Would I Explode?

I try to be a good patient, but sometimes I wonder if I ditched all my pills, would I explode or something?

The legacy of any cancer patient and anyone with chronic ailments is the pile of pills one must ingest daily. I am so sick of being tied to my pill box that I just wonder, what if I ditched them for a day, or two...? Would I ever go back?

I only take a few million, or so it seems:

• One thyroid pill - due to thyroid cancer
• One Femara (AI) to reduce breast cancer recurrence risk
• Two Lyrica for fibromyalgia
• One weekly injection for rheumatoid arthritis
• Two folic acid to reduce side effects from the injection
• Two leucovorin weekly to reduce side effects from the injection
• One daily anti-inflammatory due to bad back
• One weekly pain patch for bad back issues
• 1.5 anti depressants due to the stress and anxiety caused by all these ailments

Plus, a daily multi vitamin, two fiber pills, two calcium pills, one Vitamin E, two Calcium with D, and the Glucosamine that I have to get more of because I ran out. And my twice daily eye drops for dry eyes (which are probably a side effect of some medication).

Is that enough? I think its way too much.

So I have been wondering, what if I went off my meds? Would I become a news headline? You know the kind that ends with ''....  a family member said they had stopped taking their medication before robbing the bank?"

So my chemobrain/fibro fog allowed me to forget to put on a new pain patch this week which I usually change on Mondays. We'll just say that my pain levels imploded this morning so I had to take another pill to see if I can get it under control as I wait for my pain patch.

I guess I may not explode or implode but I would probably be very uncomfortable... Damn.

How good is your health care?

Now that we have a national healthcare system in place, a recent study on the quality of healthcare available in the US, state by state. They looked at things like dental care and tooth loss, obesity, death rates, and more.

I am lucky/happy to live in Massachusetts which has many good hospitals and doctors and had a mandated healthcare system for nearly 10 years. I have always thought I have received good health care over the years.

I read through the article and was appalled on some level at the level of health care available in differing states in this day and age. But then I read through the full report (17 page pdf) and was generally impressed with the improvements in the past five years.

So overall, while some parts of the country still do not have access to quality medical care, improvement is visible.

The Cost of Cancer Care - or Big Pharma Is Getting Rich

Today's Boston Globe has an article on the "Sky-high drug prices test cancer patients". A few little pieces of information I drew from it:

"In the United States, a month’s supply of a brand-name cancer drug is now about $10,000, double what it was a decade ago, according to the report. The most expensive drug, at $117,648 for a course of treatment, is Bristol-Myers Squibb Co.’s Yervoy, the first drug to prolong survival in patients in advanced stages of the skin cancer melanoma...."

"...On average, an insured patient’s total outlay for a year’s cancer treatment is about $9,000, excluding any assistance programs, with the insurance company covering the remaining $115,000, according to Aitken. Patients receiving older cancer drugs available as generics would pay less.

The higher the patients’ costs, the more likely they are to drop out of treatment before finishing. For example, the report notes that when copayments for hormonal breast cancer treatment exceed $30, there is a 10 percentage point drop in the number of patients who complete therapy, compared with when the copay is $30 or less. For patients who stop therapy and resume it later, the combined patient and insurer costs can jump 50 percent."

$9000 per year is not chump change and the insurance company's share is a paltry $115,000 - so you wonder why insurance companies are feeling the crunch.

But then I found a little article on Pfizer and how generics are hurting Pfizer's profits:

"Despite sharply lower expenses and taxes, Pfizer Inc.’s first-quarter profit dropped 15 percent, due to generic rivals and an end to some promotion efforts with other drug makers. Shares fell as the company missed revenue expectations by $730 million, but narrowly beat profit estimates. Revenue at the New York giant has fallen since 2011 as cheap generics hurt sales of some off-patent drugs that once brought in billions annually, particularly the cholesterol fighter Lipitor, the top-selling drug ever, with peak revenue of nearly $13 billion."

But before you feel sorry for Pfizer at all, their reported net income for the first quarter of 2014 was $2,329,000,000 on $11,353,000,000 reported sales.

So I dug a little more on Pfizer and found this lovely section on the Value of Medicines for Oncology in their Press Kits and Downloads. So I started reading after many self accolades on their benefit to society and was appalled by this section on page 2:

"Based on the average cancer drug expenditure per patient from diagnosis until death over the past decade, an analysis showed that the cost of that added year of life – plus any further benefits to the individual’s quality of living – was about $6,500. Given that surveys indicate that most Americans would be willing to pay $100–$300 thousand to extend their lives by one year, $6,500 represents a bargain for society.
 
For decades, the U.S. public and private sectors have committed substantial resources toward cancer research, but the societal payoff has not been well-understood. One study estimated between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000. Improvements in cancer survival during this period created 23 million additional life-years and roughly $1.9 trillion of additional social value. The share of value flowing to patients has been rising over time. In terms of economic rates of return, R&D investments against cancer have been a success, particularly from the patient’s point of view."

So they are justifying their high prices of cancer drugs based on the fact that most Americans would be willing to pay huge sums to extend their lives by one year. A bargain for society? So they are getting rich on our wishes not to die? Please. I have no sympathy.

A very real problem

Drug resistant bacteria are now a real problem world wide. Think of the world before antibiotics where a simple cut could kill someone if it became infected. I find this very scary. As someone with multiple health issues, I am deeply concerned about getting a germ that can't be cured because it is antibiotic resistant.

The causes of this are multiple (from my layperson understanding):

• Doctors over prescribing antiobiotics for ailments that do not require them.
• Patients not taking entire doses of antibiotics so that the germs are not destroyed but adapt and become resistant to the antibiotic.
• In the food industry, livestock is given antibiotics for some silly reason - this leads to low level exposure that help build resistance.
• Discarded antibiotics end up in the water supply - this also leads to low level exposure that help build resistance. 

Now the problem is much more rampant. The World Health Organization recently released a report on this topic.

"Antimicrobial drugs are one of the foundations of modern health care – something we all hope to rely on when we get sick with ailments including pneumonia, urinary tract or blood infections, diarrhea or sexually transmitted diseases, Fukuda says. These infections occur worldwide on a daily basis.
But because of overuse or misuse or improper use of existing treatments, the ability to fight these infections is getting harder and harder, he says.

In its first global report on antimicrobial resistance, released Wednesday, the WHO says " a post-antibiotic era – in which common infections and minor injuries can kill – is a very real possibility for the 21st century."..."

"Conservative estimates in the United States alone suggest 2 million people get antibiotic-resistant infections each year, and at least 23,000 die because current drugs no longer stop their infections."

This is the part that is most scary to me:

"Some people may wonder why they should worry. Fukuda says that anyone who gets a serious infection, develops cancer and needs chemotherapy or requires any kind of surgery could be in a bad situation with no drugs left to treat them. The same is true for premature babies or malnourished children.

After two cancers and eight surgeries, and penicillin allergies, am I going to end up this way?
 
"Bottom line," says Fukuda, "we should expect to see that there are going to be some people who have untreatable infections."

The WHO says there's a need for a global action plan, including:
– better use of vaccines; – basic hand hygiene to reduce infections, such as washing hands; – reduction of non-health uses of antimicrobial drugs;
– support of research that will lead to new and better diagnostic tests; – and better surveillance, to get a better overall global antimicrobial resistance."
 
A lot of this is up to the patient/consumer. We should not demand/expect antibiotics unless they are for an infection. If given them, we should use them properly and finish the entire dose. We need to demand meat that has been raised without antibiotics. We need to go back to the basics and wash our hands and take care of minor injuries before they become infected.

Its too scary a world for those of us with not the best health.

The Weighty Question

Here I am feeling old and fat. I am fat. I know it. I wore a dress when we went out to dinner the other night and it made me look pregnant. I am too fat. I know I have to lose weight and believe me I am trying.

Here are the problems I have with losing weight:

1. My newest medication, Lyrica, added 10 more pounds
2. My hormonal breast cancer medication was good for another 10 pounds
3. I can only exercise three days a week or am in pain and uncomfortable for a couple days
4. I like food, I like to cook, and I like to eat
5. I am an emotional eater and eat when stressed 
6. And, last but not least, I work in an office which has a candy basket that is usually full, a snack tray full of tasty and fattening foods, and people bring in goodies a couple times a week. The last two are in full view of my desk and so going back to # 5 on a bad day at work, I am doomed.

I have been working on losing weight. But it is much harder to lose these days.  Having the stomach flu where I didn't have any appetite (or go to work) for 9 days, helped me start. I am down a few pounds that seem to be staying off but want to keep them off and take off more.

I can't live on lettuce. I do like salads and healthy food like Greek yogurt, home made granola, bananas, and other healthy foods. My husband is intent on losing weight as well. Tonight's dinner will be fish with vegetables and maybe some quinoa. Tomorrow night we will probably have fish again. That will be a good start.

I know losing weight will help with fibromyalgia, back pain, RA, and reduce cancer recurrence risk so there is lots of incentive, never mind the emotional side of not wanting to go up another clothes size, again.

The weighty question is it possible for me to lose weight by changing eating habits and food choices for the two of us long term? I certainly hope so. I have blogged about this several times over the years and the scale seems to keep going in the wrong direction. Maybe its time to throw out the scale.

Back from our mini vacation

We had a great time. We stayed at a little beach front hotel on Cape Cod. The weather wasn't perfect but we enjoyed ourselves.  However my back is now giving me lots of pain so I will take it easy for a few days to see if it recovers.

Tomorrow I will go to the wake for a friend who just died from breast cancer. I had hoped to go visit her instead. I knew she wasn't well and under hospice care. She had been stage IV since January 2013 but treatment didn't seem to slow the cancer down. It will be very sad. She was only 55 and was first diagnosed about the same time is me.

Cancer really sucks sometimes.

The Best Laid Plans

The best plans have a way of falling flat and causing anxiety and indecision. Today is our anniversary and we had planned a few days on the Cape to celebrate. My husband took yesterday off from work and I planned to work half a day, go to a doctor appointment and the hit the road around 3 to beat the worst of rush hour traffic. Well that didn't exactly work out.

My doctor wanted both blood work and an x-ray, of course. The blood lab was standing room only so I headed to x-ray which was very quick. The blood lab was standing room only still so I waited close to half an hour, when it usually is a five to ten minute deal. Finally I escaped and we got on the road after four which means traffic and the it started to rain as well. We arrived after six, checked in and got the notice that a lost key is a $50 fee.

Three trips to the car in the rain and we are missing a key. I put a leaky water bottle in a bag on the bed which manages to leak all through my bag -my knitting is wet, my pill box was drowned so I might be short a few pills for a day or two (but not the important ones) and the water soaked through the bedding into the mattress..... and its raining sideways so our ocean view is tempered by sheets of rain pouring down. The rain should stop shortly and we will proceed with our day.

One additional thing from yesterday is I spoke to my friend N who I blogged about last week,  B is home on hospice and not doing well at all. We plan to visit on Sunday to see her one last time but it maybe too late. I want to see her and told her I would bring her a beer. She laughed and said she would let us know if she wanted a beer or a glass of wine. I said her choice.

At this point if she wants to open a beer with friends and take a sip or just wet her lips with it, does it really matter? She probably hasn't had a beer in a while and no one has offered her one because she's on hospice and is clearly dying.... but hell if it was me, I would be very happy to have a glass of wine with friends if it was one of my last days on earth.

I just hope Sunday isn't too late. I will get a call if anything changes in the meantime... but of course the weather and cancer coordinate to mess up our plans for some time a way.

PS As always, a note to burglars we have a house sitter  in our absence.