Monday, September 25, 2017

Water Under the Bridge....

Last summer, I got a dental infection.  It needed treatment with not one, but two antibiotics. That led to a gut infection, which pretty much left me as ill as I can recall being in years.  But here's "The Rest of the Story."

My parents were awesome people, but they grew up poor.  I remember the day my mom came home after having ALL of her teeth extracted.  I don't think I was in school yet, and she was only 20 when I was born. Regular dental visits were not part of my life, growing up.  Toothbrushes were also not a regular part of my life in early childhood:  It took some dental hygiene classes in school and some sleepovers at friends' houses to notice that we were missing something. By the time I was a teen, brushing was a regular habit, but by then the damage had been done.

When I was 21, I got a job with REALLY good dental insurance.  It took a good dentist about a year of almost weekly visits to fix what could be fixed and pull what could not.  When all was said and done, I was down 2 wisdom teeth and 4 other adult teeth, and had fillings in nearly every other remaining tooth.  I lost another tooth during medical residency - I just couldn't afford a root canal.  So when I finally got another 'real job' I started seeing a dentist again.

To cover a gap due to these missing teeth, my dentist recommended a permanent bridge, crowning 3 teeth and adding 2 'fake' teeth.  Twenty or so year later the enamal cracked, and I had to replace it.  Now, these suckers are expensive:  A 5-tooth bridge is $2500-$3500, and dental insurance at the time covered very little of it, but hey, I like to eat, and chewing with your gums isn't comfy, so I did what I had to do. When the replacement bridge was installed, I needed a root canal in one of the teeth, so the timing was good even if the cost was ungodly.

Fast forward to last summer.  The infection I had was in the tooth, under the bridge, with the root canal.  So earlier this year I went to an oral surgeon and had some procedure done that made the tooth stop getting infections.  I went for routine follow up at the end of July, and he said it was healing well, despite the fact that I told him that it felt like the bridge was, "Chewing funny."

Two days before we left for the beach, I had a routine cleaning.  I told the hygienist the same thing.  I was due for x-rays.  My regular dentist was on vacation, so another guy looked it all over, said everything looked great, see you in 6 months.

Later that same day, I was eating, and the bridge came out.  At least, that's what I thought at first.  But what actually happened was that it BROKE between the two 'fake' teeth, bringing the recently repaired tooth right out with it, root canal included.  So, there I am with essentially three teeth in my hand and....Geeze. In retrospect, the crack is completely visible on the x-rays, not that it mattered.  It would have saved me only one emergency dental visit the next day.


Today, after a lot of back-and-forth between my regular dentist and the oral surgeon, the bridge has been turned into 2 crowns, and sad remains of the other tooth pulled.  An implant was placed, and I'll tell you that I've never had so many stitches in my life as I have in my mouth right now.

The total anticipated cost on this baby is about $3500, but thanks be to God this guy takes our insurance, so I'm expecting to pay less than a third of that.  And THEN I get to see about getting a removable bridge, because no way in HELL am I putting in a third 'permanent' bridge at those prices.

And tonight, I have to say, I am incredibly grateful for hydrocodone, and for medications that cut nausea enough to make it possible to take it.

Interestingly enough, dental implants frequently require bone grafts, and I needed grafting. So I now have donor bone in my jaw (not to be disrespectful, but jamming splinters of someone else's bone up under your gums is uncomfortable while it is happening, even with Novocaine, and QUITE painful when the Novocaine wears off).  I asked the oral surgeon about the donor, thinking to write to the family and say thank you, but he said, "It came from the University of Miami, so it must have been a smart guy."  By this point I was a bit dazed by all the yanking and jamming and whatnot, but I'm planning on slapping him upside the head when I go back for my recheck to remind him that perhaps some respect is due to those who donate, right?


Tuesday, September 12, 2017

Prescription Glitches.....

 Babygirl has been managing her pill sorter for some time now. Generally, she's pretty good at it. She lets me know when she is running low on things, but yesterday for some reason I asked her to check on her supply of translplant medications. She'd asked me to call in the one that has to be filled at the local pharmacy, but I couldn't recall getting any medications from the specialty pharmacy that sends her 90 day supplies of the pricy ones.

Sure enough, one of them was pretty close to gone.  She just sorted two weeks' worth, and there are a few still in the bottle, so we have time enough to get them ordered.  Another one was about to start on the last bottle. The pharmacy usually can get them to us in three to four days, so no problem.

I put in the call, and the chaos began.

"That will be two medications, with $15 co-payments each, for a 30 day supply, okay?"

Um....not really!  "Why just 30 days?  We always get a 90 day supply. And why do we have a co-payment?  We haven't had to ever pay you for these medications before!  Not that $15 is so much, but what changed all of a sudden?" I know insurance companies sometimes change the rules, but to change two rules simultaneously seemed, well, just off.

I spent thirty minutes on the phone with a very patient and kind pharmacy representative who did her best to try to figure out what had changed and why.  When all was said and done, she really didn't know, but mentioned something about a 'cap' on the amount of medication, and read me back from the insurance coverage that this was, indeed, what the price and amount was supposed to be.

Well, we're three weeks away from out of medication on one dose, so here's my credit card number and go ahead and ship just THAT one, okay?

We've been using this mail-order specialty pharmacy for transplant medications since right after Babygirl's Medicare ended 2 1/2 years ago.  We were told, if I recall correctly, that we HAD to use it for these medications or face fairly astronomical monthly co-payments at the local pharmacy.  We've been using them without a single glitch ever since, and I have nothing bad to say about them - they've been convenient, easy to contact, and unfailingly courteous. But.

There is no way to tell someone who doesn't have a chronically ill child (or a personal catestrophic illness) just exactly how gut-clenchingly terrifying the word "CAP" is.  The implications are staggering, nauseating, insomnia-inducing, palpitating, adrenal-squeezing:  That moment when you realize the ship is going down and there is nothing you can do to stop it.

It implies that your coverage is running out. And without that coverage, bad things - VERY bad things - will happen to your child.

It was a good thing we were having chicken soup for dinner.  (Cock-a-leekie soup, actually, but no one seems to believe me when I say that, and it makes people laugh. But it's very good soup.) It's very calming.

During lunch today I called the pharmacy benefits department of our insurance.  They looked over the policy, and assured me that the mail-order people have it right:  We can only get a 30 day supply for a $15 co-pay.  "Since when?" I ask.  "Since always," they reply.  They seem to believe that the pharmacy has been working in error for 2 1/2 years, gifting us with co-payment-free medications to the tune of nearly $1500 in missed revenue without noticing.  Furthermore, they tell me, I should be getting these at my local pharmacy because the monthly co-payment THERE is only $10.

I was so mystified by this absolute crock of crap that I totally forgot to discuss the work 'cap', but under the ACA (while it stands, and God bless us, it still stands) there ARE no caps, so I'm going to let that sleeping dog lie and hope my adrenal glands and my gastric lining recover.

Meanwhile......Babygirl turned 18 on the first of this month.  I can't help but wonder if THAT tripped some trigger somewhere.


Thursday, July 6, 2017

Enjoying the Journey....

Since trips to the doctor are an inevitible part of our lives, we try to keep it interesting when possible. The quarterly trip fell near to Independence day, and the annual picnic and parade with the family, so I scheduled off for the 5th as well as the 6th and took a three day "weekend" in the middle of the week. 

The picnic and parade in Glenside were amazing, as always.  Bolivian dancers and wine.  Who could ask for more?

The next day we took my neice back to The Pratt Institute in Brooklyn.  Famous for art and architecture, it has some very interesting art installations.  This one was apparently by Wile E. Coyote.

My neice's school ID entitled her to two free passes at the Brooklyn Botanic Gardens, so we went. They were having difficulty with their credit card reader, so they let the rest of us in for free as well!  


We returned to Philly to enjoy dinner and a campfire with Uncle Ricky.  He'd never had a s'more, and we had to teach him what to do with the marshmallows.....

Closer, dude.

Today we went to CHOP in the early AM. I was a bad mommy and completely forgot to have any blood work done, so we'll have it done on Saturday.  We DID have labs done locally six weeks ago, so we thought we'd talk about that, but for some reason THOSE had never arrived at CHOP, so they are going to track those down and call us later.  She is otherwise doing well.

After CHOP, we had several hours to kill before we had to leave for Nemours.  I had randomly picked up $2 off coupons for the Liberty Museum (never heard of it) in the Philadelphia Historic District, so I looked it up online and we decided to go.  We walk half a mile to the subway, take the train for 10 minutes and, voila, we are there.  $2 off the price of admission meant that our total charge (for BOTH of us) was $5, the best deal ever no matter how good or bad the place might be, but I have to say it was a completely wonderful little museum.  It was themed around the concept that individuals are what make liberty possible.  There was a movie about the Congressional Medal of Honor, areas dedicated to women's rights, important religious figures, Nobel prize winners and ordinary people of extraordinary courage (individuals who hid Jewish families during the Holocaust, for example).  The displays were interactive and gripping.  They used original art and humor in many ways throughout to promote personal responsibility and peace:

"Truce: Rock, Scissors, Paper"

Lunch at The Bourse, a carriage ride through history, train/walk back to CHOP, and now we are at Nemours waiting for doctor #2.  After this we drive home, and we'll have earned our dinner at Perkins since we hit 10,000 steps on our FitBits a while ago.


Saturday, June 24, 2017

Mourning With Those Who Mourn.....

At the very end of the year last year Citygirl's hubby lost his grandmother. She was at their wedding, and they won the "Longest Married Couple" dance quite proudly. This loss has been devastating to their family, the more so because it occurred a long way from the family home. So this week, almost six months later, a formal funeral was held in their hometown. Hubby and I decided to come out to New Hampshire to celebrate her life with them.

A close as we are to New England, neither of us had ever been through Vermont or New Hampshire. The drive was absolutely breathtaking and was only about five hours long. We saw dozens of intriguing places we would love to have spent hours exploring!

We arrived in time for the service. Babygirl and Hubby had never seen a Catholic funeral, so the up-and-down kneeling was new to them, as well as the incense and the music. Their cantor had the voice of an angel: "An He will raise you up on eagles' wings, bear you on the breath of dawn; make you to shine like the the sun, and hold you in the palm of His hand." Goosebumps.

At the graveside, her children told stories of the kind of woman she was, and read poems she had written. Her grandchildren grieved.  And I mourned with them, remembering afresh the loss of my own mother and grandmother.

This is, I am sure, the purpose of a funeral.  It gives families a place to put their grief:  A place to remember, to share, to mourn in solidarity with each other and with friends.  A place to laugh over happy memories and cry for the loss of them:  A place to let go.

The next day we joined the family for a "Nana" tradition:  A game of mini golf with all of the grandchildren.  It was silly, sunny, happy, and rediculous - perhaps the best sort of memorial a grandmother could ask for.


Monday, May 29, 2017

Surviving the Bug....

I've been a bit under the weather this week.  I tend to be pretty tough from an immune standpoint, but this past year has hit me with more than a few bugs.  Not surprising, really:  It's a well-known fact that having people you love die has a negative impact on your immune system for a year or so, and I've been stacking up losses left and right.

That being said, it is extremely rare for anything to hit my GI system.  Even my migraines tend to leave my gut alone.  But this....THING...that Squeaker brought home from school..... Dang.

I had an eye exam Thursday morning.  They tend to trigger migraines, so I really tend to put them off.  This one was more than a year overdue, but everything was good, no change in prescription, all is well, except that two hours later when I went to work I looked like some sort of crazed junky with my right eye about normal and my left fully dialated (which, by-the-by, stayed that way for about another four hours).

So when I started feeling anxious and queasy in the mid-afternoon, I thought for sure I was going to be hit with a migraine.  In fact, my last patient of the day was being seen for migraines, and I joked with her about not worrying if I suddenly had to leave to puke.  She laughed - we migraine people find that sort of thing funny in a sad sort of way.

Once she was done, I found I was totallly unable to finish any more computer work.  I shut down and went home.

On my schedule for Friday morning were four house calls with a resident.


By morning I had gotten rid of Thursday's lunch, breakfast, rehydration attempts, and, I am pretty sure, Wednesday's dinner as well.  I actually didn't feel TOO horrible, so when the resident arrived at my house, we headed out.  First patient?  No problem. Second?  Not bad but I handed off the keys and had her drive after that and let my manager know I was a no-go for afternoon clinic.  Third?  I think I was okay, but my Tylenol had worn off, everything hurt and I was grateful for a sensible second set of eyes.  Fourth?  Well, I perked up a bit and made it through but was grateful indeed to escape in the end.

Last night was the first time I ate a solid meal since.

I'm the last to have it.  Squeaker gave it to his mom, and they were both ill for two days and recovering for one.  Babygirl had it, ill for two days and recovering for three or four.  Me?  Ill for 12 hours and recovering for 2 days.  Nasty sucker.  Hubby's in the recovery phase now and he's been the least sick.

Why. Does. Sickness. Come. On. Weekends?

If this weren't a holiday I'd be going back to work today, dammit.


Sunday, April 23, 2017

This Month's Disaster.....

We all know that Larry has a....delicate gut.  Our experience with last years' 4th of July fireworks aftermath (Sure Fire Paint Remover...) was just one example:  It took two weeks to get his tummy settled.  He can't eat people food, and we have to be careful not to switch up his dog food either.  And he's REALLY not the guy you want on a long road trip. So when he stopped eating for a day early last week, we didn't really think too much of it.

The second day, he ate some.  And then he didn't.  And then a little, and then...not.  And then came the poops.  We came home to a house that smelled like a cross between dog doodoo and death. We spent some time trying to imagine WHAT he could have gotten into and came up with nothing. He's either in the house or on a leash all the time.  The second day of this horror, he hit a bathmat.  I rinsed this out in the toilet and realized that I was seeing a LOT of blood.

Needless to say this was on a Friday evening.  Our vet has no weekend hours.  Over Friday night to Saturday he began throwing up as well, and by Saturday morning it was clear that he wouldn't make it to Monday without some professional help.

What is it with kids and dogs?  Do they all absolutely know for SURE when the doc's/vet's office closes??

There's a lovely animal walk-in not far from here.  When Simon had a tummy bug a couple of years ago they fixed him up, but they made it clear then that he was at the outer edges of what they could do on site there.  Larry was clearly a few steps over that line, so I called the Vet Hospital emergency line and they invited us on over, after informing us that there was a minimum $150 fee for weekend emergencies.

(I checked the place out online before going. Our other option would have been Cornell Vet center, an hour away, and they also ask for you to pay up front.  The reviews were either "They did a great job," or "They were great but expensive," or "What kind of bastards won't even care for your dog if you can't pay??" Personally, I understand your pain if your pet is suffering and you can't afford a vet, but dissing someone because you expect them to work for free seems unreasonable to me.)

The initial evaluation was reassuring, but the differential diagnosis somewhat alarming, as I expected.  The tests to rule out the ugly stuff was what set us back the most.  IV fluids, antiemetics, antibiotics were given and he looked like a new man when we walked out the door.  He's a bit tired today still but eating and walking, and no more of the runs.  We have a couple weeks of special diet, medications and probiotics for him. We will see our (much more affordable) regular vet in a couple of weeks for follow up.

Hemorrhagic gastroenteritis.

It usually hits little dogs, and tends to be related more to stress than infection. Untreated, it can be fatal in a matter of days. They asked about stressors, and I really couldn't think of anything in particular.

But as I was walking this morning I pictured Easter from HIS point of view:  Five extremely excited children ramming through the house at high speed screaming about baskets and eggs and CANDY and baskets and EGGS and eight or ten extra adults crammed into his space talking and laughing and eating and maybe some goodies being dropped on the floor for doggie cleanup and.....

Who knows.  He's a good boy.  He's had Thanksgiving and Christmas under his belt already, with the same people and chaos, more or less.  This might have just been one too many.  We might have to make sure he's upstairs and quiet for the next family gathering.

At our house we joke about the $1000-disaster-of-the-month.  This will do for April.


Sunday, April 16, 2017

Odd Things....

Easter Sunday is always wonderful. Crazy busy, but wonderful. Today was blue-sky sunny and 75.  Eggs were hidden outdoors, so the one we inevitably didn't find didn't matter. Dinner was perfected by that one daughter who stepped up and said, "What can I bring?" and doubled down with three choices on the veggies. Dinner is early on Easter, so there is plenty of time to sit, relax, and let the mind wander.

It's been an odd couple of weeks.

Babygirl's recent doctors visits were not bad. Her labs were drawn a week ahead, and she happened to be ill, so we had to redo them because they were a bit off, but the repeats were fine.  Her Botox injections finally appear to be paying off, and she's had more headache-free time than she has in a very, very long time.
Meanwhile, our insurance insists that the last Botox injections were experimental therapy and won't pay for them.  They DID pay for the ones before that, and the ones before THAT, and so on.  In fact, they covered the first two sets without argument and I've had to fight for each one since.  W. T. H.

My thumb has been healing slowly with no recurrence of infection.  My wrist and my shoulder, oddly, still bother me, because I tweaked them all over the place trying not to use my thumb.

I am dealing with a patient in my office who believes he was bitten by a pit viper while visiting Daytona Beach.  Given the nature of his story, I'm guessing that I might be exploring my first involuntary commitment if his leg isn't getting better.

My washer died Thursday. I discovered it when I went to move Thursday's was to the dryer and put in Friday's load.  There was some kind of error code flashing, so I just opted to try to restart it.  It pumped out all the water and then just kept pumping. And pumping. And pumping.  Since this was clearly not helpful, I pulled the plug and waited for the 'door locked' light to fade out.  The door remained locked.  I plugged it back in, hoping it had forgotten whatever it was on about, but NO, the endless pumping resumed.  I unplugged it for several hours.  Rinse. Repeat.  It's stuck on trying to empty when it's already empty, and permanently locked.  This would be less of a problem if nearly every bra I own wasn't in there, sopping wet, and, I imagine, getting fairly nasty.  I'd go shopping for more, but it's Easter Sunday and, ewww, Walmart bras?  Besides....

I found a killer mother-of-the-bride dress yesterday.  Bella is getting married in the fall, and although she didn't stay with us as long as her sister JuJuBee did, she asked me to be Mom for the wedding.  (In other news:  I saw a picture of myself from this morning and I didn't look.....bad.  Sometimes I forget how much weight I've lost.)  So although the dress was reasonably priced, hosting Easter dinner, putting together Easter baskets, and buying a fabulous dress doesn't leave a budget for new lingerie, especially if I need a new washer.  Hopefully our repair guy will be able to liberate them tomorrow and I can used Curlygirl's washer to finish washing them.

We are considering a fence for the yard.  Capone is just that crazy. And the grandkids are just to little to trust with the doors.

It's our second Easter without Mom.  Maybe SHE took the missing egg. It was always her before.