My day in the arctic chill

This morning it is a tropical -4F. A lovely morning indeed. I do not need to go to work. I get to stay mostly at home. But I am going to get a crown at the dentist this morning. Which is better? Going to the dentist when its below zero or staying home under a warm pile of blankets. Of course, I have to go out. Damn. I do not do well in cold weather.

I did fall earlier this week on the ice. Today I will wear my really fancy clothes. I have a giant puffy down parka that is rated to 50 below. Then I will strap on my winter hiking boots which are rated to 35 below. When I am done getting my teeth drilled, I get to go pick up a free sewing machine for some new crafts. I hope it isn't heavy because it is being left out for me and there won't be anyone to help me with it.

Finally, I will go purchase an old collapsible sewing table for my new-to-me sewing machine. This table is apparently about 30 lbs. I will leave it in the car until my husband gets home. Then it will be heavy and really cold. 

I posted on Facebook about feeling dizzy (and asked my mother not to read it but she did and commented on it) and the consensus is I should call my doctor about dizziness. I don't really want to but I will. This may mean another trip out into the arctic air again.

I really just want to stay home and play with my sewing machine. I have an idea for new crafts  using a combination of fleece pieces and yarn to crochet the fleece together with the yarn to make infinity scarves. And I can make mittens from fleece and can embroider those with flowers and things to make people think of summer.

That's what I'll do today - think of summer.

Quick access to medical care

Do you see the nurse or the doctor (or the physician's assistant)? Back in the good old days, you went to the doctor and saw the doctor. A nurse might come in and take your vitals, bandage something up, or some other task that was below the doctor's capabilities. They were doctors and didn't do the basic stuff that would take away from their schedule.

Now you may see the doctor, the nurse, the nurse practitioner, or a physician's assistant or even someone else.... Does it make a difference? Not really. They all give out prescriptions, send you for tests, and diagnose and treat you. They all talk to each other if there are any questions.

Back when I was young and athletic in the 80's and 90's, I used to go skiing with Club Med in Colorado (an awesome vacation every year for seven years). One year, I was put in a group of skiers which included several doctors, a nurse, a few others, and me. It snowed overnight so we went skiing in the back bowls to enjoy the fresh powder. This entailed a hike up over a ridge in loose snow at about 14,000 feet (gasping for breath), over the head wall singly, and reconnect as a group with the instructor last to clean up any debris (skis, poles, hats, gloves, etc) to ski down for a mile or two, take another lift back up to ski down the front side of the mountain.

All went as planned. Each of us went over the head wall and into the loose powder (and you say 'why is she telling this story' - be quiet there is a point here) and across the flats. Last came the instructor, schussing across the flats, until his ski hit a rock just under a thin layer of powder where the wind had blown off the other foot or so of snow. He did your basic rolling fall with equipment going everywhere (similarly to 'the agony of defeat'). We started back to help pick up everything and give him a lot of sass for it.

All jokes ended when we saw the blood pouring out of his face. In a rather inaccessible place in the mountains, he caught a ski pole in his face and ended up with an 'Al Pacino Scarface' injury. The doctors stood and gaped and said they hadn't seen anything like that since internship. The nurse ran to his side and started yelling for clean tissues, napkins, bandanas, anything to apply pressure and stop the bleeding. The nurse knew what to do. She fixed him up and rode the chairlift back up with him and went with him to the clinic where he got five stitches in his face. The doctors went to lunch.

So on that sunny day on a ski slope on the backside of a mountain in Colorado, the nurse was the winner.

Now when I go to see my PCP or oncologist, I often see a nurse practitioner. When I see my pain doctor, sometimes I see his physician's assistant. Its not that big a deal. Particularly with my PCP, if I have a new ailment and need a visit as soon as possible, I'll get one of the nurse practitioners. I could wait a week before seeing my PCP or see the nurse practitioner. I'm happy with the sooner visit.

Think of this as well. Do you remember going to the dentist and the dentist cleaned your teeth? Now a hygienist cleans your teeth and a dentist does fillings and other nasty things with drills and pointy things. When I go to the eye doctor a technician checks my vision and glasses prescription and the ophthalmologist checks my corneas.

All this is for quicker medical care and more use of specialized training in different parts of the medical world. I'm all for it - I want the quicker access to medical care.

Fibromyalgia and pain

These days  my fibromyalgia has been better under control. I can also often tell the difference between fibro pain, RA pain, and I stubbed my toe pain. This is thanks to Lyrica with its weight gain side effect (and ice cream after dinner last night).

However, this is not always the case. Fibro has this lovely habit of, for absolutely no reason whatsoever - or maybe I breathed, all of a sudden I am experiencing bone deep pain in my body.

Yesterday I was at the dentist getting my teeth cleaned and all of a sudden I experienced pain down the right side of my back - probably a solid 9 on that stupid scale. It went from my collar bone down to my waist - an excruciating, teeth grinding pain that lasted about 30 seconds.The hygienist became concerned with my facial expression. She stopped working and asked if there was anything she could do - glass of water, sit up the chair, etc. I thanked her and said no. Her reply was 'its just letting you know its still there?' My reply was yes.

That is what fibromyalgia does, among other things. Sometimes it flares up like that in a body part - usually my back or leg or arm - sometimes at a joint and sometimes not. And there is absolutely nothing anyone can do. Unless someone invents the miracle drug that will relieve a 30 second bout of pain anytime soon.

But it is better than before which is a good thing.

Coping, cooperating, and crankiness

I have had enough of serious blog posts on financial stuff and now am back to my normal (whatever that may be) level of zaniness in the crazy world of my health.

Monday I had a regular six month check up with the dentist. Something I hate/fear/detest more than almost anything - its right up there with those little medical adventures that might make me feel a 'twinge'. At the appointment, it was decided that I need two bonds which are relatively painless and quick and could help prevent future issues. I am all about my long term health (or what is left of it) so opted to have them. It was also pointed out that I have two older fillings on a single tooth which are stressing the tooth and cause it to start to crack. It was also decided it was in my best interest for what's left of my long term health to have them removed and replaced with a new white filling. Lo and behold, the dentist actually had a cancellation for yesterday morning at 830. I rearranged my schedule for yesterday morning and went for the appointment.

That was one of the worst dental appointments I have had in decades. First, I needed Novocaine on the top right and top left front, as well as the middle top right. Novocaine went in and the dentist got called away to check on another patient. The assisting tech decided to be proactive and put the clamp on my tooth to get ready for the rubber dam. Well that hurt/was uncomfortable/made me cringe and my stomach hurt. Not a good start. She took it off and tried a second one. The dentist returned and said to wait until the last minute. That's okay I was stressed already.

Then the old fillings took forever to drill off. Even the dentist said it did. She started explaining in detail that I didn't need. When she was done drilling, then she started putting in little wedges to rebuild my tooth and held it all in place with another clamp. She then moved on to the bonds but the drilling fun had taken so long I needed more novocaine. Then I went to work, with a stressed out stomach, feeling like I had a frozen face. When I got to work, I was told I didn't look very good.

That was on top of the continuing fight to get my new (old) pain patches for my RA/fibro. I was on the 5mcg pain patches but my doctor thought I should increase my dose to 10mcg because of my pain levels. The 5mcg ones I got from the mail order pharmacy for 3 months at a time with a paltry co-pay of $95. My doctor sent in a new prescription for the 10 mcg which showed up in a one month increment for the same paltry co-pay.  I called the mail order pharmacy and was told they needed a new 90 day prescription. Then I called my doctors office and asked them to change the prescription to a 90 day supply.

Then I had an allergic reaction to the damn pain patches. When I took off the patch, I had a perfect rectangle of rash which lined up exactly with the patch's adhesive. I called my doctors office again and asked them what were my options and was told to either try going with out the patches (which doesn't work unless I want to live on pain pills) or putting cortisone cream on my skin ahead of time to prevent the reaction.

I waited for the damn rash to go away and tried again with the cortisone lotion. So far its working. Then another prescription showed up in the mail with its paltry $95 co-pay for one month of patches. And a note that said state law prevents them from sending more than 30 days at a time. I called the pharmacy again and was told it was by law but they weren't sure if why I had received 90 day supply of the 5mcg patches. I called my doctor's office again and asked for the 5mcg dose in a 90 day supply. Then I received another email saying a new prescription had been processed and will be sent to me. All I know is that it will have a $95 co-pay (that would be #3 this month) but I hope its for 3 months of the right patches that won't give me a rash.

In the meantime, back at the ranch so to speak, I  have been coping with increasing pain, fatigue - where getting into my pjs at 7 pm sounds like a good idea, and trying to live a 'normal' life.

All this has led to some crankiness. And with my new RA meds, I have had to give up alcohol so I can't even have a glass of wine to cope. Crankiness is ensuing because the scale has not cooperated in making me a skinny alcohol free pain patient.

Inequality in insurance compensation

I have often wondered why there are such inequalities in insurance compensation. What I am referring to is why is dental coverage so different than general healthcare coverage? Also, why are prescription medications so different from medical care received at hospitals.

Dental care is just as important for good health as general health care. One thing is that flossing is important in cardiac care some how. I don't know how this works but flossing is important. Oral cancers cause death and are usually found by dentists. I just find it ridiculous that dental coverage is so infrequently offered and the coverage is so poor. This is from the point of view from some one who just paid a $600+ dental bill for two fillings and two checkups - one for each of us. And we are on the Federal Blue Cross program which is supposed to be one of the best around.

Also, why are medications taken orally in pill form covered so differently than infusion type medications given in the hospital. So if you get an infection and are hospitalized and get IV antibiotics, its basically covered. But if you get a prescription for regular tablet antibiotics, you are hit with the big copay? It doesn't make sense. Especially with the recent advances in cancer treatments.

So you have cancer you go for chemo infusions and they take hours. Each chemo round costs an easy $10,000+. You go every couple of weeks. That's expensive but your insurance probably charges you a regular $20-$30 copay if you are lucky. Then you switch to an oral chemo which is a pill form that you take often - maybe every day or whatever they tell you. These are a premium brand name pill and you are hit with a big fat copay. My insurance would charge me $95/refill at the mail order pharmacy and a lot more if I got it at my local drug store. And if you got three different pills that would be three times the price. That adds up each month.

So finally here in Massachusetts there is a bill slowly making its way through the legislation that would require insurers to cover chemotherapy equally, whether IV or oral pill form. I would love to see this adopted nationally and applied to all prescription medications.

And have my dental care covered equally. (Yes, I floss every day.)

Unequal distribution of medical treatment

Yesterday I said I was going to the dentist (and no cavities). Something I really hate and would prefer to skip but with my medical history (insert blah, blah, blah here) I try to be proactive about medical stuff as opposed to the what if scenario. I don't mean that going to the dentist is going to prevent cancer or something but oral hygiene is relatively important.

I posted this on Facebook (my cyber hangout) and said that I disliked the dentist but would prefer it to the gynecologist or oncologist essentially. I was surprised to find out the number of people I know who have skipped the dentist due to financial constraints. I just consider it a necessary evil and go regularly.(And I try to floss daily as well but that's another story.)

I also know others who's medical coverage does not cover all their necessary tests so they skip things that they shouldn't but do so out of financial need. Or people who have cashed in their retirement to pay for cancer treatments in hopes that they will be around long enough to need their retirement.

Personally, because of my preexisting condition (a/k/a thyroid cancer) I used to pay for my own health insurance so I could not be denied care if my employer did not offer Blue Cross. Then the laws changed here in MA so you couldn't be denied coverage due to preexisting conditions and I didn't have to do this any more.

While at the gym last week, I got caught up on my quality reading (People Magazine) while on the treadmill and they had a cover story about some Hollywood personality/model or something in her early 20's who had had 10 (yes TEN) plastic surgery procedures to enhance her looks. I am sure she paid for these up front. (There was a secondary story to say that her mother was less than thrilled at this behavior. See it pays not to tick off your mother - especially when national press is involved.) We can also look at the case of Michael Jackson and how many plastic surgeries he had - again, I am sure he paid for these in full. And what about his personal doctor? We hear about the shortage of some doctors and here are people with their own personal doctor?

This all started me thinking about medical treatment and its availability and cost. To me this is what healthcare reform is all about. We live in a country that has a great medical system but some people seem to get too much of it and some people seem to get too little. This is where the imbalance is. Why should a 50 year old be missing half her teeth because she couldn't afford dental care? Why should other employed people with medical insurance skip dental (or any other) care due to poor coverage? We should all be able to take care of the routine maintenance to keep us alive and in good health until retirement. But those who want cosmetic enhancements and can afford them, should also be able to get them provided they pay in full, and some of their disposable income could possibly go to help others in need through taxes.

Okay, its over. Don't ranting. I am tired this morning and my back hurts. Why does my back hurt (besides the normal reasons)? I fell asleep on the couch watching TV which isn't good for my back and then the cat sat on me with his delicate 13 lbs which didn't help. I had to wake up to go to bed, meaning I didn't sleep that well, and then when I did wake up this morning, the cat was sitting on me again. Back pain leads to crabbiness and I have to go work with nice cheerful people. Nothing like being around cheerful people when you aren't. Its annoying to say the least.

Reality has returned

Now its back to the real world. I have no life so of course it is very boring. Yesterday I worked at home, met a friend for lunch, and procrastinated on the internet from doing more work. The most exciting things to happen is lots more flowers are blooming in the garden (so prepare to be bored with more pictures in a day or two) and I am reaching a stage where I will have more tomatoes than I can eat (so I will make salsa and sauce).

Today is not exciting either. A little work from home this morning, a walk, and then off to work and possibly my support group. Tomorrow I get to go to the dentist so today I will be sure to brush my teeth at least 3 times and floss at least twice. Not to say that I don't keep up with dental hygiene on a regular basis but before the dentist I am usually a little more diligent. Thursday will be the high point of my week when I meet a new GI doctor to discuss my various ailments. I can't wait. It should be lots of fun. I have my lists ready. But that is Thursdays problem. Today's problem already is procrastination.

Doesn't this sound like fun?

A MUGA scan is sounding more and more exciting the more I learn about it. First of all, they dont give you an injection. They draw some blood, mix it with a radioisotope and reinject it in you. Then, you are not given an x-ray but are under a gamma camera where you have to remain completely still and you get an ECG at the same time. This takes 30-60 minutes. Lastly, there are resting MUGA scans and stress MUGA scans. The stress ones are on a stationary bike or something. Hmmm.. If the test takes three hours and the resting part only takes 30-60 minutes, I suspect I get the stress part too.

And the best part is before I go to this I get my teeth cleaned and probably a filling! Yippee! Yahoo! NOT! Ice cream for dinner to recuperate? Maybe Fritos and onion dip....

Oh, even better, apparently, you get this test more than once as you go through chemo to monitor for heart damage. Something else to look forward to!