Influential Insurance: Killing The Patient

Lately it seems that almost every day I hear about, read about or am told about directly by a breast cancer patient how they beat breast cancer and then, not too long after, it metastasized, which means that it spread to other organs, bones, or the blood or soft tissues. Once this happens it is difficult to control because of its aggressive nature, and the only way to get rid of the cancer is to die. The most frightening part, for me, is that all of these stories are coming from women under 50, most of which are under 40 and a significant portion of which are under 30.

The settings are always random: Monday night’s breast cancer defeat story was told to me on the way out to the parking lot from my brother’s baseball game by a complete stranger. I was walking with my parents and niece when suddenly a woman said, “You have the same haircut as me.” As I turned, she took off her hat, and it was clear from her tired, black rimmed eyes that she was a cancer patient. She told me all about how she’d had it once at 38, gotten rid of it, and then five years later it was in her lungs. She never had insurance and didn’t get scans (because they are REALLY expensive) until she had symptoms, at which point it was too late. Upon departing in the parking lot she said to me, “Good luck. I hope yours doesn’t come back.”

Each time I hear one of these stories I feel a little less certain about the success of my treatments and wonder if I should be doing something different. I have started considering all of these different miracle treatments that everyone and their sister’s mother’s great aunt has told me about and wondering if I should completely change my lifestyle. Blue green algae, zeolite, methylglyoxal, goji juice, all varieties of berries, ph levels, immune power herbal formula tea… I need a serious transformation in everything, apparently. And I think I should live by the ocean.

One of the most unsettling things I’ve read so far, though, is about a girl named Kristy Lasch. She was diagnosed in 2000 at 22 just after she had finished her BA degree at UM. She had surgery, went through chemotherapy, and then went on with her life. Everything was fine.

“After finishing her treatment and reconstructive surgery, Kristy’s hair grew back and she regained her strength. She decided to accept a position at the University of Miami while pursuing her M.B.A. Kristy planned a big celebration for her 25th birthday with her friends. Life was returning to normal. Kristy became active in the Susan G. Komen Foundation and spoke at the ‘Race for the Cure’ in October 2003. She continued to have blood work done every 6 months, as covered by her insurance, and the tests continued to come back negative for cancer. Her insurance didn’t let her get the scans because her blood tests came back negative. Apparently there are a significant percentage of people for whom cancer does not show up in the blood test and would go undetected without a scan.

In May of 2003, Kristy began experiencing pain in her stomach and back. Doctors reassured her that she was fine because her blood work looked normal. The pain came and went throughout the summer of 2003 and by August, she was sure that further tests should be done. Kristy had a scan done. She was diagnosed with cancer in the bones and the liver, and began an aggressive chemotherapy treatment soon after the diagnosis. “

She died on October 3, 2004 at age 26.

I guess the insurance company’s main objective is to make money, and the best way to make money is to insure only healthy people. If people aren’t healthy, it’s a burden to insure them, so it is best to get them off the policy one way or another.

Good job you sick fucks.

Influential Insurance: The Neutropenic Patient

(Note: before continuing you may want to read this post, which I wrote in a notebook back in December but only recently typed it up and posted it here. It explains “Neupogen,” “neutropena,” “neutropenic fever,” “over productive stage” and “firestorm.”)

Taxol, unlike Adriamycin and Cytoxin (AC), has caused my red blood count to be diminished and has left my white blood count at the low end of the “normal” bracket, which is 1.4-6.5, but in the bracket nonetheless… that is, until recently.

Before I started chemotherapy, my normal level was 3.6. After I started on the AC treatments it was rarely above 1.3 and had a recorded record low of 0.6. Of course, in one of my over productive stages I had a high of, if I remember correctly, 63.
For the past three weeks my white blood count has been slowly going down, and every week the nurses have commented on the possibility of giving me a Neupogen shot to prevent neutropenia. This week my white blood count was low, outside of the bracket, making me more susceptible to, well, everything.

After they “took me down” (gave me a Heprin flush, removed my tap and taped gauze to my port) I asked if I should be getting a shot because of my blood count, because while I don’t particularly care for the way the shot burns and the discomfort and internal firestorms it causes, I would really rather not get neutropenic fever and everything that entails.

HOWEVER, as it turns out, insurance policies have changed! The nurse went and asked my doctor if they should give me a shot who said, to the nurse’s surprise, that no, they were just going to hope that my system corrects itself because the insurance companies are now refusing to pay for preventative Neupogen shots and require the following criteria for a patient to get a shot: 1) The patient must have neutropenic fever and 2) the white blood gradient must be below 1.0!!!! (remember, the safe zone/normal bracket is 1.4-6.5)

How can this be a thing? Why do the insurance companies have so much power over health care? I understand the need to control the excessive administration of drugs to patients for financial purposes, but, seriously, crack down on something that is administered excessively, like antibiotics. Antibiotics have been administered to me like candy on several occasions. As a matter of fact, one of my past doctors didn’t even seem to be listening to me when I was telling her my symptoms, and, in retrospect, she should have been worried about ovarian cancer or something and have prescribed an ultrasound like the doctor I dumped her for did, NOT antibiotics.

But why prevent doctors from administering preventative medicine to cancer patients? That doesn’t even make any sense! And the doctors only have the shots administered a) to patients that need them and b) until the patient’s immune system starts functioning on its own again.
My count isn’t that bad right now (1.3), but if it were a tenth of a point or two lower, I would be concerned and really pissed off… not that I’m not angry right now, but this is more general anger whereas the other would be more selfish anger.

Basically what I’m trying to say is that insurance companies are evil and have absolutely no concern for the patients. Not that insurance company employees are all selfish, soulless, creeps, but the top dogs and policy makers that make all the money certainly appear to be.

At some point I may venture to take on the big scary monster, but I am going to need to stock up on armor first.

Influential Insurance: Aloxi vs. Zofran

The chemotherapy regiment I have been on since January 4th is Taxol (chemo) with Herceptin (not chemo, although wildly expensive… about $2000/dose every week, which will triple when I start going every three weeks and getting three times as much). With this regiment I get the following premeds in the following order: Zofran (for nausea), Dexamethasone (a steroid), Zantac (for my stomach) and Benadryl (to prevent an allergic reaction to Taxol). They take about two hours to be administered and have varying side effects.

I have been on Dex since my first Adriamycin and Cytoxin (AC) treatment, where I received the premeds Aloxi (like Zofran, but better) and Dex as well as an Emend pill (hard core nausea preventer at $354/3 pack of pills) which I ingested as soon as they got my blood counts and found out whether my white blood count was high enough to get chemo, and then on the mornings of the second and third day. Dex has a cumulative kind of side effect, it seems, because I have noticed that my anger levels have risen since I’ve been on Taxol. Or perhaps it’s the Taxol. Or perhaps it’s the Dex, but I didn’t notice when I was on the AC treatment because the Adriamycin more or less wiped out all familiar and healthy feelings and replaced them with weak, nauseated aliens.
Anyway, in case you weren’t aware, steroids cause noticeable differences in mood.

The Benadryl makes me sleepy, especially since it is administered in high doses and directly into the blood stream.

I don’t think the Zantac causes any side effects, but that’s only because the nurses haven’t blamed it for causing any of the many that I have.

The Zofran, on the other hand, causes LOTS of side effects, even though they run it very slowly in an attempt to minimize these effects. Despite their attempts, however, Zofran is powerful and still kicks my butt, leaving me with the following annoyances: dizziness, blurred vision, inability to focus, inability to walk in a straight line, jumpy vision, loss of balance, loss of appetite, and, on the following day, the feeling that somehow a succession of queen size mattresses were dropped on me from a distance of at least 15 feet, the force of which caused my body to slowly slice through the concrete to the underlying surface like a spoon through a slightly under ripe tomato.

Now, as I mentioned before, Zofran and Aloxi have the same function, but Aloxi is much better for me. I can feel when my system is saturated with Aloxi, but it does not cause the symptoms that Zofran does, which last beyond the day of treatment. I know that this is not at all in my imagination because last week one of the nurses came to me and said, “I’m going to run your Benadryl a little faster because you’re already going to be getting out of here pretty late tonight. Let me know if it bothers you,” to which I replied, “Ok. I think I should be fine, though, because the Zofran didn’t really bother me much this time. I only got a little bit woozy at the very end, and it went away pretty fast.” About twenty minutes later the nurse came back and said, “The reason the Zofran didn’t bother you is because we accidentally gave you Aloxi, which is better for you, but your insurance doesn’t want to cover it.”

At which point I said, “WHAT? My insurance dictates how you guys are allowed to fix my cancer?” And she said yes, that the insurance companies very much dictate what the medical professionals are allowed to do with their patients and what their patients are allowed to have TO CURE THEIR LIFE THREATENING DISEASES. Now, I know that Aloxi isn’t going to cure my cancer, it is just going to help make my treatment more tolerable to my system, but instead I have to have Zofran, which is supposed to do the same thing but has all of these other side effects that very much effect my quality of life. I don’t mean to sound like I’m whining, but my head is seriously messed up right now and while I am aware that it is mostly the chemotherapy, I am certain that the Zofran is a contributor, and it is extremely irritating to me that the insurance company gets to tell my medical provider what she’s allowed to give me.