Bending the Third Rail
Because We Should, We Can, We Do
Thursday, March 02, 2006
A (Hopefully) Educational Rant
I'd like to share a story of the little purple pill, the blue behemouth, a doctor trying to practice medicine, and a patient with a highly rebellious stomach. I post this as a rant. But also as a warning and/or validation to any of the rest of you facing, shall we say, your later years? Throughout my discussion, please remember this. I'm retired and I have money. Imagine the process for someone working and on a very limited budget.

I'm 51. For the last two years I've been particularly engaged with the health care "system". I put that in quotes because I'm not sure if it's a system or not given how poorly it works. How about the non-health care system? Mind you, for the last thirty or so years, I barely ever saw a doctor. Now I seem to live in health care hell.

It all began with a lump in my throat. You know how it feels if you cry really hard and get a lump in your throat? I started having that 24/7. After a series of doctors visits, I was diagnosed with GERD, gastro-esophageal reflux disease. Yeah, I had occasional heartburn, but apparently my stomach had been rebelling for years to the point that my throat said basta! The diagnosis shouldn't have been much of a surprise as there is a long history of serious stomach problems in my family, including a grandfather who died a 40 from bleeding ulcers. I later found out I'd had some other symptoms like ear infections, bronchitis and sinus problems that were also likely, at least in part, the result of GERD, but I never connected those symptoms to reflux. Again, I never had what I'd call a lot of acid indigestion. The reason GERD can be a serious concern (beyond the discomfort) is that as your esophagus burns from stomach acid, you can develop a little abnormality called Barretts Syndrome, a condition of the esophagus that can significantly predispose you to esophageal cancer.

The treatment for GERD is very straightforward. You can begin with over-the-counter medications such as Tums, Maalox, Tagamet, or Pepsid. These medications are fine, but weak for we big time refluxers. For the big stomach rebellions, you begin taking the newest generation of medications called protein-pump inhibitors (PPI's) which, in short, stop your stomach from producing much acid. You may still reflux (send food back up your esophagus) but it won't burn the tissues.

The most common of the PPI's is over-the-counter Prilosec. It's half the prescription dose, but works well. I tried that and within two days broke out in a rash and itching. The doc was hestitant to try other PPI's given they're all in the same family, but we went ahead (at my encouragement) and tried Nexium, "the little purple pill", at half the normal dose. Somewhat puzzling, it worked fine with no allergic reaction and I was enjoying the relief from refluxing. I continued taking Nexium for about four months with no ill effects and after several months, my throat began to heal.

Ah.....

Until.....

Nexium costs (at Walgreens) about $6.00 per pill. My insurance, Blue Cross PPO, gladly paid a portion for those four months. But then they insisted I try a less expensive PPI.

Off to the doc.

I tried the Prevacid Blue Cross had suggested and broke out in a rash and itching.

Back to the doc....

And back to the Nexium. Things were cool for another couple of months, then the insurance pops up again requiring me to try the cheaper Protonix. Now's when it gets interesting......

Back to the doc....

I take the protonix with no ill effects for about three or four months, thinking I had found a cheaper alternative without any allergy. Around Txgiving of 2005, I got sicker than a dog. I mean sick. I tried playing pool (as in billiards) on Xmas day, got through three games of nine ball and then had to take a three hour nap. I had zero appetite, no energy, ached, felt like someone had their hand around my throat, and was plain old sick. Went to the doc, was told I had a "virus" and to go home and sleep it off. Three weeks later, back to an emergency doc (it was the holidays) who tells me my liver tests are all fouled up. He hinted at something serious and suggested I see my regular doctor if I didn't feel better in a day or so. In the meantime, I noticed, in additon to the other symptoms, that my scalp HURT. My wife, the ever prescient one in my family said, "gee, do you suppose you could be allergic to protonix?"

Duh.

I stopped the protonix and got better, except the GERD fired up, and the lump returned. It seems that during the summer and into the fall, I had been taking Claritan for allergies, which was suppressing my allergy to protonix as well. Stop the Claritan for winter, and the allergy hit like a brick wall. Stop the Protonix and the reflux came back with a vengence.

Back to the doc.

I explained the whole thing. She doubted I had done OK on the Nexium but agreed to try it again. This time I went on the full dose Nexium and began to get itchy. No rash, and the itching was modest, but I then cut the dose in half and did fine. I reported the results to the doc. It turns out that Nexium makes a "geriatric/baby" dose. Glad to know they made provisions for me. So the doc perscribes the low dose nexium. I go to the pharmacy to pick it up, ..... and .... yep. The insurance won't pay for it unless I see a specialist, a gastroenterologist.

I happen to have one who had earlier endorsed the idea of the half dose Nexium. But now I'm supposed to see him again for his blessing, and then regular ongoing maintenance visits before my insurance will pay. By this time, two years into this, I'm about to lose it with someone. Perhaps I should resume refluxing on the insurance company?

I decide to look on the internet for a "source" in case all hell breaks loose. Guess what. I can get a NINE MONTH SUPPLY from an overseas, undisclosed location, of a generic nexium for $140! No persciption required. I believe that's cheaper than my co-pays with the insurance coverage. Or, I can go slightly less illegal and get my GP's perscription, go to a Canadian pharmacy, and get the real deal for a little over $2/pill! Oh, and you'd think cause I'm going on the itty bitty dose of the little purple pill, it would be cheaper, right? Nooooooo. The 20mg. is just as expensive as the full magilla 40 mg. ... everywhere. Remember, those magnificent drug companies are looking out for our interests! If someone can sell nexium for $.50 per pill and make a profit, what's going on when they charge $6.00 per? They have costs to recoup. Right? Oh, you mean all that R&D that they don't actually do?

I'm not positive, but assuming the generic works (and I have no reason to think it won't given other experiences), I can get a years supply of Nexium for $186 (20 mg) or $93 (taking 40 mg every other day). But to do so requires me to 1.) let the insurance company off the hook and 2.) break federal law. Same with Canada perscriptions.

Here's the irony. If I had stayed on the Nexium originally, I would have saved (all covered by insurance and mostly costs to them):

>5 Doctors office visits ~ $700
>1 Emergency Room Visit ~ $1500
>2 Blood Tests/Liver Panels ~ $300
>1 Gastroenterologists Consult (so far) ~ $300
>Several Hours in waiting rooms (if I were working, likely lost time)
>The Cost of the Doctors time and clerical support for authorizations
>The Cost of Blue Cross "cost containment" program for my case.
>A shitload of pain when I was sick for 2 solid months ~ no charge (likely missed work time had I been working).

The simple costs of the money expenses would have paid for a year and a half of Nexium at retail prices.

My experience is a microcosm of what's happening to literally millions and millions of people. The result is a deliverance of some of the worst health care/dollar spent, a lot of frustration, and encouragement to break the law. For those who won't, or can't, take on the system it means deferred medical care resulting in lower quality of life and ultimately higher costs to treat more serious illnesses.

As the population ages, it's not going to get better. If you haven't had a similar experience, you will.

Can't we do better?
4 Comments:
Blogger Lynne said...
We could do much better if the medical/pharmacy industry didn't have such a stranglehold on our "representatives". I'm ready to go to a system like Canada has, or some of the European countries. At least if the government ran things, as messed up as the government is at times, there is some level of accountability. Who is accountable to the public right now?
I also believe this is why genuine campaign finance is so critical. And so far out of reach.
Aging sucks, doesn't it?

Blogger Debra said...
I hate to bring this up at this late date, but acupuncture works on your condition quite well. In addition to relieving the origina lump in your throat which is known as plum pit qi, because it feels as if there is a plum pit stuck in your throat to relieving the acid reflux and encouraging the esophagus to heal.

This is a relatively simple series of treatments and with a competent practitioner you should have significant relief with the first three visits and happier than a pig in a mudhole by the tenth. Then it would require followup visits approximately every six weeks or so depending on your stress level.

Chewing your food until it is a liquid, no cold food out of the fridge or freezer and a few simple changes should help you. You seem to have tried the pharma method, maybe something else would help? I'm not being simplistic here, I have dealt with this problem successfully many times. You actually have a classic case, chinese medicine has hundreds of years of patient histories with this problem.

Waiting until you are thirsty is no time to start digging the well.

Blogger GreyHair said...
Debra,

Thanks for the information. I'll check it out and consider it. It would sure be nice to find a none pharma answer!

Blogger Debra said...
I am willing to answer any questions for you, it really should be a simple solution since the MD's seem to have ruled out most dangerous stuff.