Wednesday, November 25, 2009

Gluten Tuesday

On the very first day that we saw Dr. J, my wonderful mother-in-law Beverly was extoling the virtues of my culinary prowess to Dr. J.  She was describing some random pizza that I had made while she was staying with us and helping Lynette.  Dr. J immediately interjected with his warnings about gluten in the diet.  That was the beginning of Lynette's gluten restricted diet.

It's been over 6 months now.  We have not seen any harm or help from restricting Lynette's gluten intake.  At first she ate no gluten.  Then once in a while she would have something with a slight amount of gluten, like gravy thickened with wheat flour.  Then over the course of a week would have something like breaded seafood once.

We have family standards that we like to eat that contain gluten. The gluten does not seem to be causing any issues for  Lynette, so I have recently implemented Gluten Tuesday.  Two weeks ago we had quesadillas.  Last week we had muffalettas.  This Tuesday it was home grilled hamburgers. 

Of course we aren't going to go overboard, but I see no harm in a little gluten if it is not causing Lynette any issues. 

Thursday, November 19, 2009

Do you have health insurance?

We have the standard corporate employer provided health insurance.  Lynette's employer is the plan subscriber, a coverage which has remained in place during her illness. Over the years we have been happy with our coverage, paying our copayments and deductibles for office visits and minor medical procedures.  Before I changed jobs, I used to carry our health insurance. I was surprised to find out at the annual reenrollment meeting that my company was paying twice the monthly premium on my behalf that I was.  My medical insurance premium per month was nearly $1000 for my family, including mine and my company's contribution.  I was surprised to learn how costly it was for my employer to provide me with health insurance.

I'm sure it's not a surprise to most of you reading this that we have had a recent increase in our medical expenditures. If you have health insurance, you probably feel some security in having this coverage.  It's comforting to know that when you go to the doctor or take your child the doctor that your visit will be covered by your health insurance.

Lynette received a detailed statement of charges each time we went to see Dr. J.  Most of her visits over the summer included charges for a generous supply of pricey IV antibiotics. Since Dr. J was out of network, all insurance claims had to be file by the patient.  Lynette gathered up the supporting documentation, filled out the necessary forms and mailed the claims off to Cigna. When the first claim came back underpaid, Lynette realized that they had paid on the unit price for her antibiotics and not on the extended price.

Lynette contacted the insurance company to let them know of their error.  We figured this was an isolated event and it would be quickly corrected.   The next time Lynette made a similar claim, the same problem was encountered.  Lynette contacted them once again to let them know that they had incorrectly processed the claim. The next time Lynette had a similar claim to post, she took special care to annotate the supporting documentation to help the claims processor correctly encode Lynette's claim. Once again they filed the claim based on the unit price instead of the extended price. Even with extra direction, they still filed the claim based on the unit price rather than the extended price.  Lynette filed more appeals, and today we have finally received a benefit check for these claims. 

The cost of Lynette's Lyme disease treatment is approaching $50,000.  At this point I feel somewhat happy that our insurance has covered 60% percent of this cost.  We figured the insurance benefit would stop at one month of IV antibiotic therapy.  But they have not denied any of the claims once we let them know where the right numbers were. The level of the benefit has been higher than what we expected.

The Academy of Motion Picture Arts and Sciences has pared down their choices of documentary of the year to 15 movies.  One of those movies is Under Our Skin.  This is a movie about Lyme disease and the political and medical controversy that surrounds it.  I surely don't expect Under Our Skin to win the Oscar for best documentary, but I am so excited to think of the attention that would be drawn to the Lyme plight if Under Our Skin was one of the 5 nominees for best documentary. 

This is the part where I usually write about Lynette.  She's not all the way better, but she's doing pretty damn well.

Thursday, November 12, 2009

Should I Stay or Should I Go

There's a vibrant and active community of people affected by Lyme disease. Of course the internet is the best way to interact with these folks. Lynette and I both belong to a couple of social networks targeted to people who's lives have been touched by this disease.

These social networks are a great source of support and information. Although each member has a different story to tell, you start to see that you have things in common with many of them. They have similar symptoms. They are on the same medicines. They see the same doctors.

No doubt there are a lot of stories of dispair to be witnessed. There are patients who have been sick for years but just recently diagnosed. There are people who are sick and have lost their job and their income and are left alone and sick to fend for themselves. There are the typical stories of denial by the medical community. There are patients who have been aggressively treated and have made no progress.  

Jordan Fischer Smith, the forest ranger who is one of the Lyme sufferers who's illness is chronicled in the Lyme documetary Under Our Skin said on camera that he did not start to feel well until his 3rd year of treatment. Noted Lyme practitioner Joseph Burrascano endured treatment of his Lyme disease that lasted for more than 3 years. 

The worst of Lynette's symptoms came on after her sympathetic OB-Gyn wrote her a prescription for doxycycline.  Lynette's reaction to this medicine was our confirmation that she was suffering from Lyme disease.  Lynette was forced to use a walker and wheel chair to get around due to the herx that she suffered from this treatment.  Lynette's formal treatment for her Lyme disease started in the middle of February.  Although progress seemed slow to us by the beginning of May Lynette was walking unassisted. 

It is a tendency among the members of the Lyme social networks to leave these communities when the affects of their disease diminish.  As Lynette starts to return to a normal life, I find myself feeling like I too could draw away from this community.  But I do still want to be involved.  There is a lot of progress to be made in diagnosing Lyme disease, in getting proper and adequate treatment, and in recognition of how serious of a problem this illness is.  

Lynette and I are going to the wedding tomorrow night of one of our oldest daughter's childhood friends.  The other night Lynette was going through her wardrobe trying to find something to wear to the wedding that would be kind to her diminished stature.  She was also trying on shoes that she could wear and not fall over herself.  Lynette says she still has to concentrate when walking in tricky shoes. 

Lynette has set a date for her return to work.  She hopes to return to part time duty on December 7th.  Her disability insurance prohibits her from returning to work full time.  I suppose they want to avoid a relapse.  She will be on part time for a couple of months before returning to full time.  This would put her on schedule to return to full time almost exactly one year after having to go on disability. 

As it stands now, it looks like we will be visiting Dr. J again in mid January.  After Lynette's phone consult with Dr. J last Monday, she is now on oral antibiotics on a M, W, F, two weeks on, two weeks off schedule.  Lynette had not had any antibiotics for 3 weeks following the completion of her IV therapy.  She did notice some minor herx reaction upon starting the orals.  She felt some effects in her hands and feet the first couple of days that she started back on the oral antibiotics.

Lynette is getting better and I intend to stick around.

Wednesday, November 4, 2009

Top 10 reasons I like office visits better than phone consults

Lynette's PICC line was removed today.  I told her I expected to see her raking leaves this weekend! 

I pursued getting the line pulled earlier, but I couldn't get any of the smart people to support me.  Lynette's doctor sent us more supplies to keep the line going.  Lynette had a phone consult with her doctor on Monday and he approved having the line pulled.  Several phone calls were made and appointments set up and today the line was pulled.  Lynette called me immediately afterward.  She was so energized. 

The phone consult was actually more expensive than an office visit.  But an office visit would be hard for two reasons: 1) his office isn't open yet, and we haven't heard a definite date. 2) it would cost us at least $150 in travel expenses to go see him. I convinced Lynette to do the phone consult and have the PICC line pulled locally where it could be done by a practioner who is in our insurance network and 100% covered.

Based on her experiences, Lynette has made the following commentary about office visits versus phone consults:
(names changed to protect the warriors)

Top 10 reasons I like office visits better than phone consults

10.Get to file them with our insurance
9. Cost 3 times less out of pocket
8. Get to give out hugs
7. Have interesting conversations in the waiting room
6. Get to see friendly office staff
5. Shaun get's out of work
4. Get hand written prescriptions that CVS can't translate
3. Get to see Nurse Lisa
2. Get colorful chart from famed artist Dr.

#1 reason I prefer office visits -

1. Get to go to Six Pence Pub after visit

Wednesday, October 21, 2009

PSA

I'm sure you've noticed that to the right of where you are reading right now there is a list of other blogs entitiled 'My Blog List'.  The list is sorted according to the last time the blog was updated.  So if you are waiting for my lazy ass to post a new entry you can read the blogs in 'My Blog List'.  There are some interesting and compelling stories being told.  I removed a few and added a new one tonight.  Check it out!

Tuesday, October 20, 2009

Word on the Street

Word on the street is that the New Jersey Senate is proposing legislation that categorizes Lyme disease as a "Neuroendocrine Immune Disorder" (NEID). To the Lyme community this means that their disease is being classified as an autoimmune disorder. Such disorders are supposedly the result of an immune system gone awry, rather than its response to some foreign body. This position plays right into the hands of the Infectious Diseases Society of America (IDSA) which says there is no infectious agent involved in what they call "post Lyme syndrome".

The IDSA is the author of the accepted Lyme disease treatment guidelines. Unfortunately these guidelines are out of touch with the current research. The guidelines are authored by panel members who have financial interests in products involving Lyme disease testing and vaccines.  This presents a direct conflict of interest. The IDSA's denial of the existence of chronic Lyme disease results in denial of treatment to many people who are infected with Lyme disease.

I went to check out the language of the legislation proposed in the New Jersey Senate. It did not seem nearly as exclusive as I had expected. The point of the bill is to establish a research center to study diseases classified as NEIDs. These include Chronic Fatigue Syndrome, Fibromyalgia, Gulf War Syndrome, Lyme Disease, Multiple Chemical Sensitivity and other environmental illnesses. The language in the bill states that the mechanisms of transmission of NEIDs include parasite borne infection. It even mentions the extended length of time that may lapse before getting a Lyme disease diagnosis. The bill supports research to determine the etiology of these conditions.  I don't really see the harm in this legislation. You can read it here yourself.  Maybe one of the readers can explain the uproar. 

Lynette finished her IV antibiotic therapy on Friday. I took pictures. As you may recall, one of the drugs in her last cycle made her very nauseous. Lynette had a major battle with nausea through the entire cycle. Even though she had little appetite, Lynette found that she felt better with food on her stomach. While there wasn't much she wanted to eat, Lynette had cravings like a pregnant woman. Bean dip. Sushi. Steak and Cheese (hold the bread). She also developed aversions to many foods and drinks that she would normally like. She didn't even want to drink water or swallow pills. She skipped about 85% of her supplements and other prescribed medicines during this last cycle.

Today? We talked on the phone this afternoon about supper tonight.  She went to the grocery store and picked up some items for our meal.  She took chicken out of the freezer to defrost. When I got home from work she had already prepped one dish.  She chased me out of the kitchen to go change my clothes and start the grill. I love a forceful woman!

Lynette is infusing a liter of lactated ringers daily for the week following the completion of her IV antibiotic therapy. After that her PICC line will require a daily saline and heparin flush and a weekly dressing change. Due the transition of Dr. J's practice, they are not available to see Lynette until the second week in November. It is at this time that they said they could remove the PICC line.

We have enough supplies on hand to maintain the line until November 2. We are pursuing options to have the PICC line removed locally sooner. There's no way we will get up to the new JSC before we run out of supplies. We also see no reasoning for maintaining this line, considering the added risk of contamination that comes with the frequent flushes and dressing changes.

I talked to the staff at JSC and they suggested that we wait a week or so to make sure that Lynette is really feeling well. At that time they said it would be OK to have it pulled locally. I also talked to Lynette's PCP and they said they could get us an appointment to have it pulled.

Thursday, October 1, 2009

The Big News From North Carolina

State officials in North Carolina are now saying that Lyme disease can be contracted in North Carolina.  The conclusion comes from four cases of Lyme infected patients who never left their home counties. Here's a great article in today's Raleigh News and Observer about the change in policy.

This is definitely a step in the right direction.  However this news has managed to boil up a lot of anger in me.  Why has it taken this long?  The  population of our state is approaching 10,000,000.  The CDC has collected reports of North Carolina residents being infected with Lyme disease.  While the numbers are low, it is estimated that the CDC is missing as many as 80% or 90% of actual cases.  How can all of these people test positive for Lyme disease if there are no ticks carrying Lyme disease in our state? 

The wife of a man that I work with was going down the path of  a breast cancer diagnosis.  Her tests were negative and she recalled a recent tick attachment.  Her doctor tested her for Lyme disease and she was positive.  She was bitten in North Carolina.  A woman that I know who lives in Kernersville was bitten several years ago near her home.  She was treated with a short course of antibiotics and was well for a few years before symptoms returned.  She was bitten in North Carolina.  This same woman was braiding her daughter's hair and saw an embedded tick in her daughter's scalp.  A bullseye rash developed at the site of the bite.  The child had also been bitten near her home in NORTH CAROLINA.

The Department of Defense did a study of ticks removed from service members at various military installations mostly in the Eastern United States.  The ticks were tested for Lyme disease.  The highest rate of tick infection was at the Marine base Camp Lejuene.  Camp Lejeune is in North Carolina.  

One of the justifications that officials sight in denying that Lyme exists in our state, refers to a study done in Georgia that analyzed ticks found on reptiles.  In the case of one species of lizard, it was found that there was an enzyme in the lizard which was effective at cleansing their bloodstream of the Lyme bacteria.  Supposedly this eliminated the risk of infection for humans.  However, another study done in South Carolina found that another lizard species, that had ticks attached, had a 50% infection rate with borrelia.

One of the reasons that a Lyme diagnosis is often dismissed is that the tests are so innaccurate.  Unfortunately many Lyme infected patients test negative with the current tests.  Doctors in North Carolina see these negative tests as an absolute negative.  Lyme tests don't test for the presence of the Lyme bacteria.  They test for your body's response to it's presence.  The Lyme bacteria employs several tactics to evade the immune system.  This minimizes the body's immune response.  This article is the most concise one that I've found that talks about the various evasive tactics of borrelia.

Tom Grier is a Lyme patient with an education in microbology.  Although he addresses very scientific information, he has a way of writing about it that is more accessible to the layman.  For a little more detail of some of Lyme's evasive tactics as well as more indepth information about Lyme disease that bucks IDSA ideology, check it this great article.

I'm hoping that this news will change the ways of physicians like Dr. Robert Kelly of Maplewood Family Practice in Winston-Salem and Dr. Melanie Adams of Forsyth Pediatrics in Winston-Salem and Dr. Michael Blocker in Burlington. Dr.  Kelly saw Lynette and was sure that Lyme is not an issue in North Carolina.  Dr. Adams and Dr. Blocker were both aware of Anna's positive Lyme test and dismissed it.  Dr. Adams was glad that we don't have to worry about Lyme in North Carolina.

There is still a lot of pushback from the IDSA.  They are the ones responsible for the heavy handed tactics that enforce doctor's denials of Lyme and it's chronic form.  There is no doubt that the IDSA is behind the effort to shutdown doctors who treat Lyme aggressively including Dr. Joseph Burrascano in NY, Dr. Ernie Murakami in British Columbia, and Dr.Joseph Jemsek in South Carolina, who is in the process of relocating his practice for the second time in 3 years.  We have a long way to go. But we are moving in the right direction.