateful for them for working with me to try to figure out how/if the job could be modified: yes, it’s the law, but I’m also a temp.

 Today is one of those days, there aren’t enough ice packs, heating packs, muscle relaxants and e-stimulation to quell the pain.  The pain is exhausting.  In the midst of all of this, I was listening to a podcast on lower back pain: I was hoping to get tips on how to manage multi-level disc involvement.  Instead, I found a podcast delivered to medical students about how many people with chronic pain are looking for disability claims.  I felt stabbed.

 As I stood pulling information out of a warehouse, I heard the myth of chronic, persistent pain continued by a medical school professor.  Today was a day I’d give you everything I own if you could promise me a pain free day.  Just one day without pain: one day.  I wanted to find that lecturer and let him examine my body and tell me that I was seeking special treatment. I wanted to find him and show him a few years of working in jobs which caused me to undergo countless steroid injections into my back, a few nerve burnings and constant pounding dull pain. Actually, I didn’t want to see him: I wanted to find the medical students who were subjected to these myths.

 A few decades ago, a wise orthopedist told me that ‘around’ the age of 35, I’d have issues in standing, walking distances.  Telling a 15 year old that . . . well, 25 is ancient.  I wish he was wrong.  I wish one minute when I was 10 didn’t alter my life forever.  And I wish I could find a job.  The sad thing: I can work; I tried to do this job and just realized that I couldn’t.  72 hours of non-stop pounding pain and not being able to modify an aspect of a job, I had to let my boss know that I wouldn’t be back on Monday.  I had to surrender and admit that while I’m willing to do anything, my body can’t.

 And just once, just once, I’d like for my body not to betray me.  For various reasons, I’ve had 31 surgeries: 28 of them orthopedic: all on my legs (everything except my left knee, knock on wood).  And I want to find the myth-mongers who say pain like this isn’t real and let the walk in my shoes for a week.  I’m not interested in disability: just a job that doesn’t leave me wrapped in ice for 10 hours.  And just once, I’d like somebody to understand how emotionally painful this is without saying something like “well, I know my pain isn’t as bad as yours but. . .” or “Oh, I hear you.”  I don’t know what I want people to say.  Maybe just an acknowledgement that the system sucks, that most people who live with chronic pain aren’t looking for an easy way out and maybe understanding that there are jobs that just can’t be done not because of pride but because of the body.  Or maybe I just want a hug.

Well, there was cake involved . . . . Gluten-Free cake.

April 25, 2011
GF Ricotta Pound Cake

Cake only improves life!

I’ve been on the gluten-free bandwagon for about 2 years pretty hardcore. It’s made a ton of difference in my life (mostly a marked decrease of migraines, and not feeling sluggish and all) but *finding* GF desserts is a pain.  Making GF desserts is even harder (I’m convinced it’s in the flour!!) but Easter Sunday, I hit a home run. I’m thrilled.

Gluten Free Chocolate-Orange Pound Cake

1 1/2 sticks butter, at room temperature
1 1/2 c gluten free flour (I use Bob’s Red Mill)
2 1/2 tsp baking powder
1 1/2 c whole-milk ricotta cheese
1 1/2 c sugar
3 large eggs
1 tsp vanilla extract
1 tsp orange extract
2 Tbsp Godiva chocolate liquor (or any other flavoring!) (I also use the ‘airline bottles’ for cooking – so alternatively, one ‘airline bottle’.)
1. Preheat the oven to 350 degrees F. Grease a 9-by-5-by-3-inch loaf pan with butter or shortening (I use the wrappers of the butter sticks!)

2. In a bowl, add butter, ricotta and sugar. Cream until fluffy and butter is completely blended.  Add in vanilla, orange extract and flavoring of choice. Cream in baking powder.

3. Alternately add ½ c of flour and one egg until all have been added and batter is smooth and creamy (about 4 minutes)

4. Pour batter into prepared pan and bake until a toothpick comes out clean and the cake pulls away from the sides of the pan, 50-65 minutes. Let cool in pan 10 minutes, transfer to a rack to cool completely.

I found that for GF cakes, often the edges might be darker than non-GF.   Because of the variations ON GF flours, I do the knife test starting at minute 50 as not to over bake – and yes, GF flours have that much variation! This cake is exceptionally moist and holds the flavor of the chocolate liquor and orange well.  I’m in love with my cake. I can’t wait for the next excuse to make it! (and yes, I skip xanthum gum). :)