pameladean: (Default)
I was planning to do a photo essay about a recent visit to the Eloise Butler Wildflower Garden, and still plan to do one, but right now I feel impelled to write about health insurance. Not in the way that you may think. This year, David and I have insurance through MNSure, thanks to the Affordable Care Act. I am really grateful for having had insurance, and tax subsidies to help pay for it, for the past four years. And I want to dedicate this account, with an extremely unpleasant expression involving crossed eyes and a stuck-out tongue, to former Senator Joe Leiberman, who fucked up the possibility of a much better system than what we ended up with.

About a month ago I had several nights when I couldn't sleep because things in general hurt. I kept thinking that I must be coming down with the flu, but I never did. Then instead of a general achiness I started having specific muscle pains that couldn't in any way be correlated with unusual or even usual exertion. They came and went in no pattern and with no cause. Then I started feeling a really strange sort of dizziness. I can get postural hypotension from my blood pressure medication, but this was much weirder than that and, like the aches, didn't really correlate with anything.

An acquaintance posted on Twitter that her statin had been causing dizziness and brain fog. Wait, I thought, muscle pain can come from statins. I read the patient information sheet and stopped taking my Lipitor. I ought, of course, to have called the clinic and left a message for my doctor, but I was busy. I don't even have high cholesterol. I just have a 14% chance of some kind of cardiac event over the next ten years, according to some calculation the state of Minnesota does, because of the hypertension, type 2 diabetes, proportion of good and bad cholesterol, and possibly a few other things that I've forgotten. On the basis of this calculation I was advised to take a statin and daily low-dose aspirin. So I figured stopping the statin for a little while wouldn't do any harm.

Within 48 hours the aches and dizziness had vanished. On Monday I tried to send email to my doctor, but there wasn't an email button under his name in the list of my "Care Team" on MyChart. I could have emailed my eye doctor, the nurse practitioner I've seen for a few minor ailments, or the diabetes nurse who showed me how to use a glucometer. But they hadn't written the prescription. I finally scheduled an appointment with my doctor, since I'm due for a bunch of lab work anyway; and in the space left to explain why you want an appointment, I explained about the side effects and stopping the statin.

The clinic called and asked me to call back, and when I did the nurse I talked to asked if I would be willing to see a different provider so they could get me an appointment sooner than Thursday the 18th; and I was willing, so she scheduled an appointment for this afternoon.

When I arrived I went to the registration desk, and the clerk told me with every evidence of sympathy that the clinic was not in network for my insurance plan and they would have to cancel the appointment unless I wanted to sign a consent form saying I would pay out of pocket. She also said that I was enrolled in a HealthPartners Medical Assistance plan, which I knew I wasn't. MNSure checks this for you when you give them your income information, and we aren't eligible for Medical Assistance. So I hoped that if I could get this part straightened out maybe they'd let me have my appointment. I had been pretty sure that the clinic was not in network for my plan -- it is in network for some specialties like chiropractic services and chemical and mental health, which initially fooled me into thinking it was generally all right for my plan; but it's not in network for primary care. I'd been able to get my medications from the pharmacy all right, and I really didn't want to change clinics, so I hadn't done anything about it. I said I'd pay out of pocket -- I know about what they charge for visits and this was a short one; and I wasn't actually worried about the statin, but it seemed to have sent the clinic staff into a tizzy that I had stopped taking it without consulting anybody -- and then I knew I'd really have to change clinics.

So I signed the form and went upstairs, in the nick of time for my appointment; but the poor clerk came running up the stairs and caught me. Her supervisor had "come by" and said that no, really, I couldn't have the appointment. They were legally required to bill the insurance company, and then the claim would be denied because the clinic was out of network, and "that would be a problem." I didn't see any point in inquiring further into this; I could see many possible reaons that they would prefer not to be billing plans that would not pay them.

But, she said, she would take me to the office of the financial counselors, who would help me change my plan so that I could stay at the clinic. I was pretty sure that this would work only if I really were on Medical Assistance, but I went with her and explained my situation to the counselor when they called my number. The counselor said that there had been some kind of confusion with HealthPartners assigning a lot of people to Medical Assistance who weren't on it, and she had fixed that part of things in my records, but the clinic was still, really, out of network for my plan.

I walked home -- at least it was a lovely spring day -- and called the nearest Park Nicollet clinic and got an appointment with the doctor of my choice -- from a list I'd made in January before I got stubborn and busy and didn't follow up with the change of clinics -- for Thursday, May 18th. I didn't laugh at the very nice woman on the phone who was helping me, but I laughed afterwards. I then had to call my dentist and move a hygiene appointment from that date to the following Monday.

I got an automated message from MyChart saying that my appointment of today had been cancelled. The reason given was "scheduling error."

I'm sure the new clinic will be fine, but Joe Leiberman can go jump in some really nasty polluted lake.

Pamela
pameladean: (Libellula julia)
I forgot to include this in the previous post. When one is diagnosed with diabetes, at least at an HCMC Clinic that uses MyChart, a huge raft of obligations springs up in one's list of Matters that Require your attention, all marked "overdue" even though you had no idea about any of this just the day before. I've been doggedly working my way through them (microalbumin test; dilated eye exam; diabetes education, which is one three-and-a-half-hour class and three two-hour classes; a foot exam with the dread word "monofilament" in it, which makes me think nervously of Sinclair monofilament, though in fact I have looked up the exam and it is no such thing). I was most worried about the eye exam, but put it off because most insurance plans within our reach, even with subsidies, do not cover routine eye care. I hate insurance companies. They should not be allowed within a million miles of anybody's well-being. Anyway, I had the eye exam last week and everything was fine; the diabetes has as yet had no effect on my eyes. They are a little the worse for wear after 63 years, but the ophthamologist said, "Your eyes look very healthy" in a tone of faint surprise.

The classes introduced HCMC's preferred dietary guidelines, which will drive me to distraction if anything does. "Diabetes," said the first instructor, "likes consistency." I hate routine. I hated it in kindergarten, I hated it in high school, I hated it when I had a day job, and I still hate it. Eating at the same times every day, keeping the same bedtime day in and day out, timing snacks, timing exercise, argh. My only comfort is that I have not been at this very long.

Anyway, any thought I had of controlling things by diet and exercise alone has been thoroughly squashed, so I'm taking metformin. After a month of 500 mg, it and my digestive system had come to a cautious truce, at which point, naturally, the medical profession decided to raise the dose. I complained at length both about having to take it twice a day and about the probability of more digestive side effects, so they gave me an extended-release version, which is taken only once a day and has fewer reports of nasty side effects. Not wanting either last Friday's hike or my weekend generally to be messed up, I collected the prescription last Thursday but only took the first larger dose this evening.

I've also spent quite some time down a research rabbit hole about possible ranitidine (Zantac) and metformin interactions, but concluded after squinting through a bunch of scientific papers and finding starkly contradictory statements on various websites for the use of laypeople, that nobody knows much about any of that and I should quit worrying over it. In addition to hating insurance companies, which I feel is quite a rational attitude to maintain, I also, with far less good reason, hate patient information sheets. I have hardly ever read a one of them that didn't send me into a tizzy for days. I don't think they strike the right balance between accuracy about the likelihood of the things they warn about, and specificity about the symptoms one should be on the lookout for. To me they all read like this: THIS REACTION IS VERY RARE BUT IT COULD KILL YOU! EVEN IF IT JUST SEEMS LIKE THE FLU, CALL YOUR DOCTOR! COMMON EVERYDAY MINOR SYMPTOMS COULD MEAN YOU ARE GOING TO DIE!

I think that's enough complaining for one entry.

Pamela
pameladean: (Libellula julia)
The new medication seems to be settling down. I did take it separately from the blood pressure medications, but now of course I don't know if it would have settled down anyway or whether I need to continue to eat two small breakfasts half an hour apart. Oh, well.

I went over to [livejournal.com profile] arkuat's to look after Toliman. He was very purry. He sniffed the air when I opened the window, but didn't want to go out on the porch. The neighbors' dog was barking in a desultory way, so maybe that was why. I unpacked some books, with a lot of underfoot supervision.

I am having terrific difficulty getting the direction and timing of the 9 bus right, so after missing one and having the next one drive right by me as if I were invisible, I just walked up to Lake Street and waited for a 21. It is probably just as well, because the transfer point between the 9 and the 23 is at the same intersection as Mother Earth Gardens. I wouldn't buy plants on the way over to cat-sit because it would be too cumbersome, but on the way home I would have no such defenses. The fact that I haven't cleaned the hairy bellflower and motherwort out of the places that I might plant things is no deterrent.

The stop I use to get the 21 is right across the street from Merlin's Rest. The sidewalk outside the pub was full of Morris dancers, people in kilts, people in fancy dress of other sorts, and a leavening of people in jeans and T-shirts. As I crossed 36th Avenue I saw half the Morris dancers staring at me, or maybe over my shoulder, so when I gained the curb, I looked back. A young man dressed like Prince (purple coat, frothy white shirt, the right hair) was just crossing Lake Street.

While I waited for my bus, one of the men in kilts played three tunes on the bagpipes, and some of the other people danced line dances. The bus was full of congenial people doing Saturday things. But when I got off to transfer to the 18, there was a police van parked just beyond the intersection, a man lying in one of the shrubbery beds belonging to the White Castle, and two police officers. Eventually an ambulance came and they put him into it and took him away. My thoughts of what might have happened were perhaps somewhat biased by many recent events.

The Norway maples are still blooming, but the silver ones have small leaves. I heard house finches singing extempore every time I listened hard.

ETA: I checked Merlin's Rest's website. April 23rd is their ninth anniversary, and that is why they had Morris dancers and bagpipers. It is also, they informed me, St. George's Day.

Pamela
pameladean: (Libellula julia)
So I had a doctor's appointment last Wednesday, with a new doctor, who frowned at the computer screen and said, "You've been taking omeprazole since 2013? We don't really recommend it for long-term use. It can lower your calcium levels."

My patient-information sheet says that multiple daily doses, which I am not taking, can do that; but apparently they are getting more cautious because there is more information.

I accordingly stopped taking the omeprazole this morning and took a Zantac pill instead.

Urgh. Two hours of nausea. No actual barfing, but still, urgh. When that abated, I went out somewhat belatedly to take a bus over to [livejournal.com profile] arkuat's place to look after his cat. As I arrived at the bus stop, I felt so weird that I thought, "I'm going to have to go home again. I can't get on a bus like this." I found myself hanging onto the bench as if I might fall if I let go. Vertigo? Dizziness? No, actually. I could stand up perfectly well on my own. Things were not describing slow repeating arcs across my vision. Everything was fine and stable. Only something felt extremely weird in my head, and my brain kept deciding it was dizziness. "Woogly" is the term that I use for this feeling; it sometimes precedes a migraine. However, I had no other symptoms.

I did get on the bus, and bus and walk to Eric's, and hang out with a very loudly purring elderly orange cat, and walk a bit more and take two buses home again without untoward incident. I had a late lunch and a small dinner without incident. I even made some banana bread later in the evening. The woogliness persisted in a mild form and finally went away about an hour before I had to take my evening dose.

I had suspected that the nausea wasn't just caused by the new drug, but by my having taken it with all of my blood pressure medication, most of which also wants to be taken with food, without increasing the amount of food that I provided. I don't like eating in the morning. I took the evening dose 45 minutes ago on its own, with a substantial snack, and am not having nearly the same kind of problem. So I'll have to have a larger breakfast; or, since that's generally unpleasant, maybe take the Zantac first with some food, and follow up half an hour or so later with all the BP stuff and some more food. This makes for a more cumbersome morning, but there's no relation between the ranitidine and the BP meds, so I don't have to bolt them all at once. It's supposed to be so very healthy to eat a good breakfast, but this isn't the way I'd have chosen to do that. I also suspect that it's healthy enough for the people who like doing it but am dubious about the rest of us.

Has anybody else had this kind of experience with ranitidine? If so, how did it work out in the end?

It does seem to be controlling the acid reflux all right, but I'm not sure that I care for the trade-off if the morning effects persist.

It was a glorious spring day: forsythia and magnolia are on their way out, but flowering plum and cherry are in; tulips are in colorful bud, or blooming in warm places; there are purple and white violets in the grass. The maples are blooming so hard that they look as if they have come out in leaves. Lilac and spirea and honeysuckle really have come out in leaves. Raphael saw a juvenile yellow-bellied sapsucker in the neighbors' yard. So this medication nonsense needs to settle itself.

Pamela
pameladean: (Libellula julia)
So when I got up this morning and staggered to the computer, blearily clutching my yoghurt and water and my pillbox with the anti-hypertensives in it, I started my morning routine and saw that Weather Underground had changed its format.  There is probably nothing wrong with the new one and I'll be used to it in a couple of weeks; but it's the first thing I look at after I check my email, and I was taken aback and cranky.

Then I decided that Adobe had been bugging me long enough about doing a "video update," so I carelessly told the persistent popup to install, already.  I don't know if it was really Adobe -- though they do always try to sneak MacAfee past me when I update things -- but I ended up with something that messed up my Firefox Start Page and kept popping up ads and exhortations to update this or install that, all things I did not recognize.  After a lot of poking around I discovered that the right name for this nonsense was Trovi.  Aside from the obligatory sponsored link, all the first hits were to pages telling you how to get rid of it.  I poked around more to make sure these weren't somehow compromised too, and then did what they told me, which involved downloading and running four different anti-virus, anti-malware programs.  Trovi is not technically a virus, they said, but it might as well be.  It appears to be gone now.

This all made me late running my errands, and I forgot to eat any lunch.  I deposited a check at the uptown TCF and then, feeling very woogly, ducked into Lund's for some kind of sustenance.  They used to have a really nice tuna salad sandwich, but I came away (studiously ignoring the sushi, which seemed too complicated to manage) with a hummus and vegetable wrap.  The vegetables were fresh and they had put fresh cilantro in it, but they seem to think hummus is a condiment like mustard, to be applied with care, rather than the entire protein source of the sandwich.  However, it did the trick, so I took a bus over to the Whittier Clinic and finally completed a three-day saga during which I ran out of my diuretic while my doctor didn't get to the refill request and then denied it without having anybody tell me why, or even that, she had.  The kindly pharmacist had to wrangle this information out of the clinic on Wednesday, and give me a week's worth to tide me over.  Then I had to make an appointment with a different doctor, because mine wasn't available until May 2 and, despite having noted that I needed lab work before she would refill the prescription, she hadn't actually issued an order for it, so I had to see an actual practitioner to get the order for the lab work.  The other doctor, whom I saw yesterday, was puzzled, because while he said it was useful to do lab work occasionally, it wasn't mandatory to refill the prescription.  They would usually refill the prescription and send me an email or a letter telling me to make an appointment.  I will say for them that the lab work was in my email inbox within six hours, and it all looks fine.  In any case, today, Friday, the pharmacy gave me the proper month's worth of my medication, this providing me with a nice five-day cushion in case of weirdness next month.  I had planned to walk home, but the lettuce wrap was expiring and I was grumpy and also for some reason uneasy.


I came home via the alley and the back yard, so as to admire the snowdrops and see if the crocuses were more than half an inch high.  I cannot report on this issue, because as I came up the path I saw a black object on the woodpile that I took for a crow.  Then I saw that it was a cat.  Then I saw that it was OUR cat.  I assumed it was Ninja, since he has the reputation for boldness.  I called him, grabbed him rudely by the scruff and tail when he came within reach, and hauled him inside, where he was discovered to be his sister, Nuit, instead.  She has white markings on her chest and underside, but the two of them don't look very different at a distance and through an adrenaline rush.

Arwen and Naomi came up to see me while I was making amends to Nuit, but there was no Ninja.  I checked in with David, checked all the open windows, grabbed a can of wet food, and ran back outside, where I discovered Ninja sniffing around under Lydy's bedroom window.  I lured him within reach with the food, grabbed him rudely, dumped him inside, and checked all the windows again.  No loose screens, no holes, all secure.  I went to see if Lydy, who is out for the day, had opened any windows in her bedroom, and was just in time to stop Ninja from going out the broken accordion of the window air conditioner, which was flapping in the breeze.  It was not, when I came to examine it later, squirrel-chewed.  I suspect feline intervention, possibly of long duration.

I shut him in the media room and his co-conspirator in the staircase, stole duct tape from David, who was in the middle of a complex software process that could not be left; and taped up the opening from both the inside and the outside.  Then I removed various objects that ordinarily hang over Lydy's bedroom door, shut it with a resounding bang, and put a large sign on it forbidding the presence of cats.

If alcohol didn't interact badly with my meds, I would have a very large drink right about now.  We live on a busy street, and while Ninja, who has escaped before, is chipped, Nuit, Miss Innocence as she used to be, is not.  They are young cats and we are exceedingly fond of them.  Little wretches.

Pamela

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