Category Archives: Health

Me & My Migraines – A Preventative Update & a Good Excuse

So it has been a while since my last blog post and even longer since my last update on my struggle with migraines.  It’s all my migraines fault!

As I sat in the patient exam room, the nurse took my temperature, monitored my pulse, and took my blood pressure.  I had scheduled an appointment a few weeks earlier with a desire to discuss further treatment options for my migraines.  They were growing in frequency and intensity and were not controlled real well by the sumatriptans that I have relied on the last ten year to live a normal life.  Though I didn’t mention that I was currently experiencing yet another migraine on this exam day, it must have been apparent since the nurse, with extra compassion, said she hoped I felt better soon and dimmed the lights as she departed for my short wait for doctor to enter.

My former PCP had left the practice several months ago, so this was to be my first visit with my new PCP.  He was somewhat familiar since I had selected him for my husband, and my husband has been under his care for about a year and reported good things about him.

Dr. G entered the exam room, took one look, and realized I was knee-deep in a migraine attack.  He kept the lights low and introduced a medical student who was shadowing him for the day.  Dr. G took a quick history of my migraines and my treatment of them and noted that about 30 minutes earlier, I had taken a sumatriptan with the hope of overcoming the current attack.  It still wasn’t controlling it.  He advised the medical student that with my discussion of my migraine history, my medical chart, and my current state, he was not going to put me through the pain of an exam, particularly the pain of flashing a light in my eyes.  We were all quite confident of what was going on here.

His next question was one that would start a new course for me.  “What are you taking to prevent the onset of the migraines?”  I looked at him with no answer.  “You mean in all these years, no one has discussed prevention?”  My answer was, “no.”  I explained that for the most part, I was able to control the attacks, at least until the last several months.  Historically, I had a handful of migraines each month and the triptans would manage them.  However, for the last several months, I was getting several migraines each week and sometimes the triptans would work, sometimes not.  I was also at the point where I was rationing the triptans because I couldn’t refill the prescription as frequently as my head pain required.  I explained that my work was being negatively affected and my parenting was also suffering since my goal these days was to get through the day such that I could lie down and sleep.  However, even sleep was being interrupted frequently now because the pain would awaken me necessitating a trip to the bathroom to get yet another triptan.

My goal, I thought, was to obtain yet another referral to a neurologist and/or an integrated team of pain specialists.  In years past, I was told my migraines were hormonal and not neurologically based.  But perhaps this had changed I thought.  Perhaps I have both going on.  I had noticed several peri-menopausal symptoms, so my other hypothesis was that my hormones were particularly wacky and that perhaps I could find the integrated team of doctors who could treat me for both neurological and hormonal issues.  I had heard of at least two other women who found migraine relief through this type of integrated treatment approach.

Dr. G had other ideas.  “First,” he said, “We’re going to work on ridding you of your current migraine.  We need to break the cycle of pain you are on.  Then, we’re going to work on preventing your migraines.”  He explained several options.

  • Blood pressure medications.
  • Low-dose anti-seizure medications.
  • Low-dose antidepressants.
  • Lose-dose birth control pill.  Even over age 40 where there is no incidence of high blood pressure and the individual is a non-smoker many migraine sufferers have found relief with a lose-dose birth control pill – essentially, a low-dose hormonal replacement.

My blood pressure is very low, so my perception was that this preventative approach would put me super slow motion like that of a sloth and likely would not be effective.  He laughed and agreed I was not a candidate for blood pressure medications.  I inquired whether the anti-seizure mediations made sense since my migraines have been determined to be hormonal in origin.  He agreed that their effect might be limited.

That left the anti-depressants and the birth control pill (hormone replacement).  I admitted that the pill concerned me because of the research associated with hormone replacement after age 35 resulting in cancers.  I also mentioned that in the past, these pills made my migraines consistent but did not relieve them.  That left the anti-depressants.

Dr. G indicated that he believed these medications would be the best for me, but that so many patients have issues with the stigma of taking anti-depressants that he often has a difficult time convincing people to try this treatment course.  I explained to him that I would much rather be stigmatized with the ability to fully function as a mother, wife, and professional than feel like I do right now.  “Let’s try the anti-depressants,” was my reply.

He wrote out the prescription and noted that this was a first step.  If these don’t work, we can increase the strength.  If that doesn’t work, we try other avenues until we get the migraines under control.  “You have too many years until you are through menopause when it is likely these migraines will largely subside,” he said, and I agreed.

“Now,” he said, “Let’s work on getting rid of your current migraine.  I’m ordering a shot of Toradol.  This should relieve your pain today, so we can start from a painless state.”  He explained that this drug was not a narcotic, since I indicated I was concerned about driving home.  He said that it was much like a super-Ibuprofen and that I would be fine.  He wished me luck, handed me my prescription and orders to come back in about a month to assess.

Though I was still in much pain, I felt optimistic for the first time in several months.  Just the thought having several avenues of treatment gave me hope.  Minutes later, the nurse returned.  This shot will need to go in your hip and I’m told it burns a bit she had explained.  It had been years since I had a shot in the hip.  I followed directions and exposed some hip.  Burns a bit?  Ah, yes, but more than a bit!  For a few seconds, I forgot about the migraine pain since the pain in my backside superseded it!  But, it was over quickly and I made my way to check out.

I dropped off my prescriptions at CVS, took in some dry cleaning, and then made my way to the post office to pick up some stamps.  As I was standing in line, the Toradol took effect.  It was if I had walked out of a dark cave or out of a thick fog.  For the first time since late summer, I realized I was pain free.  I realized only then that I had indeed been in a constant state of pain for several months.  The pain had crept up on me without my knowledge.  I was having migraine attacks that I was progressively treating with triptans, but the medication was no longer bringing my pain down to zero.  It was enabling me to get barely functional such that I could get through the day, but getting through was it.  I was delivering my work projects at the deadline when generally by nature, I deliver in advance of the deadline.  I was parenting with an effort to get them prepared for the next day and not enjoying the current day with them.  I was parenting with very little patience, and the boys indeed were reacting in negative ways to my impatience.

I had forgotten what pain-free felt like.  It was amazing!  I thought to myself that while so many take prescription drugs, legally or illegally, to feel nothing or to feel some type of euphoria, for me, just feeling nothing was everything.  Feeling normal felt so abnormal and it was simply amazing.  “Next,” said the postal clerk, bringing me back to consciousness.

So it has been several weeks, and the daily low-dose of antidepressants seems to be working.  I have had a few migraines, but they have been quickly controlled by the triptans.  I’ve had my follow-up appointment with Dr. G and thanked him profusely.  Now being the aggressive pain manager he is, he suggested that I increase the dosage in an attempt to eradicate the incidence of migraines all together.  I responded that at the current dosage, I’m noticing none of the long list of side-effects that antidepressants can have and that if I can reduce my migraines to a handful a month and that they can be controlled by the triptans, I’m happy with that.  I can deal with this state-of-being for the next 12-15 years until I make my way through the tunnel of menopause.  More importantly, I can look forward to 12-15 years of being a fully function mom, wife, and professional again.

So this is my excuse for the delay in blog posts.  Though I have been largely pain-free for a several weeks now, after five or so months of constant pain and just getting through the day, I’ve had a lot of catching up to do.  There are still things undone, but I’m getting there, and importantly, I am no longer attempting to get through the day but rather enjoying the day – well most days.  And even the not-so-enjoyable days are better because, for the most part, they too are pain free!

Nationalized Health Care – Does it really have to be that complicated?

“The US healthcare system is the best in the world.”  I hear that from several talk show hosts and their guests.  Why people from around the world come to the US to get healthcare when they get sick!

Indeed, we do have a great healthcare system.  But it is only great if you are independently wealthy (like those people from around the world who come here to get treatment), or you are properly insured.  If you don’t meet either of those two requirements, the US healthcare system isn’t that great.

One of the themes that Barack Obama ran on was a reformation of the US healthcare system.  He argued that our system isn’t fair and it’s too costly.  And I have to agree.  There are few out there that wouldn’t argue that we could use some improvements to our system (except, of course, for those extreme conservatives and those who want nothing that the Obama administration supports to succeed).  But the reality is, office visits are expensive.  Treatment is expensive.  Drugs are expensive.  Health insurance is expensive.  And the stories of the uninsured and the underinsured are horrible, and unfortunately, plentiful.

So we’re hearing bits and pieces of the health care reform bills going through our legislature, and frankly, the bits and pieces are frightening.  If you change jobs, you have to take the government plan.  If you aren’t insured by a private plan by July 1, XXXX, you have to take the government plan (meaning that eventually, every citizen will be in the government plan).  The only exemption from this mandated government plan will be of course, the legislators who developed it (if nothing else, that alone should raise our suspicion, red flags, disgust, <insert your terms here>).

We’re also hearing about the tax proposals to cover this plan.  Those of us who are lucky enough to have private health insurance will pay a tax on that insurance, some say as much as $4,000 (they didn’t indicate whether that was per insured household or insured person).  This action too will send many to the government plan.  And, now they talk of taxing food and beverages to pay for the plan.

And lastly, we hear that some bureaucrat will be making decisions on your care based on your age, health status, and let’s face it, other things like your celebrity, your ability to bring in votes for the bureaucrat, etc.  And it’s quite likely, the way that government works, that the bureaucrats running the “reformed” system won’t be experts in the field.  They’ll be friends of the current administration.  Remember FEMA & Katrina?  Did they have operations and emergency experts directing that operation?  Nope – they were “friends” of the Bush administration.  That’s why we had semi-trucks full of ice traveling around the country for months and communications specialists telling us that all was well and under control in New Orleans while simultaneously the media displayed images of mayhem and distress – kind of our own US “Baghdad Bob” approach.

Now generally, doctors and those that work in the health care system seem to support health care reformation, but many seem reluctant about the kinds of things we’re hearing coming out of Washington.  One of the key issues they stress is that the system cannot support every citizen using it because there is a huge, well HUGE, lack of primary care/family practice physicians.  There are not enough currently and few of the future crop of physicians are electing for family practice because of the low pay (relative to specialties) and the need to pay back student loans of huge sizes (much easier on a $450,000 per year surgeon salary than a $190,000 family practice salary).

So we have a problem.  Let’s just say it.  The health care system in the US is broken.  And our current administration is adamant about fixing it (laudable).  But the problem is, that the government can do nothing in an efficient way, and efficiency is the only way to solve this problem.

So in my schooling, I am taught that “markets are efficient” – for the most part.  So why not create a real health care market focused on competition, efficient administration, demand and supply, choice, and incentives?  Why not:

  1. Create health insurance “pools” of people.  Just like an employer is a “pool” of people, perhaps a state is a pool of people.  Let insurers COMPETE to provide coverage to those pools – you know, like insurers compete for private pools of company employees.
  2. Insurance companies can then create plans for or bid on providing that “pool” of people insurance.  An insurer might bid on the Idaho pool and the Dakota’s pool because it believes it can deliver good coverage to those pools and but perhaps not to pools in the north-east states.
  3. Make citizens buy catastrophic care with some prescription coverage.  Give them the option to buy some level of preventative care, but don’t require it.  Then, if they really need it, they are covered, but if they simply don’t have money for preventative care, they can opt out until they do have money.
  4. Administer health care coverage at the state level – not at the federal level.  Can some bureaucrat sitting in DC really understand health care in Hawaii or in Utah when they grew up in NYC?  I don’t think so.  Then, aside from a handful (and only a handful) of government monitors & auditors, their is no need for an army of federal administrators and their assistants and their assistant’s assistants.
  5. Invest tax dollars in two areas:
    1. Create a fund for the education of family practice physicians; pay their schooling and REQUIRE they pursue family practice.  They also need to accept public pools of patients (with acceptable levels of reimbursement, of course) and perhaps donate a few days a year to an public-low-fee-urgent care center located in already existing ER’s (for those who cannot afford preventative care insurance and the indigent (and we’ll always have indigent)).  If these funded physicians use government funds and then decide they want to become a surgeon, then they need to pay the government back with penalties and interest on a very aggressive schedule.  If they refuse, start garnishing wages.  Once they’ve worked off their loans and time commitment, they can then go specialty, but to thwart that, after XX years of service in the family practice arena, offer them incentives – perhaps entrance into a partially federally-funded malpractice insurance pool.  Get creative for goodness sake.  There are lots of retention specialists around that could offer some consult on this!
    2. Get our medical records online.  There is no reason I or my doctor’s office should have to fill out ten forms with the same information on them.  And HIPPA can take a hike (or at least get more flexible).  All this HIPPA stuff and every celebrity with a pimple has their medical records leaked to the media!  Invest in the medical records infrastructure so we can take administrative costs out of the system.  I’m sure there are many IT companies who would take on this type of job passionately (just make sure it isn’t Halliburton, or anyone related to Halliburton, that wins the contract).
  6. Let citizens go in and out of the public pool and the private pool as their lifestyle and life-stage evolves.  It is likely the private pools will still be better because employers will offer health care insurance as incentives.  But the care the public pools offer should be decent, and if insurers are competing for the public pool business and we have an increased supply of family care doctors, it should be.

So you may say, this won’t work.  It is much more complicated than all this.  So tweak the approach, but make the approach competitive.  American’s understand competition and we want choice.  I want good health care for my fellow citizens and friends and family who are now unemployed or under-employed, but I want, if they/we desire it, to be able to strive for more, for better.  And if more-better is private insurance, let us pursue that.  For if there is no incentive or reward for working harder or taking risks to achieve more-better, why would anyone work harder or take risks?  There is effectively no more “American Dream.”

So please, no gargantuan, hugely complicated, expensive, wasteful, federally-managed (yes, I realize federally-managed is an oxymoron), health care plan.  Simplify it.  Decentralize it.  Incentivize the right things.  And let’s make the US healthcare system the real envy of the world!

Stretch Marks and Babushka’s

For over two weeks, upon arriving home, arms full of daycare and office bags and children, and turning on the television to catch the updated weather and news for the day, I am bombarded with a three-minute infomercial where a woman is loudly offering to cure me of my ugly, unwanted, and embarrassing stretch marks.  She assumes that these stretch marks are the biggest of problems and are impeding my social life to extremes.  Who would even think of stepping outside with these hideous marks on their belly?  She has magic cream that will change our lives, but only for the first women to call.  We must run to line up and pay for magic cream before they run out so we can rid ourselves of the stretch mark contagion.

Perhaps it is my age, my tiredness at the end of the day, the long list of to-dos (and “get rid of stretch marks” is not on it), or the start of perio-menopausal rage, but this commercial, this woman, and the manufacturers of this product make me boil!  Who are you to determine that stretch marks are the great catastrophe of the female body?  Who are you to advertise to mothers across the nation that they should be embarrassed of the body that was twisted, contorted, and wretched in pain to produce children?  Who are you to tell us that we should be ashamed of ourselves staying hidden until we find a cure?

Perhaps you, that are seeking this magic cream or that have lined up with open wallets to get some, as well as the rest of the American public, should take a moment to heed the advice of the ladies I knew growing up.  We fondly referred to these women as the “babushka ladies.”

I grew up in an agricultural area where pockets of Western and Eastern Europeans immigrated.  There were villages of mostly Polish, German, Irish, Hungarians, and more.  In my youth, these immigrants were in their 50s, 60s, and 70s.  They spoke with thick accents – though they never spoke in their native tongues in public, since they were proud first and foremost to be Americans.

These immigrant women lead hard-working lives.  They were plump and round, but strong with endless endurance.  They helped with the farm, the garden, fed the family, and had the cleanest of houses.  They worked from sun-up to sun-down.  Their hands and faces were weathered from so much time in the sun and wind and cold.  They lived simply.  They threw out little.  They canned all that the garden and fruit trees produced.  And could they cook!  Farmhands that came to help with the harvest each year were happy with the pay, but most pleased with the huge, flavorful meals served at the end of the day after hours of hard labor.

The babushka ladies lived simply and dressed simply.  They wore plain dresses, usually with a simple design.  The dress went several inches below the knee.  They had work dresses and a Sunday dress – all the same style.  They wore sensible shoes, often with strangely opaque nylons that went just above the knee.  And even more striking was the babushka they wore on their head.  Unintentionally, I think, it distinguished them as arrivals from the Old World, for their children and their children’s children did not wear the babushka.

For me, when I see pictures of women wearing the babushka, I automatically connect a story of a hard life, wisdom, inner-strength, simplicity, and tastes of dinners of the past.  I pause and wonder what her life’s story is or was about.

So what did the babushka lady have to say about stretch marks?  It was something like this:  “You young (she meant below 50) American ladies are quite silly (she meant superficial).  My body is old and bumpy and stretched in places.  But it is not ugly or unattractive.  Each bump and scar tells a story of my life.  Each mark holds a memory – some good, some bad.  Many of the scars have a lesson in them.  You girls spend all of your time trying to erase these things.  What a terrible waste of time.  Be proud of the stories your body has to tell.”

And years later, with two everlasting stretch-marks, one from each of my children (and I know which one belongs to each), Ms. Babushka Lady, I cannot agree more!  While I’ve no plans to label them or put them on public display, I’ve no plans to rid myself of them either.  Nor will I attempt to scrub the scar from my leg as a result of slipping on the dewy steps of the sugar beet truck (10 stitches) or the scar on my wrist as a result of throwing a heavy item into a fire and causing burning debris to land on my arm.  These are all memories and teaching moments and proof of survival.  And it is likely, that as I age, there will be more.

So stretch-mark-cream-pusher-lady, keep your unproven tonics, snake oils and quackery cures and your disdain.  I will bear (privately) my stretch marks with pride and hang out with the babushka ladies – they’ve much more flavorful stories to tell, lessons to teach, and home-cooked dinners to enjoy!

Programmed to Climb – Round Two

Being used to spit up and all kinds of other things coming my way, when I am dressed in work clothing that requires dry cleaning, I’m pretty efficient at getting the top layer off prior to food and body-stuffs landing on my person.  As soon as Alexander paused from his vomiting episode, I quickly removed my jacket and tossed it to the corner.

Doug made it back upstairs with some towels in hand (our normal approach to this type of event), and I asked him to turn on the light.  I examined Alexander’s ear and though covered in some vomit, there appeared to be no bleeding or other ear discharge that would indicate bleeding had resumed from the fracture.  However, the fear of the possibility still did not leave our conscious. 

With towels and warm washcloths, we attempted to clean him up, change his clothes, and get him comfortable again.  He was tired, but the endorphin rush from throwing up gave him some playful energy and he obviously did not to realize that he was about to endure a second challenging round to recovery from the fall just three days prior.  He was ready to head downstairs and start the day.

In the midst of the chaos, Nicholas awoke.  When we told him what happened, he reaction was, “Yuck!”  I found this momentous in his growth as he has just lately been reacting to unpleasant smells and messes with disgust.  It makes me wonder oftentimes if disgust is a learned response to various smells and messes versus a natural one, since they have never bothered him in the past.  I have played a role in that training I know, since I have begun to hear him repeat my words with increasing frequency when it comes to smells and messes:  “That’s just nasty,” he’ll often say.

Though work responsibilities were gathering, I knew there would be none today.  While Alexander wandered, we got Nicholas ready for pre-school and I sent emails letting my colleagues know that I’d be out, and quite likely for the rest of the week.  There was some relief in just stating that.  By nature, I knew I’d sneak in an email here and there, but the statement designed to manage the expectations of my colleagues also served to manage my own expectations for the next several days.

Doug had no meetings, so decided to take Nicholas into school and then return to work at home.  Both Nicholas and Alexander, who typically have breakfast we take into school, were excited about pancakes on a school day.  Perhaps Alexander just got gagging from coughing?  I tentatively prepared a pancake with a little hint of syrup thinking that if he was sick, at least this was a bland type of food.

This would be the start of a pattern for the next 48 hours.  Alexander would beg for food, we’d relent and give him some, and somewhere between 15-30 minutes later, he would throw it up.

So, after his stomach’s rejection of the pancake and some cleaning, Doug took Nicholas into school.  He would make a stop at CVS to get some Pedialyte such that we could start introducing fluids back into Alexander’s stomach.  I waited anxiously for the pediatrician’s office to open and made the call.  The triage nurse wanted Alexander seen and scheduled us for the first appointment.  Within minutes of hanging up, we were headed out the door for the four mile drive to the doctor’s office.

Like most kids doctors’ offices, a large prominent fish tank sits in the middle of the room.  Filled with colorful fish and other sea animals, this tank is every parent’s diversion dream as it does the trick for most of the waiting time.  We were promptly taken to the exam room and Alexander was weighed and listened to by the nurse, none of which he wanted done.

Shortly thereafter, Dr. Mary came to take a look at him.  With a quick examination, she determined she’d like us to return to the children’s hospital and would prescribe a follow-up CT.  Our hearts sank.  Could there now be complications?  Wasn’t this just a virus?  She exited the room saying she wanted to talk with the UM pediatric group that oversaw his care.

We sat in silence in the room steering Alexander away from gadgets he shouldn’t tear from the wall.  He vomited once more, but we had come well-prepared with towels and wiped away the little output that was produced.  I noticed out the window that the snow had really begun to fall again – more inches added to a record for the year already.

Dr. Mary returned.  “Well,” she said, “His team at Mott feels that the likelihood that the vomiting is a result of complications from the fracture is extremely low.  The position of the fracture is such that the probability is minimal.  After I was able to talk to them about its positioning, we all feel that this is very likely a stomach virus.  So, with the weather like it is, let’s have you take him home, give him Pedialyte at one teaspoon every five minutes, and then call me a noon with an update.”  We felt some cautious relief.  With the vision from Sunday of the infant across the curtain in our shared ER room who was suffering from a roto-virus, as well as a few others we caught a glimpse of while there, certainly, the chances that Alexander had picked up the virus were quite high, since we’ve known these viruses to be quite efficient.  We paid our co-pay, ducked into the falling snow and got tucked back into the Jeep for the short drive home.

The rest of the morning was filled with encouraging Alexander to take Pedialyte.  He wasn’t a fan, so with those medicines he refuses, I take a dropper and squirt it into his mouth.  We also diluted some and he drank enough that the dropper technique wasn’t required.  In addition, at about noontime, he demanded something to eat, so we gave him a few saltine crackers.  We were feeling quite confident that this would be under control soon.  He was responding well and hadn’t thrown up in about three hours.  I made the call to the doctor’s office and let them know we were doing well.  I hung up the phone, and Alexander promptly threw up.

For the rest of the afternoon, he would drink, throw-up, we’d wait a half hour and then start again.  We’d gain confidence that things were getting better, and then his stomach almost seemed to taunt me – “Nope, I’m not ready yet.”  I would call the doctor’s office just before closing, and they assured me it really was acting like a virus.

Doug went and collected Nicholas from pre-school, and strangely, all four of us had a somewhat normal dinner together.  Finally, Alexander was eating and it was staying down.  Dr. Mary, bless her, called us at about 7:30p.  I reported with glee that he had held supper down for well over an hour.  She was relieved, but noted not to hesitate if we needed to talk with the office tonight.  I hung up, and Alexander promptly threw-up.  “Nope, I’m not ready yet,” was his stomach’s reply.  Thirty minutes later, we started with fluids again.  And shortly thereafter, the diarrhea began. 

So the good news with diarrhea, my belief that this was indeed a virus reached 99% – because that is what roto-viruses are infamous for.  If we could keep him hydrated, we could get through this – a greater challenge for sure since now we had stuff coming out both ends, but a lesser challenge than vomiting due to bleeding into the brain.

The night would go fairly well.  I didn’t sleep much since when I have either of the kids sleeping beside me, I don’t.  But the rest with them beside me is better than a constant up/down to check on them when they are sick, so that’s the way we do it. 

Thursday morning came.  Nicholas got to have breakfast at home again and both he and Doug left for the day.  My nerves were acting up and had left me quite nauseous.  Alexander seemed better again and demanded to eat something.  So after successfully holding down fluids for an hour, I made him a pancake.  He looked at it, but decided not to eat it.  By day two, Alexander was noticeably weaker and probably now suspect of solid foods.  He would settle for liquids for the day, most notably, the diluted Gatorade. 

We read some books, watched some Einstein videos, now an addiction after so many days with them, and cuddled quite a bit.  The lack of sleep was gaining on me and my nerves were back at my stomach.  Alexander took more diluted Gatorade, (Pedialyte was fully rejected), and about 12:30, he laid down for a nap.  I called Doug with an update and encouraged him to come home as soon as he could since I was feeling exhausted, and Doug had the benefit of a good night’s sleep behind him.  He would do his best.

I hung up, and this time, it was my stomach that rebelled.  I would spend the next several minutes emptying my stomach.  “Yup,” I thought, “This is definitely a stomach bug.”  With a bit of an endorphin rush, I cleaned up the kitchen and tidied up a few other things, then crawled in the couch close to Alexander.  Thankfully, he slept for almost three hours.  He drank a bit more then played quietly as I laid on the couch watching him with one eye open.

I called Doug a bit after 4:00p.  “Are you coming home soon?” I asked.  “Yes, just one more thing to finish.  How are you doing?” he replied in a somewhat perky voice that almost irritated me.  “Well, I’m puking and pooping (sorry a direct quote) every 30 minutes.  I really need you to get home.” I said.  “Oh (pause), well hang in there for a bit longer.  I’ll wrap things up and get Nicholas – I’ll get some McDonald’s for dinner.  Do you want anything?” he asked.  “Ah no.  I just really need to be able to lay down and sleep – no food.  Please hurry, but drive safe.” I pleaded.

About 5:30p, I heard Nicholas knocking at the door.  He loves to knock and have whoever is home answer it.  Laying on the couch in the toy-room, I ignored it long enough that he finally gave up and came in the door.  Alexander and I wandered to the kitchen in time to see Doug walk in with some Happy Meals from McDonalds.  Both boys started getting settled in to start eating, and I went and threw up.  It was good timing I suppose, because Doug took me seriously now – I was sick.  The sound from the bathroom made him realize it wasn’t just an upset stomach.  The endorphin rush enabled me to pick up a few things from school and get the lunch bag unpacked.  Alexander had not thrown up all day, so I pulled out his lunch bag hoping Doug would get both packed for Friday.

As the endorphins went away and the chills and body aches kicked in, I announced that I was going to lay down on the couch for awhile.  I could hear the boys fussing over dinner a bit.  Neither was too interested in their food, and Doug was trying, with only limited success, to offer other things simply to get something in their bellies.  Alexander was still most interested in drinking, though he had eaten a couple French fries.  After Doug determined dinner was done, the three of them retreated to the toy room.

Periodically, I’d make my trip to the bathroom to get sick, and after most visits with the help of the endorphins, I’d do a bit of tidying and would check in on the boys.  Shortly thereafter, the misery of the virus would return and I’d head back to my position on the couch.  I was able to help a bit with readying the boys for bed.  Alexander, thankfully, was holding his own and still drinking.

At some point, the lights in the household went dark.  Doug stayed in Alexander’s room, so I had our bed to myself.  I had gotten sick about 10p but somehow felt the worst was over.

The house was quiet through the night.  Around 4:00a, I heard a strange sound.  It sounded like a large animal choking.  Was there a dog outside the house?  As I gained some clarity, I realized it was no dog.  The sound was Doug – vomiting from the first floor.  The virus had taken its third victim.  In the past, I would have gone downstairs to see if I could help.  After six years of marriage, I’ve learned that when Doug is in this condition, he doesn’t want help.  It’s best just to stay out of the way.  So, still tired from my condition, I stayed in bed hoping that his dance with the roto virus would be short-lived.  However, I was wide awake and felt the need for a shower.  So at 4:00a, I got up and took a shower, which was exhausting, and then headed to the kitchen.  In all the chaos, Doug hadn’t gotten to the lunches, so I packed both boys lunch.  It took all the energy I had, so I headed back up to bed.  I would rise when the first boy let me know he was up.

It was of course, Alexander, whose sleeping patterns were now out of sync.  It was around 6:00a, and he was happy.  He drank some water and had a pancake.  I got him changed for school.  Doug was on the couch – in the same condition and position I was just hours earlier.  I heard Nicholas wander down the steps.  When he reach us, he announced, “I just threw up in my bed.  I’m sick, so I don’t have to go to school.”

He didn’t really appear to be sick, and his excitement about it made me wonder.  I still had some things to do to get the boys ready for school, so I had him drink some water and left him playing with his brother.  I went up to his bed, and sure enough, there was a small spot of liquid.  It didn’t look like much.  Perhaps he had sneezed?  I pulled him some clothes from his chest and started downstairs.  Upon my return, I found Nicholas laid out on the loveseat and Doug announced from his position on the couch that Nicholas had just thrown up.  This time, Nicholas wasn’t excited and he looked rather miserable.  The roto virus had just taken its fourth and final victim in our house.

I gathered Alexander and took him to daycare.  He screamed as I left, but I kept going.  I made a few stops for more Gatorade and other items that would help us out of this misery.  My stomach was still uneasy and upon returning home and tending to the latest two victims, I rested for a bit.  And that was how the rest of the day would go.  Do some laundry, help Nicholas get sick, listen to Doug getting sick, rest a little.  Soon however, it was time to collect Alexander.

His teachers reported that he’d had a good day – that he was quieter than usual, but he’d had a good day and eaten a little.

Friday night would be a quiet one with me following Alexander around playing a bit and waiting for bedtime.  Doug & Nicholas were holding some liquids in, so progress was made there.  Perhaps the weekend would be a nice recovery of this wounded family!

Nicholas awoke Saturday morning and announced he was done being sick.  And he was.  He ate two pancakes.  Alexander still hadn’t returned to a normal appetite, but he was grazing quite a bit and continued to drink.  Doug was still down for much of the day.  By late afternoon, we thought that perhaps a quick trip out would be good for the family.  We needed groceries, so we’d go to their favorite restaurant (yes, McDonald’s) and then pick up some groceries.

The boys were eating well.  Finally!  And just as I sat down to bite into my 69 cent cheeseburger, Alexander began to choke.  Or did he?  Anyway, the result was that he threw up.  At this juncture, we are now pro’s at catching this stuff.  Doug grabbed the burger wrapping and caught most of it.  I ran to get more napkins and we got the rest cleaned up.  Not much spilled, except all over Alexander’s pants.  There would be no grocery shopping tonight.  We finished quickly and returned home.

Sunday would bring one more throw-up session from Alexander.  Our conclusion was that since this was his first stomach bug, perhaps his stomach was just simply sensitive.  He would eat and go for hours without getting sick.  We’d get comfortable, and he’d cough or choke or even just cry about something as toddlers do and he’d throw up.  We were quite confident the bug was through, and on Monday, we would all make our way to school and work.  For the first time in nine days, the house would sit empty except for the cats in the basement.

We were exhausted that week and Alexander was (is) struggling with getting back to a normal sleeping schedule since he now wants to be held to go to sleep and have someone sleeping in his room which will require some “sleep training,” but we are making our way out of the fog of Round II at last.  The saga that started with a kid with the instinct to climb was coming to an end.  We would survive to see the next one whenever it arrives. 

I arrived to pick up the kids on Wednesday.  Alexander’s teacher announced, “Hey, I think Alexander may have pink eye.”  Hmm, my left eye feels itchy too . . . so here we go again!

Programmed to Climb – Round One

This morning as I finished getting ready for work, I looked in the mirror.  Staring back at me, I saw an older, frumpy-like woman with dark circles under tired eyes staring back – a different image than the one I carry in my mind on a daily basis.  The last 11 days, and the reason for such a delay between posts, have taken their toll.

It was a typical Sunday evening.  After a weekend of mostly indoor play because of the single digit temperatures, the boys and my husband were in the basement burning energy before we were to get baths & start preparing for bed.  It had been an eventful weekend for my 19 month old who proved his blossoming talent for climbing on all things.  This weekend, he had successfully climbed out of his crib skillfully throwing a leg over, then pushing his body over the railing, and letting himself down slowly to the ground.  No falling or hard landings – he was too strong for that.  He had shown up downstairs after his nap standing in the door with both of his blankies and a big smile of pride from ear to ear.  Curious, having heard no thuds, I took him back up and put him in his crib to see his technique which he then demonstrated.  Of course, after this trick, then he decided he’d try to climb back in.  I stopped him at that one.

As my husband and I stood just outside his room while he and his older brother were playing in it, we noticed his chest of drawers begin to tip over like a large just cut tree in the forest that begins to fall and gradually picks up speed.  The top drawers began to fall out as it tipped and thankfully, the chest’s fall was broken as it landed on the side of his big boy bed.  Alexander had fallen into the space below with not a scratch on him.  After additional climbs this weekend up to counters, table tops and desks, it was at this moment we decided to move all climbing options out of his room and place the mattress on the floor.  He would officially be moving to the big boy bed, ready or not.

So this Sunday evening, as I made the final lunch preparations for the four of us, I could hear the boys driving the trucks in our unfinished basement.  Doug has been working on finishing it for some time now and is getting close to finishing the plumbing for the bathroom.

From the basement, I heard my husband shout, “Oh, no” followed by a few seconds of silence and then some crying from Alexander.  Since this is not uncommon, I had no panic, but rather walked to the top of the steps and yelled down, “Is everything okay?”  Typically, I get a “Yup” in response.  This time, however, I received a, “No.”

Doug appeared at the bottom of the shadowy steps, Alexander in his arms crying and with blood streaming out of his right ear. As he climbed the steps with his son, he explained with grief, “He found the ladder.  He fell from the ladder.  I never leave the ladder out.”

Having been through a significant head bump with Nicholas at about the same age who fell while standing on a chair, since his mother was pulling hot rhubarb crunch from the oven and didn’t go make him sit down right away, I was somewhat calm as I assessed the situation.  Alexander hadn’t lost consciousness nor had he thrown up.  His pupils were equal and looked of normal dilation, and his loud crying was a great sign that there was no concussion.

With some relief, as my husband held him at the kitchen counter , and using a syringe, I began to gently squirt water at the outer part of his ear.  Surely he had hit something on the ladder that had scratched his ear causing all of this blood.  However, it soon became apparent that the blood was not on the outside.  The blood was streaming from inside the ear.

We called our pediactrician’s on-call service, who upon hearing my story immediately connected me to the nurse.  “I want him seen now.  Can you get him to the University of Michigan ER?  They have a pediatric ER there and will be prepared to assess his condition.”

We gathered up Nicholas who had just changed into his pajamas, I grabbed some crayons and paper for him should we be there a while, the diaper bag, and a few other items.  Doug, with a look of anxiousness that had not left his face since I saw him at the bottom of the steps, grabbed a blanket and we headed to car to make the 25 minute drive to the ER.

It was a quiet drive with an occasional question from Nicholas about the hospital and emergency room.  Doug kept Alexander awake, since from my scare with Nicholas, they had told me not to let him go to sleep for at least two hours.

The drive to the ER was familiar as it was the same route I took for OB visits and for the momentous drive to deliver Alexander.  We arrived at the patient drop-off and Doug took Alexander in his arms through the doors while Nicholas and I received our ticket from the valet.

We scurried through the double doors of the ER shivering with cold and worry for Alexander.  They checked us in quickly since Alexander was in the records from his delivery.  A triage nurse assured us he was doing well because of the fussing.  The nurse tried to tease Alexander a bit to get a first look at him, but to no avail.  He told Nicholas that he had cool pajamas which made Nicholas proud, and then escorted us to our pediatric ER holding room.

The room holds two patients.  We passed by our family of roommates to head to the back side of the curtain.  I could see a small baby boy, perhaps 6-10 months of age, hooked up to an IV.  He was laying there frightened I’m sure, but too depleted of energy to resist.  I heard the doctors say they were sure that it was just the roto-virus that had gone through the rest of the family earlier in the week, and that the fluids should have some effect on him soon.  The three family members had the look of concern and obvious exhaustion as they were likely still in recovery from the virus themselves.

Nicholas was amazed at all the gadgets and taking it all in.  He was also quite excited to have access to a remote where he could watch cartoons the whole time (poor boy hasn’t been exposed to cable television much).  Alexander on the other hand, wasn’t so amused and had a look of suspicion.  The nursing and physician staff began their usual interviews asking us to tell the story – a story that we would repeat upwards of five times as I’m sure they were looking to compare notes and assure we had not somehow done this purposefully to our child.

After some initial vital signs, all conducted amidst extreme resistance and volume from Alexander, the exam of the head and ear was to begin.  It didn’t take long – with a quick look into the ear, the doctor determined the blood was indeed coming from the ear canal.  Now the next step would be to get a head CT to determine if there was anything broken or a possibility of bleeding into the brain or a concussion.

I remained optimistic because he had not lost consciousness nor thrown up and he continued to resist with vigor the exams he was being put through.  My concern now was how we were going to get a head CT accomplished since it required him to be perfectly still for three minutes, and the physicians did not want to put his little body through sedation.  The goal then, was that we would attempt to get Alexander to sleep, and while he was sleeping, conduct the CT.

Shortly thereafter, a staff member lead us out of the room, passing again the exhausted little guy being filled with fluids, and into a room where we could dim the lights and get Alexander to sleep.  I was not optimistic about accomplishing this.

So waits in the ER, from my intern experiences in 1993, are largely due to getting labs taken and getting them read.  Of course, the ER needs to triage results for the most urgent.  It was a good 90 minutes before the CT was ready for Alexander, and it took almost all of those minutes to finally get him to stop crying, struggling, and arching his back for freedom, before he gave into exhaustion and went to sleep in my arms.  This time, the long wait was a blessing.  Nicholas, in the meantime, had gone to sleep on the patient bed.

A staff member motioned me to follow him to lead me to the CT room.  I placed a small blanket we had brought on Alexander’s eyes to shield the bright hallway lights that might wake him.  The walk was fairly short, but with the dramatic effect of going through two large automatically opening doors wide enough to fit large beds through.

The gentlemen used his card to access the door to the CT room.  They directed me around the front and I laid my limp bundle on the table with his head between two pieces that looked like bookends.  They wrapped him tightly.  Amazingly, he did not wake or even budge.  The gentleman spoke softly and said, “Mom, I think he is going to be alright without you.  Let’s have you step out so we don’t have to expose you to unneeded radiation.  We’ll get you when we’re done or if we need you to calm him.  It will only be about five minutes.”  He led me to the hallway behind a set of large doors.

I was there by myself. And that is the point that I nearly lost control.  My baby was out of my sight and there was a slight panic that set in.  Above the large doors, a light would flash with a soft moan every time the CT machine was in action and radiation was present.  Indeed, this was the longest five minutes I had spent in a long time.  Was he okay in there?

Finally, the door opened.  “He did fine – never woke up,” the technition said.  I scurried around the front and picked my son up, still sleeping soundly and unaware of this latest experience.  We had made it through without sedation.  I was led back to our room in the ER.

“Did they get it?” Doug asked?  I nodded and saw some relief on his worried face.  Now to wait for the results.  Someone stepped around the curtain and informed us it would be about 20 minutes to get it read.

At about the 20 minute mark, a physician step around the corner with a pleased look on her face.  “He has a skull fracture,” she said, and we gulped.  “But, there is no evidence of any bleeding or brain damage.  He’ll be fine” she said.  “We will want to monitor him for awhile and neurosurgery will be here to sign off and discharge you here or send him to a general room for a while.  It’s going to be awhile, so you should discuss who might want to take your oldest son home and who will stay.  He’s going to be okay,” she reassured again.

We had both intended to wait for neurosurgeon, but by 12:30a, determined that it could be several hours more.  I wanted to stay, but I could see the Doug “needed” to stay.  He needed to be with his son for whom he was guilt ridden.  His only concern was that I could comfort him better, but I was sure that in my absence, daddy’s arms would be fine.  I would gather Nicholas and make the drive home.

I kissed them both as we left and walked out the door.  I changed my mind at started to go back in.  I stopped myself and we proceeded to find our way to the exit.  I handed the valet our ticket at the booth and he told us to go wait in the heated doorway while he got our Jeep.  I needed to stay I decided.  I’d have him wait with the Jeep while I made the switch.  I looked down at Nicholas.  He was so tired and was so good with all this.  “I can’t drag him back through the halls,” I thought.

The valet pulled around with my Jeep.  I asked him how much and he informed me that valet parking at the ER had no charge.  I can’t tell you what a positive impact that made on me – then and still now.  I strapped Nicholas in and we headed for home.

I got about two miles from the hospital and started to turn around to go back.  Again, I looked at Nicholas who had immediately fallen asleep and realized I just needed to keep going and get him home.

The drive was both long and short.  The cold early morning winter day seemed so dark and lonely, but the drive was somehow theurapeutic – perhaps because for these 25 minutes I was in control of something.  I was driving and I could control that at least.

We got home, lights still on and cats having a field day climbing on things that they are always shooed off.  I helped Nicholas get his shoes and coat off & up the stairs to his familiar bed.

I came back downstairs and looked around the house.  It looked like we left it – as if the boys and dad were still downstairs.  It felt comfortable to be home but very empty and I was chilled.  I shook off the moment and got to work preparing for Nicholas to go to pre-school, things to take to the hospital, sent some emails to let my colleagues know I’d be out, and organized the call list that I would use later in that morning.  After a bit of nervous picking up around the house to stay busy, I changed and went to bed and laid there wide awake.

I think I drifted off about 4:00a and I’d set the alarm for 6:30a.  It awoke me and I was bought back into the memory of the previous evening.  I laid there a bit and decided not to call Doug hoping that both he and Alexander were getting some rest.  And I was sure if anything was happening that I needed to know, Doug would call.

Nicholas was still sleeping soundly in his bed, so I went downstairs to get a shower.  I needed to cancel a couple of appointments for the day so would have to wait until 8:00 to make those calls.  It would enable Nicholas to get some more sleep too.  He wandered downstairs about 7:30, so I got him some breakfast.

Shortly thereafter, I decided to give Doug a call.  I’d left my cell phone with him, so I dialed my number.  After several rings, it went to voicemail.  I waited a few minutes and again got voicemail.  It dawned on me that with all the gadgetry, it may not be ringing, so I call the main patient number and asked to have Alexander’s room called.  I advised the operator that I wasn’t exactly sure where they were now.  “Let’s see now” she said.  “Oh yes, Alexander is in the pediatric ICU in Pod C.”  My heart sank, “The pediatric ICU?  What?”  The operator tried to comfort me, “Sometimes if they don’t have a room available, they will send them there to move them out of the ER.  I’m sure it’s fine,” and she transferred me.

After a few rings, Doug answered.  “Why are you in the ICU?  Is he okay?” I asked hurriedly.  With a calm tone Doug informed me that at about 4:30a they moved them to the ICU so that they could monitor Alexander closely.  They took vitals every hour, and he was doing fine.  He should be released sometime in the afternoon.  Finally, a sense of relief.

I dropped Nicholas at pre-school and gave Alexander’s teacher an update and then proceeded to make the drive back to the hospital.  I needed to stop by my office to pick up a couple things since I imagined I’d be working at home for a couple days.  At the stop light before I made it to the street where my office is located, the tears began to flow and I started to sob.  I’m not sure why there or why then, but they came.  I parked and got myself together.

My colleagues were wonderful offering support good wishes.  I gathered a few files and was headed off to the hospital.

After getting credentials to be on the floor, I was guided to Pod C of the ICU.  The nurses pointed me to the direction of Alexander.  In the back corner, I could see a small child covered up by a familiar blanket inside a large crib.  There at least five cords coming from a nearby machine with a large monitor.  The cords disappeared under the blanket.  As I approached, he looked like he had a cast on his left arm.  After some successful attempts at pulling it out, they had had to wrap the IV so he couldn’t get to it.  He was sleeping peacefully.  My husband arose from the nearby rocking chair as I made my way over.  As I moved to the side of Alexander’s crib and gently touched him, once again my tears began to flow.  He would be alright.

I had just missed rounds where neurology had informed my husband that they had recommended Alexander for discharge.  His case was with the pediatric unit who had to give the final order.  It would be another six hours before we would be on our way out the door.  During that time we entertained Alexander with books, held him while attached with five cords to the vitals machine, and gave him snacks.  We were surprised at his acceptance of restraint to his movement (not something he’d ever been made to do nor would I have guessed he would submit).  Though it was a long wait, there was some relief in being there just in case something went wrong.

When the final discharge occurred, I stood with disbelief at the orders for after care.  The physician said, “I’m sending you home with a prescription for antibiotic ear drops.  The ear drum perforation should heal in about a week.  We’ll have him come back for a hearing exam in about a month.”  I asked, “Does he need a soft helmet of some kind for the skull fracture?”  “No,” said the physician, “He can resume normal behavior and routine.”  Both Doug and I were stunned. “But what if he trips and falls and bumps his head?” I said.  “It won’t impact the fracture.  He can resume his normal routine” he said again.

We left the hospital tired, relieved, and feeling so lucky.  Our climber had escaped serious injury.  We collected Nicholas at daycare and all went home to an almost normal dinnertime.  Alexander was a bit subdued, but nearly back to himself.  He climbed on a few chairs, but minded well when we told him to sit.  I stayed home with him the next day (Tuesday) and determined that his energy level was good, he was eating well, and on Wednesday, he would return to daycare and we would resume our normal schedules.

On Wednesday, the alarm clock went off at its usual time.  I arose and headed to the shower.  I dressed and grabbed a bit to eat before heading up to get Alexander and get him dressed.  Doug had just gone down to grab a cup of coffee.

As I approached Alexander’s bedroom, I heard some coughing and then some gagging.  As I entered his room, there he lay, on his back, throwing up.  It was coming out his mouth and back onto his face and he seemed to be choking.  I ran to him to turn him on his side.  “Doug,” I screamed, “He’s throwing up.  Alexander’s throwing up.”  And with that would begin Round Two.

Me and My Migraines – An Update

I mentioned in an earlier post that I was going to seek some alternative care to treat my migraines.  Since late November 2008, I have been seeing a chiropractor.  He said I definitely have what they call a subluxation and he expects it to take about six months to correct.  So as time and weather have permitted, I’m going in for a “treatment” twice a week.  The office is close to mine, so it’s a quick trip on my lunch hour.

I wish I could say that the migraines have decreased in quantity or severity, but I’m not experiencing that just yet.  I remain optimistic and do feel positive in that I’m at least attempting to gain some control over them now versus waiting for menopause to solve the problem in 15-20 years.  I will say that the stiffness in my back, neck, and shoulders has improved tremendously.  If nothing else, I’m a bit more productive at work and sleeping better.

On the drug front, the good news for my pocket-book and that of my insurance company, is that the patent for Imitrex expired and sumatripans are now available in generic form – still the same awful packaging, but so much more affordable!  Hopefully that will be of some help to those that were not able to share in migraine relief due to the cost.

“Administrative Health Care Costs” Revealed!

The United States health care system, if you can call it a system, is a myriad of services supposedly dedicated to the betterment of life and living for US citizens.  It is a recessionary-proof industry, for like university tuition and property taxes, no matter the state of the economy, the cost just goes up and up.

Some blame it on our aging population, the cost of new treatment technologies, prescription drugs, malpractice insurance and greedy trial lawyers, overpaid specialists, and excessive administrative costs.  The truth is, that it is likely a combination of these things and they are complex.  But we are a country of smart, ingenious people.  We should be able to put politics and big money aside and tackle this for the good of our people.  Other countries are doing it, or have at least made progress.  We can too.  And we should.

So here is my contribution, not just to the debate, but to a small part of the solution.  I have finally figured out the “costs” part of administrative health care costs.  This has been an area that for years, I couldn’t quite wrap my arms around, but over the past six weeks, I finally understand.  And once you understand causation, you aren’t that far from developing solutions (if you can put aside politics and pork, of course).

My mother suffers from neuropathy.  Neuropathy is disease that at the start, causes tingling or numbness in certain areas of the body, especially the hands and feet.  At the start, it’s much like Restless Leg Syndrome (RLS).  As the condition progresses, it’s much like RLS on steroids.

My family is genetically disposed to RLS, and probably as we are learning, to neuropathy.  I come from a long line of people whose legs jump and tingle with varying levels of pain while attempting to sleep or when seated for long periods of time, like those required for long haul air travel.  Now the term “tingle” doesn’t do it justice for those with more progressed RLS and neuropathy.  Imagine a team of people placing needles in your legs and feet from the knee downward, then shaking your legs with the needles in place.  Then imagine attempting to sleep or sit with this team pinning and shaking whenever you are at a resting state.  For some, RLS is a lot like the transition from when you realize you arm/hand/foot has gone to sleep to when the blood flow returns it to its normal state.  The transition from sleep-state to normal can be quite painful.  My mother’s neuropathy, from her description is much like that, except that as it progresses, her feet are going numb.  Not numb from prickly pain, but numb to the touch.  And oh yes, they are always cold.

My mother has been on various medications over the years.  They will not cure the condition but rather are intended to treat the symptoms, or at least manage them to some extent.  In recent past, she started with Neurontin, a drug originally developed to treat epilepsy.  She had some side-effects that then caused the physician to diagnose Topamax, known as an anticonvulsant.  Her doctor was quite excited about this drug and had real hope for her.

However, we as individuals are of course unique.  We are walking chemical experiments, and as with many drugs, what works in one chemical environment does not work in all.  The Topamax caused side effects including urinary bladder infections, depression, and inability to concentrate (she couldn’t read a magazine article or write a letter).  Prior to understanding these were effects of the drug, we were worried that she was showing signs of early Alzheimer’s or early dementia, multiple sclerosis or perhaps Lupus, and she went through a battery of tests to test for all these.  Then, the doctor decided to take her off Topamax, and see if possibly, that was what was causing all this.  Incredibly, the symptoms disappeared.  He then introduced her to Lyrica.  This is a drug that is for the treatment of Fibromyalgia and nerve pain associated with diabetes.

Finally, she found a drug that could manage the pain.  There was still some there, but it was at least manageable!

Now (get ready to insert sarcasm), my mother is “unfortunate” that she is not a diabetic.  From my Internet research and some discussions with her neurologists, it seems that most of the research is being done for neuropathy related to diabetes.  Her cause is unknown.  But the pain and the deteriation is the same whether it is caused by diabetes or the cause is unknown.  And let’s remember that these drugs are not treating the cause, they are treating the pain.

So, a few months ago, my father received a prescription of Lyrica, presumably for RLS (yup, got it on both sides of the family), but due to interactions or some other complications, he did not finish it.  It was the same dosage as that which my mother was taken.  Now get ready for the “ironic” part of this story.

So my mom, knowing that Lyrica, with no generic equivalent, is an expensive drug, wanted to SAVE HER INSURANCE COMPANY MONEY, so she took the rest of dad’s Lyrica and didn’t refill her prescription in the normal cycle.  When she did call to renew, Blue Cross Blue Shield told her that they would not fill the prescription and she would now need to have her physician resubmit.  The doctor did.

She then received a letter saying the Lyrica is not approved for non-diabetic neuropathy (just for that caused by diabetes).  So, unless there were extenuating circumstances, the insurance company was making the decision not to fill the prescription.

So, the physician put her back on Neurontin.  If it works this time, great.  If not, they would have the circumstances to lobby for the Lyrica.  Within two weeks, she developed a bladder infection, she was “overwhelmed” by simple tasks, wanted to cancel Christmas, and well, you get the drift.  The side effects are not those that she can live with them.  This drug will not work for her.  The physician gave her his supply of Lyrica samples to get her through the next few days, because surely, it would now be approved.  It was not.  The next letter told her they would not fill it and that was it.  She could appeal, however.

So, she is still in the process of appeal.  We have found other people who did not finish their Lyrica prescriptions and have given them to her and she is also continuing on samples.  She has had perhaps six-ten office visits and several lab tests.  She has talked to several “customer care” representatives at the insurance company.

Now all of this appeal, testing, office visits, etc. come with a cost, right?  Is the insurance company, who also is paying for the visits, labs, and likely an army of “customer care” representatives and other paper pushers (someone has to review all those appeals) really saving money?  Yes, Lyrica is expensive, but does its costs really supersede the costs of all these other medical and people costs that would not be required if they just filled the darn prescription?

And why on earth does an insurance company get to override a doctor’s order?  Why do they hide behind “you’re not a diabetic, so we don’t have to fill this?”  The drug works for her.  The others do not. 

The latest suggestion from the “customer care” representative is that from her experience, the appeal will be rejected unless my mother is prescribed another similar drug and that proves to be insufficient also.  So yes, let’s put her back on Topamax and see if that works.  Are you kidding me?  Just look at her medical records – the history is quite clear.  Do not make her recreate history so you can delay and “save” money as she then makes additional medical visits, incurs still more lab tests, and fills out more paperwork that you have to pay people to review.  And oh yes, now that she is under stress and moving towards depression, the extra costs added to her case for drugs to assist her through this period – or might she need to be a diabetic to get those too?  I can just hear the “customer care” rep:  “We only approve drugs for depression caused by lack of treating neuropathy for those whose cause is determined to be diabetes – you can appeal though.”

If this is the administrative process for refilling a prescription, I have to imagine there are many other “administrative processes” for other heath care issues.  So, might it be the case that the administrative costs that are designed to reduce costs are ultimately exceeding the costs of just doing what the doctor ordered?  Let’s get some actuary, who is paid independently (not by lobbyists or pork-seekers), on this and test the hypothesis.  And then let’s use the data to make good decisions – to control costs, but also, to ease the suffering of our people.

And one more thing.  Stop picking on my mom!