BUT WHAT HAPPENS IF THE FAX IS BROKEN? – Marilyn Armstrong

In case you haven’t noticed, doctor’s offices rely heavily on faxes to get prescriptions to the pharmacy. Although that has always left me a bit twitchy — personally, fax machines and I get along about as well as my printer and I get along, which is to say, not well — I have come to assume they know what they are doing.

I know, for example, that my doctor’s office is very good about getting prescriptions done quickly. If I call in the morning, the pharmacy usually has the script ready to pick up in an hour or two. Considering I pretty much left my last two doctors because they couldn’t seem to get a prescription ready inside of a week, I consider this amazing.

Windy day in a parking lot

Since two important prescriptions were canceled last week due to unavailability and we are planning to be away on vacation next week, I’ve been trying really hard to get all this stuff worked out. There really isn’t anything crazier than realizing your script ran out and you’re miles from your pharmacy.

I got the prescription worked out for the pain medication over the weekend. Not only did I get a prescription, but it works a lot better than the previous one. I actually wake up in the morning feeling like I can move. Not very fast at the moment because my left knee is pretty dodgy, but the rest of me feels almost like … well … normal. I didn’t think it was possible!

As for the Adderall gone missing, it’s all CVS’s fault. Through some accident — I’m serious about this, so laugh all you want — they ordered ALL the Adderall. All of it. So if you don’t shop at CVS — I don’t because I can go to Hannaford and get a prescription immediately — while it’s always a half an hour wait on a long line at CVS. For just about anything.

But honest to god, that’s what the doctor’s office told me. So all the smaller pharmacies are completely out until the next order. You think maybe CVS did it on purpose?

Eventually, we got this worked out. I’m getting double strength pills and I just have to split them. I already split some of my BP meds, so it’s no big deal … but I had a lot of weird mental issues about CVS ordering ALL the Adderall from the manufacturer. They must have tons of it. Literally tons.

The problem with my regular doctor was far more peculiar. I called, said the medication had worked gangbusters and I was really happy with the replacement and they said they would ship the fax over immediately.

But the pharmacy didn’t have the fax. I called again — both doctor and pharmacy — and the doctor’s office sent another fax and Hannaford didn’t get it.

Because, as it turns out, the fax machine was broken.

Some of the ladies who work in the front office are not tech savvy. They manage to deal with computers, but they always look emotionally and mentally strained. They are sure — always — that something is going to blow up.

I’m very patient with them. They are nice women and work hard. Not everyone does well with electronics, even very smart people. I can do almost anything with a computer but put me in front of a printer or fax machine and my brain dies.

Photo: Garry Armstrong

Their fax machine was broken. That’s why Hannaford didn’t get the fax.

Apparently, they didn’t know anything was wrong until they started getting calls from all the pharmacies in the area that prescription faxes hadn’t arrived. Putting two and two together, they got at least 22. Most of the pharmacies agreed to take the orders by phone — just this once. I guess now they are going to have to (gasp) buy a new machine. Hook it up. Convince it to connect. It’s probably wireless and will only work when it feels like it.

Just like my printer.

So I spent almost all day on the phone because the fax machine in the doctor’s office is broken and they didn’t know it. Apparently, the people at the pharmacy worked through the problem with them.

And meanwhile, my glasses are ready to be picked up tomorrow! Yay! Are things finally beginning to run a little more smoothly? Will we make it to vacation alive? Tune in!

IDIOPATHIC – Marilyn Armstrong

FOWC with Fandango — Idiosyncrasy

I am the proud owner of a body which does its own thing Although I knew the word “idiosyncrasy,” until I got into understanding “doctor-speak,” I didn’t really understand the word.

When a doctor says you have an “idiopathic neuropathy” in your left foot, it means your left foot doesn’t work the way it should and he/she has no idea why. Anything idiopathic in medical language is the equivalent of the doctor shrugging his or her shoulders.

Over the years of my life, many things have been officially idiopathic or, as I prefer to put it, idiotic.

Reflexes that stop working. Sensations that disappear (aka “idiopathic neuropathy”) and later reappear. Idiopathic dizziness, idiopathic raising/lowering creatinine, changing levels of red blood cells, iron deficiency, electrolytes that vanish, then reappear … and the list goes on.

None of these things have ever been diagnosed. All of them eventually went away without medical intervention. Frequently, my hardest act to pull off is not letting them give me medication that is going to give me a whole new set of problems I didn’t have before.

It’s not that I don’t think we all need regular checkups. We do.

But our bodies do stuff. On the whole, a lot of it doesn’t mean anything important. Our bodies adjust themselves, pushing this level up and another down and when it sorts itself out, it settles down. We have become so used to reading stats that when anything seems out of line, this doctor or another feels he or she should DO something about it.

First, they have to figure out what to do and that always involves a lot of expensive testing. After which the result is usually nothing. Sometimes you hear, “You’re getting older” — as if I didn’t know that. My personal favorite: “You should probably drink more liquids.” Thank you for reminding me.

My favorite line yesterday was the nurse who asked me why the electronic blood pressure machine doesn’t work on me. How in the world would I know? Ask the machine or its manufacturer. Read the manual.

Or forget the machine. Take a standard, manual blood pressure reading, the kind every nursing student learns during their first five minutes in training.

EKG setup

It’s why I often wonder why do a dozen tests so they can then tell you it was “a massive yet idiosyncratic drop-off of blood sodium levels” that should have killed you. “It’s amazing you could even stand up.”

Not only did it not kill me, but if they hadn’t called and told me something was terribly wrong, I’d never have noticed anything. It did, as it turns out, finally explain those cramps in my legs and feet.

Electrolyte insufficiency. If I drink Gatorade or any of the dozens of other electrolytes drinks, my legs and feet don’t cramp. After years of pain and agony, the answer was “sports drinks.” I don’t have to take any expensive and likely to kill me medicine, either. Amazing.

Meanwhile, I learned yesterday I still do NOT have cancer (again). My anemia is gone. Let’s hear it for those little, dissoluble iron pills. All my levels are NORMAL, especially for someone who had two kinds of cancer nine years ago, and major heart surgery 4-1/2 years ago.

I’m in fabulous condition — except for the broken spine. the hypertrophic obstructive cardiomyopathy, and the dysfunctional gastrointestinal thingamabob. Also, whatever was making my left eye cease seeing has gone away so I can probably skip the expensive tests they were going to run.

Glass on glass

I probably didn’t have a stroke. Maybe I just need tinted glasses. I absolutely need new eyeglasses because I can’t see very well at any distance except really close up. Maybe I can get the hospital to pay for them instead of $10,000 worth of tests they were going to run.

Just call me idiopathic

FEELING A BIT WAN – Marilyn Armstrong

RDP Thursday – WAN

After yesterday’s doctor visit, having to go to yet another doctor seems like charging up the same hill — and there’s a guy at the top with a machine gun. Nonetheless, gotta do it. I still don’t know where to put my head. I feel like I carry poisonous genes and have passed them down the line.

But, speaking of wan, I’m still in the process of trying to work my way out of anemia — the last of the repairable issues on my medical agenda. I’ve actually found an iron pill that seems to work and doesn’t make me ill. I’m not taking enough of it, I know, but it beats out the nothing I was taking before.

I’m beginning to really resent DNA.

Junco and I think a House Finch

Isn’t what you inherit supposed to be a sort of grab-bag? You get some of the stuff, but not ALL of it? Because I seem to have collected everything and be in the process of passing it along.

The good news? Yesterday’s doctor seemed to think that I didn’t look particularly anemic now. My gums have stopped being pale and that’s a good sign. Now all I have to do is worry whether or not I’ve managed to pass everything along to another generation. Or two.

So feeling wan? Literally and figuratively. At the same time!

INTREPID BY ROAD – Marilyn Armstrong

FOWC with Fandango — Intrepid

Intrepid will always be the name of one of Horatio Hornblower’s ships. Somewhere in my 20s, I discovered Horatio Hornblower … and that’s how I learned that there was an actual use for trigonometry! If only they had mentioned this in school, I might have had a clue what I was doing instead of random calculations used to reach an answer that meant absolutely NOTHING to me.

We probably should have named The Duke “Intrepid.” He is quite the intrepid voyager. Except he likes when we come out and let him IN the yard, even though he jumped out. I guess out is easier?

Today I am off to see the wizard, also known as my cardiologist. He’s a new one. I’m trying to finally shake off Boston and get all my physicians lined up locally. Boston made the news the other night as officially (who is the official calculator of such things?) having the worst traffic of any city in the U.S. Not in the world. I think there are quite a few cities in Europe (and how about the traffic in London!) that could compete.

Boston has gotten terrible. When I moved here in 1988, traffic wasn’t great, but you could get from one place to another and generally even park when you got there. Not any more. Not only can it be impossible to get there, but if you do parking will cost the price of feeding two people for a week. Or more.

Bad. Very, very bad.

We spent something like 50 billion dollars to remodel our road and I swear they are worse than they were before we spend more than a decade redoing everything. The thing is, they move things around, but they didn’t make them bigger. Just stuck them underground (cough, cough, cough) or straightened out the crooked pieces.  So we’ve got nice straight bumper-to-bumper traffic.

Boston traffic is only for the intrepid.

We’re away shortly. As we head for UMass, a mere 20 miles away, call us intrepid. Also, please hope they don’t find anything new or interesting.

TOM’S CATARACT SURGERY – BY ELLIN CURLEY

Recently, Tom’s cataracts started to give him problems driving at night. He began seeing large halos around the headlights of the oncoming cars, which made driving a challenge. He went to the eye doctor who told Tom that his cataracts were ‘ripe’ and it was time to get cataract surgery in both eyes.

Now, no one looks forward to someone slicing and dicing their eyeballs, but Tom was borderline phobic about anyone touching his eyes. We had two close friends who had recently had the surgery and they both reassured Tom that they had felt nothing during the procedure and little if any discomfort afterward.

Tom listened to them but didn’t believe them on some level. So he procrastinated about scheduling the surgery – and procrastinated, and procrastinated.

When he finally scheduled it, he didn’t feel good about it. He worried more and more as the surgery date drew near and he reached a peak of panic the sleepless night before D-Day. On the ride to the surgery center, as well as in the waiting room, Tom kept repeating that he really didn’t want to do this. I began to worry that he might make a run for it.

Of course, Tom had to wait endlessly at the doctor’s office before he was finally taken in for the seven-minute procedure. So by the time he saw the doctor, his blood pressure must have been off the charts. Fortunately, along with buckets of numbing drops, they gave him some ‘good drugs’ to relax him.

I waited anxiously in the waiting room for an hour before he came out the other end. During that time, I saw a veritable parade of post-surgery patients, smiling in their identical pairs of unfashionable sunglasses. I relaxed as I realized that no one seemed freaked out or even stressed.

So I was not surprised when Tom reappeared, gushing about what a weird but not unpleasant experience it had been. As he had been told, he felt nothing but water being pumped into his eye. He saw strange lights and heard psychedelic music, which made it all feel like a mini acid trip.

Tom in his ‘cataract sunglasses’

Fresh out of surgery, his eye was blurry and totally dilated, and he felt like he had a grain of sand in his eye, but he could already tell how much better his vision was. Everything was brighter and clearer, especially colors. Tom said it was as if he had been looking at the world through a yellow filter and suddenly now he was seeing everything in vibrant, living color.

We bumped into an old friend in the waiting room who was coming in for the same surgery. Tom went on and on about how awesome his vision was now and told his friend not to worry but to get ready to be amazed at how colorful and sharp the world is.

By the next day the dilation was gone and even though only one eye was fixed, Tom’s vision was dramatically improved. He no longer needed his glasses for distance vision but will still permanently need reading glasses. Not a big deal. He also could see that our sunroom was painted bright blue, not green or teal.  And he was telling everyone what a miracle he had just experienced!

Tom seeing great without his glasses for the first time in decades

Now Tom can’t wait for the second surgery!

DETERMINATION CAN GET YOU THROUGH, BUT IS IT WORTH IT? – Marilyn Armstrong

FOWC with Fandango — Determined

I can relate to determined.

It was that kind of day. We needed some food, but no money comes in until next Thursday, so we are flat broke … but prescriptions still need to be filled. I sent Garry to the store with a list and a reminder that we are seriously broke, so ONLY get what’s on the list.

Also, I had to reschedule a hospital appointment because they’ve deferred me so often, the original tests are two months old and I don’t even know if I’m still anemic or it has bounced back to normal. I’ve been on the edge of below or slightly above anemic most of my life so it wouldn’t surprise me if I was now back in the normal range.

University of Medicine and roads

I have no complaints about the medical care at UMass Memorial, but getting an appointment in a reasonable amount of time is crazy. Garry got in fast because … well … he knew someone. That’s right. He had an old connection from his working days. I, on the other hand, do not have a connection. Worse, UMass is the kind of place where they don’t listen to you.

I have seizures. Short, limited, with a quick bounce back — but still frightening. I thought, after the last one, I should see a neurologist. Garry, who has the hell scared out of him, agreed. My doctor agreed. We all agreed, but I could not convince any neurologist at UMass to see me without requiring I get a head MRI first.

My doctor and nurse couldn’t convince him either. He was dead set on that MRI, even though I would probably have all my problems solved because following the MRI, I’d be dead.

You see, I have a metal pacemaker in my chest. Even being in the room with MRI equipment would kill me. Literally, would tear the pacemaker out of my chest and leave me gored, bloody, and dead. I can’t prove it because apparently, I’m not mentally equipped to explain my medical problems on my own.

So I never saw a neurologist. Never talked to one. Never heard from anyone. It has been months, maybe close to a year. Every time I get a bit dizzy, I’m terrified I’ll have another seizure, but since I can’t see a neurologist without dying, I figure I’ll have to live with the seizures.

And now, it’s time to change cardiologists because Garry and I are getting too old to haul our asses into Boston. I need a local doctor. Even though I can and did completely describe my heart surgery — all of it — I still have to prove it. PROVE IT?

How do you prove heart surgery? Can’t they just call Beth Israel and get the records from them? I may have the records somewhere, but they aren’t “legal” if they don’t come from the hospital. But we have all these medical privacy laws, so they can’t GET the records without a lot of transferring of paperwork.

Medical Building and ramps

Meanwhile, I still have to go to the lab and get my tests redone and maybe  (MAYBE!) they will be done before I go to the hospital where they will take my entire medical history again and it will be the same as the ones they’ve taken before including all my medications.

ALL of this information — everything that has ever happened to my body — is in their computer including the heart surgery, both replaced heart valves, the bypass, pacemaker, and cardiomyectomy. They have the serial numbers for each implant (I am full of serial numbers) and serial number for both of my breasts that are ALSO implants. I will never be an unidentified corpse on a slab because all of my body parts have their own USB code. Unless they fix that computer, too.

Everything has been put on their computer. But, since they “fixed” their software program, they can’t find anything.

And then there was the telephone which doesn’t work and the ten pounds of mail I have yet to finish sorting.

That’s been my day. How has yours been? You have to admit that only a determined 72-year-old woman could make it through this sort of day.  When I was done, I cooked dinner. Mussels with spices, tomatoes, Worcestershire Sauce on angel hair pasta. And I cleaned up, too.

SURVIVING WHEN YOU CAN’T PAY FOR DRUGS – A GUEST POST

Case Management

When you are diagnosed with an illness for which there is no cure, but long time survival is possible, you quickly learn that the most important case manager you will ever have is yourself.  You need to learn everything you can to survive — legally and, if necessary, illegally.  You tend to drop your concern for law when your life is at stake, especially when you will “First, do no harm” (Primum non nocere), the oath of doctors and others helping people survive.

Support group members will urge you to not merely educate yourself about the disease, but to get a good case manager. After you understand all your treatment options and the decisions you will have to make, your case manager can help you navigate the maze of health care bureaucracy. This is important for everyone, whether or not they have a job or insurance. Anyone can be taken advantage of by the system.

Illustration: NBC News

Early after an HIV positive diagnosis, I was laid off from the job which provided my health insurance.  The fight to start COBRA coverage was immediate.  Many states have programs to help pay for continued health insurance under COBRA (Consolidated Omnibus Budget Reconciliation Act).  There may also be other drug assistance programs because the cost of medication, even with insurance, may be out of reach for those without jobs and even those with minimal jobs.

While state help was being lined up, my well-known insurance company was deciding whether to grant continued insurance.  Their basic argument was they were headquartered in another state and therefore were following other guidelines. The case manager got experienced lawyers familiar with this sort of trick to deal with the insurance company.  They finally offered COBRA and the state came through with payments.  This was the value of a knowledgeable case manager, but the process took time.

A Re-Purpose

The interval during the battle for coverage brought other concerns.  I knew I might be able to afford the multiple drugs for a month or two, but the extreme costs would quickly wipe me out.  That is when I learned about “other” assistance.  This kind of assistance is spoken of quietly by those who are desperate, but can be trusted.  It is the kind of help that takes place all over our region, and probably across the country too.

My case manager told me he might be able to help with some drugs, but not all.  When I came for an appointment one day, he told me to wait. He went to a pharmacy and came back with some of the medication I needed.  He took a black marker and carefully crossed out a name and gave it to me. He said it was mine now and not to say anything to anyone about this.  Ever. I left and kept quiet for years.  The agency he worked at is gone now, and I don’t know what happened to the case manager.

He had gone to a pharmacy that had secretly offered help.  When a patient did not pick up their HIV drugs for over a month, they did not put the item back in stock, but held it on the side for emergencies. If the item had been covered already by insurance, and the customer did not pick it up, they felt free to hand it to another. The drug company was paid and the insurance company was none the wiser.  This tactic is illegal, but many will run the risk to save lives.

Helping One Another

Not all managers are so resourceful or willing to run such risks.  Strictly speaking, it is against the law — dispensing drugs without a license.  There are individuals in support groups who are willing to assist with drugs, when no one else can.  For a while, there was an agency here that had acted as a go between to pass drugs from one patient to another.

In support groups, some would mention how they could bring unopened bottles of HIV medicine to the agency and they would keep it for those in need. Then if a member could prove they had a prescription for a particular drug the agency had on hand, they would give a month or two of the drug to the client.  That agency no longer does this or will even admit they did it for many years.  They could be shut down just like the agency referred to above.

Drugs are collected in many ways.  If someone who has gotten a three-month supply of medication, but then the drug was changed by his doctor, he would bring the unopened bottles to the agency to lock up in secret. If someone passed away, a mate might turn in unopened items to help someone else.

The fear of being caught helping to save lives has led many away from this type of help. Patients are left to do what they can for each other via contacts in support groups — or even “on the streets.”  Those fighting the disease can not imagine throwing out drugs that can help others.  Turning in drugs to be destroyed seems a bigger crime than “dispensing drugs without a license” for those who hold a prescription for a life-saving drug.

“Healing those who seek my help”

With the loss of agencies willing to help patients get drugs, legally or illegally, some doctors are willing to fill the void. There are those who collect back unopened drugs so others who can not afford them will benefit.  A doctor knows the prescription of a patient and will generally learn in private conversation who needs help.  If the drugs have already been bought and paid for, it seems a humane thing to do. In this country, this kind of help is unfortunately necessary.

The High Cost of Drugs

HIV drugs come in several classes and a patient is likely to take one or more from each of 3 or 4 groups per day.  Few drugs have generics and even those are expensive.  The retail cost in the United States for three or four of these drugs could run 4 to 5 thousand dollars per month.  Patients receiving various assistance programs are terrified of health care “reform.”  Out of necessity, we help each other.

When I was in Germany and discovered I had miscounted a medication. Of course I was panic-stricken.  I went to a pharmacy, who sent me to a local physician who spoke English.  I told her of my plight. When she was satisfied I had demonstrated I had such a prescription (I always bring proof if I travel), she wrote a new prescription. I went back to the pharmacy, prepared to charge to my credit card an outrageous amount due to my miscalculation. I knew my insurance card would not be honored overseas. The drug was reasonably priced, about one tenth what it costs retail here.

Aside from one doctor I know of, many who would otherwise be willing to help with drugs and health care services have been driven away –or at least underground.  Americans do not have the protections other countries around the world offer. In the absence of legal support, we do what we can to help everyone — not just with advice, but with life-saving drugs denied to many because they can’t afford them.


People without insurance die.
This is not a political opinion. It is a fact. 

NOTE: Since the author isn’t available to answer questions, comments are “off.”  I can’t answer questions because I don’t have any answers, sorry.