This book had wide appeal for those who need help with medical bills. To date I have not found a book that concisely describes the most effective strategies for managing medical costs and speaking to billers and collectors. I have assembled a straight-forward approach for doing exactly that. The most common problems that people struggle with in this respect are relatively simple to me because I've worked several years at the corporate level and on the front lines of a national healthcare management company and have a master's degree in hospital administration. The wide variety of medical bill problems makes it difficult to address every possible type of problem, so I've tried to focus on the most common issues. This book will benefit the following patient and patient families:

- Insured patient who are experiencing difficulty paying the deductibles, copay, and coinsurance.

- Uninsured patients who are unemployed and cannot affor health insurance.

- Patients and families of patients who have survived a catastrophic medical episode like cancer, heart attack, or major surgery.

- Patients with chronic diseases requiring continuous, costly medical care like heart disease, COPD, or diabetes.

The very fact that you've selected this book tells me that you need help. You don't have to worry anymore. I've been there, on both sides of the phone, and it's going to be okay. The first thing I want to do is alleviate your anxiety by sharing a story about my first success as a patient advocate.

Carol was fifty years old and had not been to a gynecologist in twenty-five years. She had chronic pain for years and refused to see a physician. One day the pain was so unbearably excruciating that she was actually toying with the idea of going to an urgent care, but figured she might save a few dollars by first talking to her nurse sister-in-law Maggie. Maggie was appalled and immediately had Carol admitted to the hospital. This saved Carol's life, as she would have been dead within a few hours. Over the next two years, Carol would have multiple major surgeries, oncology treatments, and intensive care stays. She would lose over fifty pounds and all of her hair. She would have her colon detached, re-attached, and detached again forcing her to wear a colostomy bag for the rest of her life. She would also have a major relapse and remain comatose for over ten days after an emergency surgery.

Though Carol was insured, she was stubbornly inclined to declare bankruptcy to wipe out the tens of thousands of dollars of deductibles, copays, and coinsurances she owed. I learned she was screening her calls so she wouldn't have to talk to billers and become angry and vulgar to those that did get through. She had ignored her financial problems in the same way she had ignored her disease and made virtually every wrong decision possible along the way.

Despite ignoring her bills for the better part of a year, I spoke to over ten of Carol's providers about her situation over a six-week period and was able to eliminate the vast majority of her obligations. Her largest debtor, the hospital, ultimately waived 70% of her account because of my calls.

I am not in a secret club and there's no secret password. All of the things I said to Carol's billers are contained in this book. Carol was the quintessential procrastinator. She was and...

Roasted Shrimp with Fresh Ginger on Wilted WatercressThe sweet flavor of shrimp is complemented by the complex blend known as five-spice powder, which is in turn counterbalanced by peppery watercress. A completely satisfying meal.

Makes 2 Servings

2 tablespoons olive oil
1 tablespoon chopped fresh ginger
1 large garlic clove, finely chopped
¼ teaspoon five-spice powder
½ teaspoon kosher salt
½ teaspoon freshly milled black pepper
12 ounces large shrimp, peeled
4 cups watercress, rinsed and rough stems removed

Preheat the oven to 350° F. Stir together the oil, ginger, garlic, five-spice powder, salt, and pepper in a medium bowl. Toss in the shrimp, coating evenly, then cover and let stand for 10 minutes or so.

Arrange the shrimp in one layer on a baking sheet. Roast until the shrimp turns pink, 3 minutes. Remove the shrimp from the oven and set aside on a warm plate, covered, to keep warm. Place the watercress (still wet from washing) in a hot skillet and stir-fry just until wilted, about 1 minute. Divide the watercress between two dinner plates and top with hot roasted shrimp. Serve at once.

Nutritional Analysis: 263 calories, FAT 16 g, PROTEIN 28 g, CARB 3 g, FIBER 1 g, CHOL 242 mg, IRON 5 mg, SODIUM 888 mg, CALC 141 mg

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Thai Style Beef Mint Salad

This dazzling green salad is truly mouthwatering. It combines salty, sour, and sweet flavors for a completely satisfying meal. The dressing recipe is a basic Thai sauce that can be used on many other mixed greens, bean sprouts, and cabbage. Some theorize that crunchy food is so appealing because it allows us to vent our frustrations; better to crunch on a salad than on potato chips . . . or your coworkers or your partner.
Makes 2 servings

Dressing
½ cup fresh lime juice (about 2 limes)
2 tablespoons fish sauce (nuoc mam)
¼ teaspoon sugar
2 teaspoons vegetable oil
One 6-inch piece fresh lemongrass (tender center cut into three 2-inch pieces)
One 10-ounce New York strip steak
1 tablespoon chili powder (we love Gebhardt's)
2 cups romaine lettuce, washed, dried, and sliced into 1-inch-thick ribbons
¾ cup fresh mint leaves, cut into ribbons
½ cup fresh basil leaves, cut into ribbons
1 large hard-cooked egg, sliced

Mix together the dressing ingredients in a large salad bowl and set aside.
Heat an indoor or outdoor gas grill or a dry cast-iron skillet for 5 minutes, or light a charcoal fire. Grill the steak until medium-rare, 3 to 4 minutes on each side (if using a black skillet, you will want to spray it with cooking spray). When the meat is cooked, cut it into thin slices and toss with the dressing. Remove to a plate and sprinkle the steak slices with chili powder. Remove the lemongrass stalks from the dressing. Now, in the same bowl, toss in the romaine lettuce, mint leaves, and basil leaves. Toss the greens thoroughly and divide them equally between two plates. Top with slices of steak and sliced eggs. Sprinkle the eggs with chili powder.

Nutritional Analysis: 573 calories, FAT 33 g, PROTEIN 57 g, CARB 11 g, FIBER 3 g, CHOL 246 mg, IRON 7 mg, SODIUM 1,549 mg, CALC 133 mg

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Shirley's Sautéed Sherry Chicken

Keep packages of chicken tenders or boneless, skinless chicken breasts...

Chapter 1
MOTIVATING YOURSELF

First and foremost, before you start any exercise program, you need to have had a physical and a clean bill of health within the last year. Once you get the OK from your doctor, you should be ready to start a gradual exercise program.

The hardest part about exercising is getting started. Everyone has a hundred excuses not to work out, including brides-to-be-and I've heard them all! Preparing for your wedding is time-consuming, but don't make that an excuse for not exercising. The time to start exercising was yesterday, but I'm willing to give you a break. The time to start is now, today, not next Monday! Don't think, "I'll do it later," because later never happens! Suck it up, put on your workout clothes, and get going! I tell my clients, "If it were easy, everybody would be doing it." Exercise is not easy; it's a commitment-just like planning a wedding. You wouldn't shortchange yourself on the cake and flowers, so why even think about shortchanging your own body? I always remind brides-to-be that the cake and flowers are forgotten after the wedding is over. But how many people leave their wedding picture on the mantel for the rest of their lives? If anything, that should be motivation enough! Who wants to look at her wedding picture year after year and regret not being in shape or even not feeling her best?

That's the beauty of this book. It focuses on simple, effective workouts that can be done in your own home. Most of the workouts outlined in the following pages can be completed, start to finish, in only an hour. That's all it takes! If you can, find a friend, a bridesmaid, your maid of honor-anyone who is willing to work out with you and motivate you-and do the program together. Brides often ask me, "When is the best time of day to work out?" There's a simple answer: The best time to work out is any time when you will actually do it. Try to schedule your workouts during the most convenient time of the day. If you have a busy schedule (as most of us do!), you must create the time. This book is not magic; you must make the commitment to work out consistently. Consistency yields positive results. I recommend working out at least three times a week; irregular training will take much more time to achieve results.

Most of all, make your training sessions fun! Wear exercise clothing that makes you feel good, even if you are training in the privacy of your own home. Put away the bulky leg warmers you haven't worn since 1987 and break out the sports bra! Reinforce feeling well by wearing something that makes you feel good!

The average American watches 12 to 15 hours of TV a week. Do you think on your wedding day you'll regret having missed another Friends rerun? Or will you wish you'd taken the time to get your arms looking like Jennifer Aniston's?

Incorporating exercise into your daily life should be a priority, whether you are getting married or not. Exercise affects your mood and will also increase your energy level. Again, schedule exercise into your day at a time when it's convenient for you, but don't procrastinate!

THE BEGINNING

Don't bite off more than you can chew. Most brides-to-be who start working out get frustrated early on because they try to do too much at the start. If the day after exercising you are so sore and achy that you can hardly move, you started at a level you weren't prepared for physically. More is not better when it comes to starting an exercise program. Feel good about your workouts, and don't expect your body to do something it...

Chapter One
The World's Fattest People

Why make an effort to reform our dietary habits from the ground up? I hate to say it, but at this stage in the game, it's because we have no choice. In recent decades, we've seen a disturbing trend ripple around the world: people are getting fatter, and as a consequence, their lives are getting shorter. In 2006 there were more than 1.6 billion overweight people in the world, and the World Health Organization (WHO) projected that these numbers would grow by 40 percent by 2016.1

According to WHO, these are the places in the world with the most overweight adults:2

1. Nauru (94.5%)

2. Federated States of Micronesia (91.1%)

3. Cook Islands (90.9%)

4. Tonga (90.8%)

5. Niue (81.7%)

6. Samoa (80.4%)

7. Palau (78.4%)

8. Kuwait (74.2%)

9. United States (74.1%)

10. Kiribati (73.6%)

11. Dominica (71.0%)

12. Barbados (69.7%)

13. Argentina and Egypt (tie) (69.4%)

14. Malta (68.7%)

The number you see after each country reflects the percentage of adults (age fifteen and up) who have a body mass index greater than or equal to 25, which is considered overweight. Even though the United States isn't number one, experts consider it to be the most alarming country on the list. That's because with more than 225 million overweight people, the United States has the largest number of obese individuals in the world. It also exports its unhealthy habits to countries all over the globe. The passion for fast food that started in America is now a worldwide phenomenon.

According to the National Center for Health Statistics, nearly

two-thirds of the U.S. population qualifies as overweight. Half of that group--or nearly one-third of the population as a whole--has been categorized as obese, which is defined as having a body mass index over 30, or more than thirty pounds over a healthy body weight.3

In the United States alone, obesity costs $117 billion a year, a figure that seems to get bigger every day.4 In 1997-1999, hospital costs for obese children and adolescents topped $127 million. Just twenty years earlier, those costs were only $35 million.5 Not only that, but our collective girth is triggering huge health problems across the board. Carrying extra weight can increase a person's risk for a wide range of conditions: hypertension, cardiovascular disease, diabetes, and some types of cancer, to name just a few. The saddest part of all is that most of the illnesses associated with obesity are 100 percent preventable.

Of course, it's not just what we Americans eat that keeps thickening our waistlines. It's also our misconceptions about eating in general--from how we prepare our meals to when and where we eat them. In this book, we'll be looking abroad to learn how to make more responsible, and more fun, decisions about every aspect of eating--decisions that will keep the pounds off, prolonging and enhancing the quality of our lives.

But before we set about studying, and eventually imitating, how other cultures live and eat, we need to focus on the home front--on the bad habits that got us into all this trouble in the first place. Of all the nations on earth, we have no excuse for being this fat and unhealthy. America is the richest nation on the planet; we have top-notch doctors, advanced medical technology, widespread food availability, and gyms on every corner....

From the book

Chapter One

Cardio's Reign of Terror

In 1977 Jim Fixx published his first book, The Complete Book of Running. It sold more than a million copies, and at the time it was the bestselling nonfiction book ever published. With that one book, the whole cardio craze was unleashed. Since then, we have heard hundreds, if not thousands, of doctors, exercise physiologists, and fitness experts go on and on about all the benefits of cardiovascular exercise.

In 1981 I was living in London and was about to turn twenty-one. Determined to drop some weight (I just couldn't face that milestone birthday feeling so out of shape), I took up running. I was twenty pounds overweight and trying to quit smoking for the fifty-third time, so I used the running to offset the extra calories I feared I would be consuming when a cigarette wasn't in my mouth. I didn't gain any more weight, but I didn't lose any either. For months I was running every day for an hour to an hour and a half, for a total of about ten hours per week, and didn't lose an ounce. If you eat, eat, eat and run, run, run (or perform any form of cardio) as I did, at the end of the day, you won't lose any weight. Learn from my mistake, and don't blow ten hours a week exercising for nothing.

As running became more popular, high-impact aerobics was also hitting the scene. To relieve some stress and try to get rid of the extra pounds (since the running didn't work), I took up high-impact aerobics, still convinced that cardio was the key to weight loss. One Saturday the teacher did not show up for the eight a.m. high-impact aerobics class. About a hundred of us, mostly overweight regulars, stood around for fifteen minutes until I said, "If someone can find a tape, I'll teach." I had the routine memorized, which is never a good thing (as you will soon learn), so up I went to teach the class. Since the teacher didn't show up for the nine o'clock class either, I taught that one as well.

After that class, the manager of the club approached me and asked if I wanted a job as an instructor. I asked what the offer was and he said, "You get four dollars an hour plus a free membership." So began my career as an aerobics instructor.

From that day on, my doomed relationship with cardio was official. Okay, I want to be honest. I am a recovering cardioholic. I have been "clean" for many, many years, and continue to stay as far away from straight cardio as possible, and I'm in the best shape of my life! But for quite a long period of time, I, too, was adamant that cardio was the key to weight loss. Boy, was I ever wrong.

Here is the rest of my history with cardio, which I refer to as the Karas Cardio Rap Sheet:

• Low-impact aerobics: Same concept as high-impact, but less jumping, so it wasn't quite as painful on my body, but I still didn't lose any weight.
• The Step: Similar to low-impact, but there was a lot of flailing around like a crazy person and almost tripping and falling as I went up and down, up and down a step.
• The Slide: It was sort of fun to slide back and forth on a slick surface. I didn't lose any weight, but I did relive childhood memories of sliding on the ice.
• Spinning: Spinning really took the cardio world by storm. To this day, spin class is popular among those who still haven't figured out that all that cardio won't get them the results they are...

INTRODUCTION

As an athlete, staying in shape has been my life's work. It's also my passion and the source of my strength and confidence. When I work out, I feel most like myself and most comfortable in my body and mind. I feel motivated to continue to set new goals for myself, go after them, and give them my all. You might think that this tenacity comes from being an Olympic athlete, but I believe it's the result of living in my body in an active way. Working out and staying in shape is simply how I take care of myself, and when I do this, everything else in my life falls into place. The same can happen for you. You might not have come to this book with aspirations to make the Olympics, but I can promise that what you find here will not only show you how to achieve your best physical shape, it will also inspire you to be the best you can be in all areas of your life.

Gold Medal Fitness is a five-week plan that will reshape your body through revolutionary strengthening and resistance stretching exercises that lengthen, tighten, and build your muscles. The plan will also offer a fresh, efficient way to include cardio in your workout, and share what has become my secret weapon--an active recovery phase. This plan is based on the training I've been doing for the past four years, since I made the decision, as a thirty-nine-year-old new mom, to try out for the 2008 Olympic team. Because of these cutting-edge techniques, my own fierce determination, and the support of a handful of devoted trainers, I not only went to Beijing to compete, I came home with three silver medals.

The games in Beijing were my fifth Olympics. My competitive swimming career has spanned three decades, and I'm not finished yet. As a student at the University of Florida, I earned the maximum possible number of NCAA all-American swimming awards--twenty-eight--and as the first U.S. swimmer to compete in five Olympic Games, I set three world records and won twelve Olympic medals, including four gold. And I'm still not finished.

This book is for all of you who don't want to hang up your suit, take off your running shoes, or give up on feeling--and looking--great. My memoir, Age Is Just a Number, might have introduced you to me and some of the events in my life. But this book will share my workout regimen with you. We may not have exactly the same goals, but I bet we do share similar needs. Wouldn't you like to pick up your kids without your back aching? Have the energy for an early-morning workout before getting kids to school or yourself off to work? Achieve a sense of balance that enables you to feel relaxed, confident, and strong instead of depleted by the end of the day? I will show you how to achieve these results--and more--while getting into the best shape of your life.

How This Book Came to Be

After the 2008 Beijing Olympics and the publication of my memoir, I traveled around the country doing a book tour and making appearances as spokesperson for Hewlett-Packard, Fitness Nutritions and other companies and organizations. During this busy year, as I continued to train for the nationals and World Championships, I met thousands of women and men of all ages who wanted to hear about how I had made a comeback as a forty-one-year-old athlete. As I crisscrossed the country, I was struck by how many women approached me with questions. "How do you do it?" "I can't believe you're still going so strong! What's your secret?" I began to think about how I approach training and how my regimen might actually help other people--regardless of their age or level of athleticism--get...

Chapter 1
STARTING

As with any fitness regimen, before you even begin this one you must visit your doctor or health care professional to make sure you're in fighting shape to start Making the Cut. Once you get the all-clear, the first step toward success is setting goals-you can't get anywhere if you don't know where you're going and what you want. But it's no good setting goals if you're not straight with yourself about where you're starting from, which is why Making the Cut begins with a thorough assessment of your current situation. Identify in cold hard terms where you are right now, and you'll have a crystal-clear idea of where you want to be. And once you get there, you'll never want to go back! Having a record of where you started is also a critical and often-overlooked source of motivation. Sure, you may know that when you complete my program you will lose inches from all over your body and get stronger. But if the going gets tough and you need an inspirational boost to keep going, you won't believe how motivating it is to take a step back and be able to chart the progress you've already made.

Last but hardly least, it is important to make sure you are mentally prepared for the hard work and the changes that lie ahead. Most fitness books deal only with the diet and exercise parts of losing weight and getting fit. In my experience, mental readiness is just as key to your lasting success.

The following chapters walk you through all of the important first steps, so that we're sure you're starting with your best foot forward.

GOODBYE PHOTOS

Where would any kick-ass makeover be without "before" and "after" pictures? Well, that's where we're going to start, except this is more than a before picture; this is a goodbye picture. Say goodbye to the old you, and get ready to embark upon a fitness journey that will change you for life. Take several photos from different angles, one from the front, one from the side, and one from the rear. And wear as little as possible-the more you show, the more you'll know.

BODY FAT ANALYSIS

Let's be clear: Making the Cut isn't about losing 100 pounds;

"I am somebody with cancer and I am somebody without cancer."SAMANTHA EISENSTEIN

I became a survivor when I was diagnosed with Ewing's sarcoma in December of 1999.

I went down to New York for treatment and started in January of 2000. Treatment went through September of 2000 with seven rounds of high-dose chemo and surgery. The tumor was in my leg, in the tibia. I spent about four months at home afterward, September through December, recovering with physical therapy. I was a senior in college when I was diagnosed and only had one semester left. I went back to school in January of 2001 and was always tired, always bruising, and always catching everything that was going around. Because of the high-dose chemo that I got, I kept going in for tests, but the doctors just kept saying, "Your bone marrow is tired. It'll start working. It's just working slowly." Finally, I went in for a bone-marrow biopsy in April of 2001 and they found the secondary myelodysplastic syndrome, which is one of the precursors to leukemia. I said to them, "If there is anything I can be doing from now until May when I graduate, I'll do it, but otherwise, leave me alone. I want to go back to school." I knew that the search for a bone-marrow donor could be long and drawn out. They said that was fine. So I went back and graduated from college in May of 2001. I started chemo again in June or July to get the disease back into remission, because it had started to progress. I was home for a couple of weeks and they found a perfect donor match for me. All they told me was that he was young and male. I found out later he's from St. Louis, but I haven't met him yet. I underwent the bone-marrow transplant in August of 2001, was in the hospital for three months, spent the nine months afterward going in for tests and medications and anti-rejection and anti-everything drugs, and finally in June of 2002, they said, "Okay. You're set. Go do your thing." So I went up to graduate school at Middlebury College for the summer and moved to Boston in September of 2002. I started working for a public-health-education nonprofit where we do mostly HIV-prevention research, and interventions and violence prevention.

Then last year I went to the I'm Too Young for This symposium that was held at MIT. It was the first time I even found out that there were other young-adult survivors, because in a hospital like the one I was treated in, sadly, nobody ever really left. All of my friends had passed away. I didn't have any people that I went through treatment with who made it long enough to go through the survivorship journey with me. Since I finished, I had been struggling with my appearance and scars, all the issues that are not the day-to-day chemo stuff and therefore didn't feel legitimate. But I went to that conference and saw that there was a whole community of people like me out there. The keynote speaker talked about how he gets approached by so many survivors who say, "I need to quit my job. I don't know what I want to do, but this is where I want to be." And I realized that's exactly how I felt. So my friend Bridget and I started talking about organizing a benefit concert for young-adult survivors to help them transition out of treatment and into the "real world." We started doing research and found that there aren't any organizations designed to provide educational scholarships, professional training, and advice on rent, loans, car payments, grocery and residual medical bills for young-adult survivors. But instead of being discouraged and giving up completely, we gave up the idea of the benefit concert and just decided to go full steam ahead and create our own...