Let's see....
Since our last little cliffhanger, (Cancelled....) I've spent about 2 hours on phones, off and on, trying to make all of this work somehow. Each call has landed on a different day.
First, a second call to Nemours to see why, after nearly two days, they haven't called back.
Next, and longest, was the insurance company. Finding out what was holding up the Botox was...opaque, to say the least. The number on our pharmacy card reaches the mail-order pharmacy, which is a fairly useless (to us) place. We found out during the Great Transplant Medication Shortage (The Terror of Running Short....) that this is not actually considered to be OUR mail-in pharmacy (We can get 'ordinary' medications mailed to us from there if we want, but it is more expensive than using out local pharmacy. And for 'special' medicines like transplant stuff, we have to use our local pharmacy, 'cause THAT's our ACTUAL mail in pharmacy, even though we just walk in and pick them up. Don't ask me. I'm just The Fixer.). But I had to start somewhere, so....
The very nice lady who answered wasn't sure what the issue was, because Botox is in a Super Special Category that is neither "regular" nor "mail order," so it wasn't her department. "I'm going to need to talk to someone else, and it could take quite a while. If you don't want to listen to the whole thing, I can put you on hold."
Well, honestly, I'm still at work, and I have a lot of charting and dictation to do that I really don't want YOU to listen to, so sure, sounds like a plan. "Do you think I'll have time to run to the bathroom, because I probably should have done that before I called you!" She assured me that if she comes back on and I'm gone, she'll wait for me.
No need to have worried. Fortunately, the Muzak was not too grating, because a full hour after I got back to my seat, she came back on. It turns out that the Botox authorization WAS still attached to Nemours neurology. She could see a record of ONE call from the new neurologist requesting that it be released to them, but no calls from Nemours allowing it to be released.
By the time I had this information, it was too late on Thursday to call Nemours again. Friday I got ahold of the injections scheduler, and she said the reason the provider hadn't called back was because she was concerned that they wouldn't be able to get the Botox, because it had been released to the new provider. Well, damn skippy. "As a matter of fact, no, it has NOT." I filled her in on what the insurance company had said, and she was a bit miffed at them, since she herself had called them.
(So either she never called, or the insurance company made no note of the call and failed to release the medication that my kid needs, making it necessary for her to WAIT an extra three weeks. I'm placing ALL my money on it being the insurance company. I've been playing this game with them for more than a minute now.)
At this point, we are running out of options. I'm going to assume that our appointment with the new neurologist is, in fact, cancelled (something that I confess I have failed to confirm one way or the other since this all began. If I ask her to release the medication now, this will likely backfire badly; and honestly, I don't think I can be polite to the scheduler in the new doctor's office at this point.
So: "Can she be fit in when we are coming down in December? I'll clear my schedule and come a day early, stay a day longer, whatever works."
I got a call at the end of today: She has an appointment.
I admit I cried when I put the phone down. I just needed a minute. I am getting too old for this stuff.
DeeDee
Follow a mom and a child with nephronophthisis through the kidney failure and transplantation process.
Monday, November 18, 2019
Tuesday, November 12, 2019
Cancelled.....
Babygirl is due for Botox injections every 12 weeks, so she should have them November 21. Due to miscellaneous scheduling issues, our new local neurologist set her up for November 25 when she first met him back in August. Shortly after that appointment, his office called me.
"I'm trying to get authorization for the Botox, but your specialty pharmacy tells me that there is already a prior authorization in place elsewhere that needs to be cancelled so we can set one up here."
No problem. I'll call them.
Nemours informs me that cancelling the PA isn't needed, the new doctor just needs to ask the insurance company to transfer it over to them.
I'll let them know.
"I've contacted your insurance and they assure me that the other hospital needs to cancel the PA before we can proceed."
Got it. I'll let them know. In person, since we happen to be going down there.
"We do this all the time, and we know they are wrong, but we'll be glad to call your insurance company and talk to them."
Somewhere in the middle of all of this, I called the insurance to see if I could get a handle on where exactly the problem was. I'm pretty sure they told me the new doctor only had to submit the appropriate paperwork.
I let them know. And that was the last I heard about it, likely about 3 weeks after we saw our Nemours neurologist for her last set of injections at the end of August.
Today I got a message on my phone while I was at work. "We're just letting you know that we don't accept your insurance for Botox. Give me a call and let me know if you want me to put in a referral to the pain management center." Hmmm....refer us to Pain Management, at the hospital where I DON'T work, when my JOB IS PAIN MANAGEMENT at my OWN hospital????
Problem is, we aren't set up for Botox at our center (yet) and the other neurology group doesn't do it at all. And our insurance barely covers the other pain management group - Hubby used to go there and our bills were outrageous.
So I call back. The lady who has been working on the PA is clearly frustrated, and tells me: A) Nemours still has not "released" the PA they have on the Botox, and she has tried NINE TIMES to get the paperwork through, and B) even if she does, our insurance is apparently famous for authorizing it and then not paying for it anyway (which, if you knew that, WHY did you not say so 3 months ago?).
Well. I can hear that she's frustrated, and I understand, but she's at least 10 levels less frustrated than I am. I have a kid whose headaches are already in pre-Botox ramp-up mode and she's been suffering pretty badly for more than a couple of weeks, and the shots as planned were already going to be half a week late. Even if she refers me to the other place, there is NO CHANCE that we will get in in less than a week for those shots.
"I can pay for the Botox. We have a Health Savings Account, it's no problem." "How can you pay for it if I can't even GET it for you?"
Frackin' crap on a cracker. I. Just. Can't. Even.
I put in a call to Nemours Neurology. We have to go to CHOP on December 12, maybe they can fit us in (but by that time we will be THREE weeks overdue). They are checking schedules and will get back to me. Tomorrow I'll call our insurance and have a WTF conversation with them. And if all else fails I'm going to have a come-to-Jesus doctor-to-doctor conversation with a specialist that I've been sending patients to for literally more that 20 years, and let him know that he owes it to ME to take care of my kid, just this once.
I've never called in my chips on a specialist before. But this may be the time.
DeeDee
"I'm trying to get authorization for the Botox, but your specialty pharmacy tells me that there is already a prior authorization in place elsewhere that needs to be cancelled so we can set one up here."
No problem. I'll call them.
Nemours informs me that cancelling the PA isn't needed, the new doctor just needs to ask the insurance company to transfer it over to them.
I'll let them know.
"I've contacted your insurance and they assure me that the other hospital needs to cancel the PA before we can proceed."
Got it. I'll let them know. In person, since we happen to be going down there.
"We do this all the time, and we know they are wrong, but we'll be glad to call your insurance company and talk to them."
Somewhere in the middle of all of this, I called the insurance to see if I could get a handle on where exactly the problem was. I'm pretty sure they told me the new doctor only had to submit the appropriate paperwork.
I let them know. And that was the last I heard about it, likely about 3 weeks after we saw our Nemours neurologist for her last set of injections at the end of August.
Today I got a message on my phone while I was at work. "We're just letting you know that we don't accept your insurance for Botox. Give me a call and let me know if you want me to put in a referral to the pain management center." Hmmm....refer us to Pain Management, at the hospital where I DON'T work, when my JOB IS PAIN MANAGEMENT at my OWN hospital????
Problem is, we aren't set up for Botox at our center (yet) and the other neurology group doesn't do it at all. And our insurance barely covers the other pain management group - Hubby used to go there and our bills were outrageous.
So I call back. The lady who has been working on the PA is clearly frustrated, and tells me: A) Nemours still has not "released" the PA they have on the Botox, and she has tried NINE TIMES to get the paperwork through, and B) even if she does, our insurance is apparently famous for authorizing it and then not paying for it anyway (which, if you knew that, WHY did you not say so 3 months ago?).
Well. I can hear that she's frustrated, and I understand, but she's at least 10 levels less frustrated than I am. I have a kid whose headaches are already in pre-Botox ramp-up mode and she's been suffering pretty badly for more than a couple of weeks, and the shots as planned were already going to be half a week late. Even if she refers me to the other place, there is NO CHANCE that we will get in in less than a week for those shots.
"I can pay for the Botox. We have a Health Savings Account, it's no problem." "How can you pay for it if I can't even GET it for you?"
Frackin' crap on a cracker. I. Just. Can't. Even.
I put in a call to Nemours Neurology. We have to go to CHOP on December 12, maybe they can fit us in (but by that time we will be THREE weeks overdue). They are checking schedules and will get back to me. Tomorrow I'll call our insurance and have a WTF conversation with them. And if all else fails I'm going to have a come-to-Jesus doctor-to-doctor conversation with a specialist that I've been sending patients to for literally more that 20 years, and let him know that he owes it to ME to take care of my kid, just this once.
I've never called in my chips on a specialist before. But this may be the time.
DeeDee
Saturday, August 31, 2019
Letting Go......
Babygirl had her last pediatric neurology appointment two days ago, and her first adult neurology appointment two weeks ago. The peculiar overlap had to do with realizing that we don't need an adult Ubercenter for her headaches, so being turned down by the specialists in Rochester was enlightening and relieving (once I had time to process the idea that there is some area of her health that is no longer so "special" that a local doctor can't manage it). Meeting the new doctor before saying goodbye to the current one was also reassuring from a purely personal standpoint: Babygirl and I both like his style of communication, and is feels comfortable. It makes letting go of the amazing nurse practitioner we've been seeing for 3 1/2 years a just a little easier.
We haven't frequently talked about A.I. DuPont/Nemours Children's Hospital, but since we left CHOP neurology (Snapped.....), our specialist there has been nothing but amazing. She has been patient, communicative, aggressive, and effective. Although Babygirl still has headaches, she has them infrequently and manageably. In other words, she has migraines, but the migraines don't have her.
So although CHOP saved her life, Nemours saved her quality of life, and that is no small thing at all.
Why do you take your kid so far away for her health care? People ask this all the time.
Because you gotta do what you gotta do. This was 24 miles further down the road from where we were already going. I'm grateful that we could do it. So grateful.
DeeDee
We haven't frequently talked about A.I. DuPont/Nemours Children's Hospital, but since we left CHOP neurology (Snapped.....), our specialist there has been nothing but amazing. She has been patient, communicative, aggressive, and effective. Although Babygirl still has headaches, she has them infrequently and manageably. In other words, she has migraines, but the migraines don't have her.
So although CHOP saved her life, Nemours saved her quality of life, and that is no small thing at all.
Why do you take your kid so far away for her health care? People ask this all the time.
Because you gotta do what you gotta do. This was 24 miles further down the road from where we were already going. I'm grateful that we could do it. So grateful.
DeeDee
Thursday, August 15, 2019
Well, Maybe Not ALL Pharmacists.....
I decided to call today and check on the prescription that got sent to the mail order pharmacy yesterday. For those of you who haven't had the pleasure, this begins with you speaking your insurance number to a Robot, who can't understand unaccented English, and then you punch in the numbers, and repeat for the patients date of birth. Then you wait a bit for someone who isn't "helping other customers." By the time they get to you, the Robot has apparently forgotten who you are and you get to start over.
It took a minute for the gentleman on the other end to locate the prescription, and then the fun began.
Him: "We aren't your mail order pharmacy."
Me: "Yes, you are. We get our Botox from you guys four times a year. We used to mail order with you all the time until the local pharmacy got cheaper."
Him: "We do specialty drugs, but your mail order is Loor-dez pharmacy."
Me: "Lourdes is my local pharmacy. They gave us a 5 day supply and they can't get any more. There isn't any in the warehouse and there's a shortage nationwide."
Him: "They just need to order it. It should get there in a couple days."
Me: ". . . . I'm not sure how to say that any plainer, sir. They. Can't. Get. Any. More."
Him: "Ascension is a big organization, ma'am. You should notify your Human Resources Department if your mail order pharmacy is not getting what you need."
Me: "Not sure how that will help me right now sir, but I'll certainly take that under advisement. In the meantime, i'd be happy to pay cash for this if our insurance won't cover it at your pharmacy. I just need to make sure you have current payment information."
Him: "Let me check....."
Me: "Maybe before you do that, could you see if you have this in stock?"
Him: ". . . . . . . . . . . . We do not.... Do you want me to order this for you?"
Me: "F@*K.,,,, Oh, sorry, sorry. Yes, go ahead."
I suspect there's not a snowball's chance in hell that we're going to get that prescription filled.
DeeDee
It took a minute for the gentleman on the other end to locate the prescription, and then the fun began.
Him: "We aren't your mail order pharmacy."
Me: "Yes, you are. We get our Botox from you guys four times a year. We used to mail order with you all the time until the local pharmacy got cheaper."
Him: "We do specialty drugs, but your mail order is Loor-dez pharmacy."
Me: "Lourdes is my local pharmacy. They gave us a 5 day supply and they can't get any more. There isn't any in the warehouse and there's a shortage nationwide."
Him: "They just need to order it. It should get there in a couple days."
Me: ". . . . I'm not sure how to say that any plainer, sir. They. Can't. Get. Any. More."
Him: "Ascension is a big organization, ma'am. You should notify your Human Resources Department if your mail order pharmacy is not getting what you need."
Me: "Not sure how that will help me right now sir, but I'll certainly take that under advisement. In the meantime, i'd be happy to pay cash for this if our insurance won't cover it at your pharmacy. I just need to make sure you have current payment information."
Him: "Let me check....."
Me: "Maybe before you do that, could you see if you have this in stock?"
Him: ". . . . . . . . . . . . We do not.... Do you want me to order this for you?"
Me: "F@*K.,,,, Oh, sorry, sorry. Yes, go ahead."
I suspect there's not a snowball's chance in hell that we're going to get that prescription filled.
DeeDee
Wednesday, August 14, 2019
Pharmacists Keep Capes and Tights in the Back.....
Here's the follow up to Babygirl's medication shortage crisis:
Wegmans pharmacy contacted me yesterday to let me know two different things.
#1) We can't pick up more medication until Thursday because we just got a 5 day supply.
#2) Our insurance won't pay for the medication at Wegmans. We have to mail order it, so #1 is COMPLETELY irrelevant.
Alrighty, then. We are leaving for the beach on Friday. We can't wait for a mail order delivery, and I have no way at all of predicting whether THAT pharmacy has any tacrolimus anyway.
Mentally wincing, I asked, "How much is it if I pay cash?" "Let me run it through with a Wegmans discount card.....It's about $90." "Get it ready. I'll pick it up after work tomorrow." I've paid higher co-payments than that, seriously, so, go for it.
Then this morning, a note appeared on my desk, "Medicine Shoppe called. They have 300 1 mg tacrolimus."
Now, if you read my post from 2 days ago, you'll realize that this was the ONE single pharmacy I did NOT call. But the pharmacy is a block from my new office, and the pharmacist just started working a couple of days at our hospital pharmacy as well. She was on duty for the beginning of my frantic search, so when she put her cape and tights on an flew back to her home base, she checked the shelves THERE. (Keep in mind that this means that this woman had to remember both my maiden name AND my married name, connect them together. AND link it to Babygirl, and then recall where I work NOW. And she's NEW.)
I called her. Three hundred pills is a 50 day supply, plus the 30 days we have waiting at Wegmans. Like the others, insurance won't cover it. "How much for cash?" "$84.50, pharmacy cost." Screw asking anybody else to deal with this at this point - I put my doctor hat on and "called in" the prescription over the phone, and picked them up on my lunch break. And then....
Since insurance didn't cover ANY of that, I got back on the phone with CHOP. This time I reached our nurse practitioner. The transplant team is VERY aware of the problem, unlike the general nephrologist I chatted with on call. She sounded.....tired. Maybe a little afraid. "Do you have enough?" I told her what I'd done and she was frankly relieved. She has some resources, but things are getting tight. I asked her to send a request for a 90 d supply to our mail-order specialty pharmacy. "Do they have any?" she asked. "I don't know. I hope so."
So. Here I am, contemplating the fact that, by the grace of God, I am in a position where I can throw down $200 for an emergency expense and not worry about what I'm not going to be able to pay for this week, or whether we'll eat. By the grace of God I have a pharmacist who went the extra miles needed to make sure that Babygirl has what she needs to weather the crisis, and that I can smooth the path a little.
And I'm saying prayers for those who can't. Because somewhere, I am ABSOLUTELY certain, there is a mother weeping RIGHT NOW because she cannot, cannot, cannot solve this problem.
DeeDee
Wegmans pharmacy contacted me yesterday to let me know two different things.
#1) We can't pick up more medication until Thursday because we just got a 5 day supply.
#2) Our insurance won't pay for the medication at Wegmans. We have to mail order it, so #1 is COMPLETELY irrelevant.
Alrighty, then. We are leaving for the beach on Friday. We can't wait for a mail order delivery, and I have no way at all of predicting whether THAT pharmacy has any tacrolimus anyway.
Mentally wincing, I asked, "How much is it if I pay cash?" "Let me run it through with a Wegmans discount card.....It's about $90." "Get it ready. I'll pick it up after work tomorrow." I've paid higher co-payments than that, seriously, so, go for it.
Then this morning, a note appeared on my desk, "Medicine Shoppe called. They have 300 1 mg tacrolimus."
Now, if you read my post from 2 days ago, you'll realize that this was the ONE single pharmacy I did NOT call. But the pharmacy is a block from my new office, and the pharmacist just started working a couple of days at our hospital pharmacy as well. She was on duty for the beginning of my frantic search, so when she put her cape and tights on an flew back to her home base, she checked the shelves THERE. (Keep in mind that this means that this woman had to remember both my maiden name AND my married name, connect them together. AND link it to Babygirl, and then recall where I work NOW. And she's NEW.)
I called her. Three hundred pills is a 50 day supply, plus the 30 days we have waiting at Wegmans. Like the others, insurance won't cover it. "How much for cash?" "$84.50, pharmacy cost." Screw asking anybody else to deal with this at this point - I put my doctor hat on and "called in" the prescription over the phone, and picked them up on my lunch break. And then....
Since insurance didn't cover ANY of that, I got back on the phone with CHOP. This time I reached our nurse practitioner. The transplant team is VERY aware of the problem, unlike the general nephrologist I chatted with on call. She sounded.....tired. Maybe a little afraid. "Do you have enough?" I told her what I'd done and she was frankly relieved. She has some resources, but things are getting tight. I asked her to send a request for a 90 d supply to our mail-order specialty pharmacy. "Do they have any?" she asked. "I don't know. I hope so."
So. Here I am, contemplating the fact that, by the grace of God, I am in a position where I can throw down $200 for an emergency expense and not worry about what I'm not going to be able to pay for this week, or whether we'll eat. By the grace of God I have a pharmacist who went the extra miles needed to make sure that Babygirl has what she needs to weather the crisis, and that I can smooth the path a little.
And I'm saying prayers for those who can't. Because somewhere, I am ABSOLUTELY certain, there is a mother weeping RIGHT NOW because she cannot, cannot, cannot solve this problem.
DeeDee
Monday, August 12, 2019
The Terror of Running Short.....
I went hiking with friends on Sunday. I was enjoying a sunny, woodsy adventure laced with a ton of girl talk, when my I got a text from Hubby. Now, the kids send text messages all the time, as if I have no predictable job or other activities, but Hubby generally waits for a face-to-face, so I pulled it up.
"The pharmacy only has 40 tacrolimus and can't order any more because manufacturer is out or behind."
Um.....What??
"Call Monday. There are none in the warehouse."
Well. This is alarming.
Let's back up a little, since it's been a LONG time since we've had to talk about medications.
When Babygirl's own kidneys died when she was 11, she went on dialysis: Very restricted diet, painful nightly machine hookups, misery. And statistically a poor life expectancy. Most dialysis patients live 5-10 years.
When she got her kidney transplant at age 12, that improved her odds somewhat. A deceased donor kidney averages 10-15 years, and the quality of life is better. But there's a catch: You have to stay on medication for the rest of your life (or until the donor kidney dies) to keep your body from rejecting the kidney. If you miss about three days in a row, you can pretty much kiss the kidney goodbye. Babygirl, like most transplant recipients, is on a cocktail: Mycophenolate (Cellcept), tacrolimus (Prograf) and prednisone. So far it's working beautifully.
But what do you do when, for some reason, there is a nationwide shortage of one of your medications?
Tacrolimus was noted by the FDA on its official website to be at risk for shortages in May of this year (due to a lack of availability of one of it's ingredients, apparently). According to this FDA website, it was expected that this shortfall could become critical by the end of July....and here we are, right on schedule.
So, when I had the chance today, between patients, during lunch, and after patients (paperwork be damned for a bit), I confirmed with our pharmacy that they could not, indeed, get this drug anytime soon from their suppliers. The 40 pills we have are all we are going to get. Babygirl takes EIGHT of these daily. We have a few left of last months' supply. We now have about a weeks' worth of a medication critical for keeping the donor kidney alive.
I called the transplant team by 10 AM to see if they could come up with a backup plan. The unthinkable happened. For the first time in almost 9 years, no one called me back.
Well, frack.
Back on the phone. CVS? about 3 days available, no warehouse supplies. Walmart? Nope. Walgreens? No can get. Wegmans? "We have about 3 days' worth, but we can order more tomorrow." "Are you sure??" The sweet young man was somewhat taken aback by my doubt, but he double checked. "We have 3 suppliers. Two are completely out but I can get 240 tablets from the third if you can get me a prescription." Oh HELL yes I can get you a prescription.
I think.
I squashed my immediate reaction, which was to call back as my physician self and give them the prescription over the phone. I called the transplant after-hours on-call doctor for the first time in YEARS (and the only time when Babygirl wasn't actually ill). The nephrology fellow called back in less than 5 minutes, and I explained the situation to her. Apparently we are the first to hit this wall, so she was appalled when the overall implications hit her. She immediately called in the prescription for us. Because we got a 5 day supply yesterday, our insurance is making us wait until Thursday to pick it up. I confirmed with Wegmans that they had indeed actually put the order in (THAT lady was a bit snarky about it, but hey, my kid's life is at stake here, so suck it up lady and just check, okay?), and we'll have a one month cushion, enough to get us through to our next appointment with the transplant team.
I came home and had an ugly cry. My eyes are still pretty swollen.
The FDA knew in the middle of MAY that this shortage was coming. Since 1988, over 750,000 people have received organ transplants in the US. Assume that some are no longer living. Some do not need anti-rejection medication (corneas, tendons), but most DO, and that's a lot of people who are at risk of some pretty severe, potentially fatal, consequences if one of the major anti-rejection medications just disappears from the market. It's not like blood pressure medication, where there are 40-60 reasonable alternatives. In this field there are maybe 8-12 drugs, and you have to be on three of them at once.
Why didn't the FDA act?
In this specific case I can't speak with certainty. But in the case of many, many recent medication shortages the issue is Hurricane Maria. Puerto Rico was the source of many of our affordable generic medication, and many of our medical supplies (you know, those cute little IV bags that piggyback your antibiotics to grownup IV bag? Those were in short supply for a YEAR or more after that hurricane). Puerto Rico has had 3 governors in the last month, and parts of the island are approaching the second anniversary of the storm with no restoration of electricity or water. And, apparently, building new drug factories on the mainland takes time?
Our failure to see beyond ourselves politically is coming back to bite us medically.
DeeDee
"The pharmacy only has 40 tacrolimus and can't order any more because manufacturer is out or behind."
Um.....What??
"Call Monday. There are none in the warehouse."
Well. This is alarming.
Let's back up a little, since it's been a LONG time since we've had to talk about medications.
When Babygirl's own kidneys died when she was 11, she went on dialysis: Very restricted diet, painful nightly machine hookups, misery. And statistically a poor life expectancy. Most dialysis patients live 5-10 years.
When she got her kidney transplant at age 12, that improved her odds somewhat. A deceased donor kidney averages 10-15 years, and the quality of life is better. But there's a catch: You have to stay on medication for the rest of your life (or until the donor kidney dies) to keep your body from rejecting the kidney. If you miss about three days in a row, you can pretty much kiss the kidney goodbye. Babygirl, like most transplant recipients, is on a cocktail: Mycophenolate (Cellcept), tacrolimus (Prograf) and prednisone. So far it's working beautifully.
But what do you do when, for some reason, there is a nationwide shortage of one of your medications?
Tacrolimus was noted by the FDA on its official website to be at risk for shortages in May of this year (due to a lack of availability of one of it's ingredients, apparently). According to this FDA website, it was expected that this shortfall could become critical by the end of July....and here we are, right on schedule.
So, when I had the chance today, between patients, during lunch, and after patients (paperwork be damned for a bit), I confirmed with our pharmacy that they could not, indeed, get this drug anytime soon from their suppliers. The 40 pills we have are all we are going to get. Babygirl takes EIGHT of these daily. We have a few left of last months' supply. We now have about a weeks' worth of a medication critical for keeping the donor kidney alive.
I called the transplant team by 10 AM to see if they could come up with a backup plan. The unthinkable happened. For the first time in almost 9 years, no one called me back.
Well, frack.
Back on the phone. CVS? about 3 days available, no warehouse supplies. Walmart? Nope. Walgreens? No can get. Wegmans? "We have about 3 days' worth, but we can order more tomorrow." "Are you sure??" The sweet young man was somewhat taken aback by my doubt, but he double checked. "We have 3 suppliers. Two are completely out but I can get 240 tablets from the third if you can get me a prescription." Oh HELL yes I can get you a prescription.
I think.
I squashed my immediate reaction, which was to call back as my physician self and give them the prescription over the phone. I called the transplant after-hours on-call doctor for the first time in YEARS (and the only time when Babygirl wasn't actually ill). The nephrology fellow called back in less than 5 minutes, and I explained the situation to her. Apparently we are the first to hit this wall, so she was appalled when the overall implications hit her. She immediately called in the prescription for us. Because we got a 5 day supply yesterday, our insurance is making us wait until Thursday to pick it up. I confirmed with Wegmans that they had indeed actually put the order in (THAT lady was a bit snarky about it, but hey, my kid's life is at stake here, so suck it up lady and just check, okay?), and we'll have a one month cushion, enough to get us through to our next appointment with the transplant team.
I came home and had an ugly cry. My eyes are still pretty swollen.
The FDA knew in the middle of MAY that this shortage was coming. Since 1988, over 750,000 people have received organ transplants in the US. Assume that some are no longer living. Some do not need anti-rejection medication (corneas, tendons), but most DO, and that's a lot of people who are at risk of some pretty severe, potentially fatal, consequences if one of the major anti-rejection medications just disappears from the market. It's not like blood pressure medication, where there are 40-60 reasonable alternatives. In this field there are maybe 8-12 drugs, and you have to be on three of them at once.
Why didn't the FDA act?
In this specific case I can't speak with certainty. But in the case of many, many recent medication shortages the issue is Hurricane Maria. Puerto Rico was the source of many of our affordable generic medication, and many of our medical supplies (you know, those cute little IV bags that piggyback your antibiotics to grownup IV bag? Those were in short supply for a YEAR or more after that hurricane). Puerto Rico has had 3 governors in the last month, and parts of the island are approaching the second anniversary of the storm with no restoration of electricity or water. And, apparently, building new drug factories on the mainland takes time?
Our failure to see beyond ourselves politically is coming back to bite us medically.
DeeDee
Wednesday, June 26, 2019
Moving On Up......
As Babygirl gets older, we are needing to move from kid doctors to adult doctors. First to go is Ob/Gyn (yes, as horrifying as it is to contemplate, pediatric Ob/Gyn is a Thing), so we just spent half an hour filling out 10 pages of paperwork for the new doctor that we're pretty sure she won't entirely read. After all, it asks about exercise TWICE.
But they wanted to know if she's ever had HPV vaccines. She has, of course. Interestingly, it was a requirement for transplantation. Since the medications that prevent rejection increase cancer risk, it is logical to do everything possible to prevent cancer in the first place. As I wasn't entirely certain whether this doctor tied directly into our hospital computer system, I pulled out this little baby:
It's the massive zip-up three-ring binder that CHOP gave us on our first visit to their transplant team. It came complete with a shoulder strap, and I can actually throw my computer in there. It has her surgical records, dialysis records, lab reports, and vaccine records (to a point - I think her most recent meningitis vaccines might not be in there, now that I look at it). There are actually copies of her Guatemalan medical records as well. It's stored under my bed, and it still contains the waterproof emergency dialysis orders that we were to grab-and-go with in case of disaster.
You can see a pocket for the accumulated cards of those who have cared for her over time. Social workers, surgeons, dietitians, nephrologists, cardiologists, "Oh, yeah, THAT was that guy's first name!"
A number of these folks we learned to dislike because of what we saw as poor patient care, making us choose to go an extra 130 miles for better care. Some that we loved and trusted with our whole hearts have retired. In any case, Babygirl may be MY baby, but she's not a little girl any more. It's time to move up.
We meet with the family doc on Friday to get some referrals to the Grown-Up Doctors.
DeeDee
P.S, Entirely inexplicably, there is a card in that file from a probation officer from the county in which we live. Precisely NONE of our doctors are located in this county, none of MY kids have been on probation, and really, just.....why?
Sunday, June 2, 2019
Critters.....
One of the grandkids recently had headlice. This would be less of a problem if said child's parents' work schedules hadn't been set up in such a way that they needed someone to take him to school every morning. And, rather than awaken him and a babysitter at O'Dark:30, he's been spending the night in our guest room so Babygirl could get him up and walk him to school.
Now, this is not a crisis of the epic proportions that it was when his Mama and her 5 long-haired sisters spent ONE ENTIRE SUMMER struggling with an infestation of lice. (I have a touch of PTSD thinking about that: A vivid flashback to a tub full of little girls with smelly cream rinse in their long hair whining about those dreadful combs - UGH.) It's just a one-room intensive cleanup with the usual transplant-level clean of the rest of the house, but....
Babygirl CANNOT get headlice. This is just one more ridiculously simple infection that NO ONE considers important that people with suppressed immune systems cannot tolerate. These little critters bite the scalp, opening up the skin to all kinds of infections like cellulitis and lymphadenitis.
That is correct: Babygirl could end up hospitalized because of a simple case of head lice. This is what anti-rejection medications do to your immune system.
One more time: Transplantation is a treatment for kidney failure, not a cure. It has its own long-term, never-ending risks as well as benefits compared to dialysis. We need a cure.
DeeDee
Sunday, May 5, 2019
Nuts and Bolts....
Many of you know already that I've retired from family practice after 30 years in essentially one location. Lots of people have, of course, asked why.
The answer is, of course, quite complex. But lately it feels like the average family practice patient arrives at a 20 minute visit with a list of 6 complex problems, 8 of which require lab work, updated x-rays and orders for health-maintenance studies like colonoscopies, with 2 additional that get remembered when I have already said good-bye and have my hand on the doorknob or am halfway down the hall.
And my last night on-call, I took a call from a young mother whose 15-month-old had had 3 consecutive febrile seizures, so she was started on medication to prevent further episodes and referred to a specialist. At 3:30 AM this mother called to ask if she could stop giving the baby the new medication as it was making her hyper, and mommy wasn't getting any sleep..... Well, you can't UN-give the dose that's keeping her awake right now, can you? And I can't reach through the phone and remove your uterus through your nostrils so you don't reproduce again, can I?? Oh, wait, no, can't say that. Yup. Time to get out of family practice LOL.
So now I'm working in Pain and Wellness, which is, oddly, a wonderful change. One problem per person per visit - what a luxury! And our building has a therapy dog, and a weight loss sauna. I can do this!
So now I'm home for dinner every night, and Babygirl and I are catching up on projects here and there. Yesterday we disassembled an antique table to move it to her room, and were naming tools as we went:
Me: "Washers look like nickles with holes in the middle. The male parts are bolts, and the female parts are nuts."
Babygirl: "Seems like THAT should be the other way around....."
O. M. Goodness. That kid is funny.
DeeDee
The answer is, of course, quite complex. But lately it feels like the average family practice patient arrives at a 20 minute visit with a list of 6 complex problems, 8 of which require lab work, updated x-rays and orders for health-maintenance studies like colonoscopies, with 2 additional that get remembered when I have already said good-bye and have my hand on the doorknob or am halfway down the hall.
And my last night on-call, I took a call from a young mother whose 15-month-old had had 3 consecutive febrile seizures, so she was started on medication to prevent further episodes and referred to a specialist. At 3:30 AM this mother called to ask if she could stop giving the baby the new medication as it was making her hyper, and mommy wasn't getting any sleep..... Well, you can't UN-give the dose that's keeping her awake right now, can you? And I can't reach through the phone and remove your uterus through your nostrils so you don't reproduce again, can I?? Oh, wait, no, can't say that. Yup. Time to get out of family practice LOL.
So now I'm working in Pain and Wellness, which is, oddly, a wonderful change. One problem per person per visit - what a luxury! And our building has a therapy dog, and a weight loss sauna. I can do this!
So now I'm home for dinner every night, and Babygirl and I are catching up on projects here and there. Yesterday we disassembled an antique table to move it to her room, and were naming tools as we went:
Me: "Washers look like nickles with holes in the middle. The male parts are bolts, and the female parts are nuts."
Babygirl: "Seems like THAT should be the other way around....."
O. M. Goodness. That kid is funny.
DeeDee
Monday, April 1, 2019
The Annual Numbers Game....
I always leave our taxes 'til the last possible moment. It's part disorganization, part procrastination, and part knowing that it's not likely to be good news anyway. But putting it off was a bit Russian roulette-ish this year: Our tax preparer's significant other is very high on the kidney transplant list. As much as they want that kidney they must be praying for a two-week delay so they can get through tax season before the medical bills begin to really hit!
And with prayers for them in my heart, here are our numbers for 2018:
Our biggest expenses were the most hidden ones. My insurance premiums are taken out of my paycheck biweekly, pre tax. The annual totals are pretty startling.
Medical insurance: $6015
Dental insurance: $1072
Vision insurance: $281
Total insurance costs: $9968, $830/month, $383 right out of every single paycheck before I see it. We usually don't include these costs when calculating our out-of-pocket expenses.
Medical expenses:
Doctor/Hospitals: $7215
(2016, $7302)
(2017, $5893)
Medication copayments: $3438
(2016, $3416)
(2017, $3509)
Parking and Tolls: $133
(2016, $157)
(2017, $112)
Medical Mileage: 3487, $872 allowable expense.
(2016, 3040)
(2017, 2111)
Grand total out-of-pocket: $11,503. That's $958/month ON TOP OF the $830/month I'm spending to, theoretically, PREVENT these expenses. And keep in mind that not ONE of us was hospitalized in 2018. Eighteen hundred dollars a month. Twenty grand a year. And we did not spend enough to qualify for the medical deductible.
Babygirl collects disability at this point. $787 far exceeds her monthly stipend. And while I realize that our totals are for the three of us, the doctor/hospital section is mostly her. The medication section is 75% her dad and I. The mileage, parking and tolls are ALL her. Most of her income goes toward meeting her medical obligations. This does make things easier for us, of course, but it's a very discouraging reality for her.
We had exactly one month this year with no medical travel for anyone. No PT, doctor visits, eye exams or dental recalls. Ahhh, November.
I have to wonder. What percentage of all of this is spent on our actual health, and how much on insurance company profits? How much goes to pay the pharmaceutical sales reps, the billing specialists, the corporate CEOs? What percentage of all of this is being spent lobbying my government representatives to block universal health care?
DeeDee
And with prayers for them in my heart, here are our numbers for 2018:
Our biggest expenses were the most hidden ones. My insurance premiums are taken out of my paycheck biweekly, pre tax. The annual totals are pretty startling.
Medical insurance: $6015
Dental insurance: $1072
Vision insurance: $281
Total insurance costs: $9968, $830/month, $383 right out of every single paycheck before I see it. We usually don't include these costs when calculating our out-of-pocket expenses.
Medical expenses:
Doctor/Hospitals: $7215
(2016, $7302)
(2017, $5893)
Medication copayments: $3438
(2016, $3416)
(2017, $3509)
Parking and Tolls: $133
(2016, $157)
(2017, $112)
Medical Mileage: 3487, $872 allowable expense.
(2016, 3040)
(2017, 2111)
Grand total out-of-pocket: $11,503. That's $958/month ON TOP OF the $830/month I'm spending to, theoretically, PREVENT these expenses. And keep in mind that not ONE of us was hospitalized in 2018. Eighteen hundred dollars a month. Twenty grand a year. And we did not spend enough to qualify for the medical deductible.
Babygirl collects disability at this point. $787 far exceeds her monthly stipend. And while I realize that our totals are for the three of us, the doctor/hospital section is mostly her. The medication section is 75% her dad and I. The mileage, parking and tolls are ALL her. Most of her income goes toward meeting her medical obligations. This does make things easier for us, of course, but it's a very discouraging reality for her.
We had exactly one month this year with no medical travel for anyone. No PT, doctor visits, eye exams or dental recalls. Ahhh, November.
I have to wonder. What percentage of all of this is spent on our actual health, and how much on insurance company profits? How much goes to pay the pharmaceutical sales reps, the billing specialists, the corporate CEOs? What percentage of all of this is being spent lobbying my government representatives to block universal health care?
DeeDee
Monday, February 4, 2019
Seven Years......
People kindly say I don't look my age, that I have lovely skin, that the way my hair has turned grey is actually pretty. I don't disagree. Outwardly, I think I look pretty well.
But my soul is crosshatched with lines, wrinkles and scars. I got a few in my crazy childhood, a solid fistful from medical school, and divorce and single motherhood leave a mark or two. Watching your kids struggle with chronic but common childhood illnesses skins you up some. Watching academic struggles caused by a biological parents' drug or alcohol abuse: That's a gut-kick, for sure. Seeing your kids move into relationships of their own, making families, getting their hearts broken and being unable to help at all? Radically painful.
And under and over and around it all plays the music of Babygirl's kidney disease. It isn't that the things that happen to her sisters have been or are small, or even transient: They are enormous, life-changing, permanent.
But perhaps because Babygirl is still home, the day-to-day reality of her illness hovers more. The medication alarms (which the dogs now associate with their nightly treats LOL), the endless pill bottles, the habit of low-lighting to avoid increasing headache pain are all minute-by-minute reminders of our surreal version of reality.
So my soul sometimes sags like an old lady's boobs.
I have to confess that I've spent too much of the last nearly 8 years intermittently pissed about it. I mean, I get that crap happens. I get we don't get to choose. I get, I REALLY get, that God isn't doing this to her, to US, and that He will work with us to get us through it.
But our pastor said something Sunday. Something I've heard a thousand times in my life, but that somehow just sounded.....different....to me this time. He was just preparing for communion, and quoting the passage where Jesus asks his Father to "let this cup pass from me." Jesus knew, REALLY knew before He asked, that the answer was going to be, "No." And he was okay with it. He just..... needed to ask.
I'm not sure why that comforts me so much. Maybe because it's permission, in a way, to say to God, "Look, I KNOW there's no turning back, but you know I wish we could. I'm just glad you don't hold that against me."
It makes it easier to be in my saggy, scarred soul, and be entirely grateful every single day that God gave me daughters who grew up to be my friends, Babygirl included.
Seven years ago today a team of doctors and nurses installed the kidney of a stranger into my little girl, and made her life infinitely better despite the day-to-day struggle. That boy's parent's still mourn his loss every day. Pray for Jorge's family. They will never not miss him.
DeeDee
But my soul is crosshatched with lines, wrinkles and scars. I got a few in my crazy childhood, a solid fistful from medical school, and divorce and single motherhood leave a mark or two. Watching your kids struggle with chronic but common childhood illnesses skins you up some. Watching academic struggles caused by a biological parents' drug or alcohol abuse: That's a gut-kick, for sure. Seeing your kids move into relationships of their own, making families, getting their hearts broken and being unable to help at all? Radically painful.
And under and over and around it all plays the music of Babygirl's kidney disease. It isn't that the things that happen to her sisters have been or are small, or even transient: They are enormous, life-changing, permanent.
But perhaps because Babygirl is still home, the day-to-day reality of her illness hovers more. The medication alarms (which the dogs now associate with their nightly treats LOL), the endless pill bottles, the habit of low-lighting to avoid increasing headache pain are all minute-by-minute reminders of our surreal version of reality.
So my soul sometimes sags like an old lady's boobs.
I have to confess that I've spent too much of the last nearly 8 years intermittently pissed about it. I mean, I get that crap happens. I get we don't get to choose. I get, I REALLY get, that God isn't doing this to her, to US, and that He will work with us to get us through it.
But our pastor said something Sunday. Something I've heard a thousand times in my life, but that somehow just sounded.....different....to me this time. He was just preparing for communion, and quoting the passage where Jesus asks his Father to "let this cup pass from me." Jesus knew, REALLY knew before He asked, that the answer was going to be, "No." And he was okay with it. He just..... needed to ask.
I'm not sure why that comforts me so much. Maybe because it's permission, in a way, to say to God, "Look, I KNOW there's no turning back, but you know I wish we could. I'm just glad you don't hold that against me."
It makes it easier to be in my saggy, scarred soul, and be entirely grateful every single day that God gave me daughters who grew up to be my friends, Babygirl included.
Seven years ago today a team of doctors and nurses installed the kidney of a stranger into my little girl, and made her life infinitely better despite the day-to-day struggle. That boy's parent's still mourn his loss every day. Pray for Jorge's family. They will never not miss him.
DeeDee
Saturday, February 2, 2019
The Night Before....
One of the interesting things about Facebook is the feature that brings up memories every year. One of today's was this:
"They called us a 12:22 AM. Babygirl's a match, but they don't know yet if we need to come. I told them to call us if they want us to come. That call would have come in by 3 at the latest. It's not our turn this time. Thank you all for your prayers!"
I posted this at 5:57 AM, February 1sr, 2012 after what I'm guessing was a pretty sleepless night, what with one thing and another. Looking back, I know I packed bags for Babygirl and I in case we really did have to leave for the hospital. She would have been on the dialysis machine, always a death sentence to sleep anyway. I would have been crawling out of bed that Wednesday morning, struggling to face another day after yet another disappointment.
Not our kidney. Not yet. How much longer is the kid going to be on this ride? How many more nights of agony on dialysis?
It turns out: Two more. We had one night to recover, and then we were on the road for real.
There is a clear demarcation between Before and After. For Babygirl, I think the line is between February third and fourth: Between dialysis and donor kidney. Or maybe it was August 22, 2011: Before dialysis vs after dialysis.
For me, the line remains April 28, 2011. That was the day I blithely took my healthy-seeming child to her camp physical. On the other side of the line was the 29th, when the call came telling me just how wrong I was about her health, the day when everything I thought was true, wasn't.
Thinking of that moment can still rip my heart, stop my breath, and make me weak. When people talk about going back to some other time in their lives, like high school or their 20's, I think to myself, "I'd give anything to go back to when she was 9." The problem is, of course, that there would have been nothing to do that would have changed things. But like all of that kind of thinking, perhaps if I'd known what was coming I would have taken the time to enjoy the freedom more.
DeeDee
"They called us a 12:22 AM. Babygirl's a match, but they don't know yet if we need to come. I told them to call us if they want us to come. That call would have come in by 3 at the latest. It's not our turn this time. Thank you all for your prayers!"
I posted this at 5:57 AM, February 1sr, 2012 after what I'm guessing was a pretty sleepless night, what with one thing and another. Looking back, I know I packed bags for Babygirl and I in case we really did have to leave for the hospital. She would have been on the dialysis machine, always a death sentence to sleep anyway. I would have been crawling out of bed that Wednesday morning, struggling to face another day after yet another disappointment.
Not our kidney. Not yet. How much longer is the kid going to be on this ride? How many more nights of agony on dialysis?
It turns out: Two more. We had one night to recover, and then we were on the road for real.
There is a clear demarcation between Before and After. For Babygirl, I think the line is between February third and fourth: Between dialysis and donor kidney. Or maybe it was August 22, 2011: Before dialysis vs after dialysis.
For me, the line remains April 28, 2011. That was the day I blithely took my healthy-seeming child to her camp physical. On the other side of the line was the 29th, when the call came telling me just how wrong I was about her health, the day when everything I thought was true, wasn't.
Thinking of that moment can still rip my heart, stop my breath, and make me weak. When people talk about going back to some other time in their lives, like high school or their 20's, I think to myself, "I'd give anything to go back to when she was 9." The problem is, of course, that there would have been nothing to do that would have changed things. But like all of that kind of thinking, perhaps if I'd known what was coming I would have taken the time to enjoy the freedom more.
DeeDee
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