This morning's news includes a story on a gentleman with stage IV esophageal cancer who is disputing with his insurance company to cover the costs of his treatment. He is treated at Dana Farber and is pursuing alternative treatments. I am fully supportive of efforts to prevent insurance companies from making medical decisions.
Also, I am a big fan of preventing bloated insurance costs where people expect everything to be covered and then can't understand why their premiums keep going up in leaps and bounds. There has to be a happy medium while is why insurance companies need to be allowed to draw the line somewhere.
As you are aware, I do not believe insurance companies are capable of making individual medical decisions. They may employ their own oncologists and other doctors to review decisions. But unless the doctors have met with the patient and examined them, they have no idea what they are doing. At the very least the patient's doctors recommendations should be the guidelines followed. Not someone who is reading an actuarial guide and cost/benefit analysis. That is no way to make a decision that might permanently affect some one else's life.
However, and this is a big fat HOWEVER, if the treatment has not been shown to have any proven results I do not believe the insurance providers should be required to cover it.
There are all sorts of quackery theories on curing cancer and myths about treating and curing cancer. There are also many alternative treatments that are not necessarily covered by insurance but have proven to be beneficial to cancer and other patients. This would include things like acupuncture.
The problem with this gentleman's request is that he is asking for coverage for something called Insulin Potential Therapy or IPT. I googled it and the first two results were from Quackwatch.org and from the American Cancer Society showing that their was no real proof it works.
While I understand he is fighting for his life, I am actually on the side of the insurance company here. The treatment he wants has not been shown to be effective. He has a full medical team available to him where he is being treated. While he may be feeling better currently, there is no way to tell if it can be attributed to the IPT or some other reason.
Showing posts with label treatment options. Show all posts
Showing posts with label treatment options. Show all posts
Rheumatoid treatment options
When I was diagnosed with rheumatoid last fall, I was already fairly aware of treatment options as my mother has had RA since 1989. The current theory for treatment is to hit it fast and early to slow progression and joint deformities.
I was immediately put on plaquenile and prednisone. Plaquenile is an old drug from the 1930s or so and has successfully been proven to treat RA but it is slow working - months to have an effect - so usually prednisone is given for a brief period of time to get the swelling and pain down faster. That was bad news for me because I turned out to be allergic to both.
I was then put on methotrexate orally and after three months, was upped to the maximum oral dose but still not much progress against RA. Then after another three months, I was switched to injectable methotrexate which is not my favorite thing. This seems to be causing a few problems in reacting to the injection and I have been concerned about my options.
I go to my new rheumatologist in July to talk options. I have limited options because all those lovely new biologic drugs like Enbrel and Humira that are advertised on TV are not for me because they don't like giving them to people who have had cancer. (There's a choice - living in pain or cancer.) There is one new option that has only been out for a short time that might be a possibility but it is very expensive.
So while I have been over thinking this whole thing and spending all too much time consulting with the evil Dr. Google I just learned about a new study that says that the older drugs - methotrexate, plaquenile and another drug that I have not been put on are proving just as effective as the new and expensive ones that I can't take. And they cost a lot left. The article also notes that between 20-40% of patients do not react to methotrexate. So maybe I am not alone.
Now I am going to stop over thinking this, step away from Dr. Google and wait until I see my rheumatologist next month.
I was immediately put on plaquenile and prednisone. Plaquenile is an old drug from the 1930s or so and has successfully been proven to treat RA but it is slow working - months to have an effect - so usually prednisone is given for a brief period of time to get the swelling and pain down faster. That was bad news for me because I turned out to be allergic to both.
I was then put on methotrexate orally and after three months, was upped to the maximum oral dose but still not much progress against RA. Then after another three months, I was switched to injectable methotrexate which is not my favorite thing. This seems to be causing a few problems in reacting to the injection and I have been concerned about my options.
I go to my new rheumatologist in July to talk options. I have limited options because all those lovely new biologic drugs like Enbrel and Humira that are advertised on TV are not for me because they don't like giving them to people who have had cancer. (There's a choice - living in pain or cancer.) There is one new option that has only been out for a short time that might be a possibility but it is very expensive.
So while I have been over thinking this whole thing and spending all too much time consulting with the evil Dr. Google I just learned about a new study that says that the older drugs - methotrexate, plaquenile and another drug that I have not been put on are proving just as effective as the new and expensive ones that I can't take. And they cost a lot left. The article also notes that between 20-40% of patients do not react to methotrexate. So maybe I am not alone.
Now I am going to stop over thinking this, step away from Dr. Google and wait until I see my rheumatologist next month.
Off to play doctor
No, not like that! Get your minds out of the gutter!
I have an appointment this morning with my pain management doctor. My back has been hurting a lot recently. Having been through the medical school and now having the degree called 'Professional Patient PW' (PW=Perpetually Waiting), I am ready to tell my doctor the next steps,unless he has some wizardry that I don't know about.
My back has caused significant amounts of pain recently which immobilizes me and makes me cranky. We were going to wait six months between visits but I opted for four months and then called and moved my appointment up by two weeks because of the pain.
My theory is that the last 'fun' procedure which involved heated needles in my spine has worn off (meaning the pesky nerves have grown back) and its time to schedule a new one. I am not sure what there is that can be done in the meantime and I know it can take up to 6 to 8 weeks to get it scheduled as well.
But I hope the appointment will go l ike this:
"How are you doing?"
"Not well, my back hurts a lot. I think the last treatment wore off."
"Okay, lets see if we can schedule it for next week."
I know it won't be that simple. It will involve him bending me to see how much he can make my back hurt and poking and prodding. But I hope it ends up the way I want it with an appointment soon. Maybe he will even have a short term solution for the interim.
I have an appointment this morning with my pain management doctor. My back has been hurting a lot recently. Having been through the medical school and now having the degree called 'Professional Patient PW' (PW=Perpetually Waiting), I am ready to tell my doctor the next steps,unless he has some wizardry that I don't know about.
My back has caused significant amounts of pain recently which immobilizes me and makes me cranky. We were going to wait six months between visits but I opted for four months and then called and moved my appointment up by two weeks because of the pain.
My theory is that the last 'fun' procedure which involved heated needles in my spine has worn off (meaning the pesky nerves have grown back) and its time to schedule a new one. I am not sure what there is that can be done in the meantime and I know it can take up to 6 to 8 weeks to get it scheduled as well.
But I hope the appointment will go l ike this:
"How are you doing?"
"Not well, my back hurts a lot. I think the last treatment wore off."
"Okay, lets see if we can schedule it for next week."
I know it won't be that simple. It will involve him bending me to see how much he can make my back hurt and poking and prodding. But I hope it ends up the way I want it with an appointment soon. Maybe he will even have a short term solution for the interim.
The Best New Doctor Reaction Yet
He laughed.
I went to see a physicians assistant in the rheumatology department yesterday about the bump on my arm (not on a log). He was a very nice man and spent some time talking to me.
He said what I have is probably a ganglion cyst and he could stick a needle in it and drain it but it might come back. I said lymphedema arm. He said 'oops, no needle'. I said when I move my thumb around it makes it hurt more, he said I could give you a thumb splint but that would make your arm swell up.
So we left it that I will monitoradmire it, and if it does become problematic, I would be referred to a surgeon to see if there was anything else that could be done. On the other hand, sometimes they go away on their own, or disappear and then reappear. But its not arthritis and its not cancer so what they hell, I can stick with it.
Then he asked me how I was doing with the RA. I told him about being allergic to both plaquenil and prednisone. Prednisone is often given to RA patients to give the other treatments a boost to get them started or during a flare to help get it under control. Not for me.
I also said that I can't take the organics like Humira, Enbrel, etc because of my cancer history. And I'm allergic to benadryl and the cillins as well.
He laughed and said 'oh you are a great patient to treat!'. I have multiple ailments, can't take many regular treatments, and have allergies that pop up all the time.
Yes I could see the humor in it. But at least I didn't have to scrape a new doctor off the floor for once upon hearing all my medical history..
I went to see a physicians assistant in the rheumatology department yesterday about the bump on my arm (not on a log). He was a very nice man and spent some time talking to me.
He said what I have is probably a ganglion cyst and he could stick a needle in it and drain it but it might come back. I said lymphedema arm. He said 'oops, no needle'. I said when I move my thumb around it makes it hurt more, he said I could give you a thumb splint but that would make your arm swell up.
So we left it that I will monitor
Then he asked me how I was doing with the RA. I told him about being allergic to both plaquenil and prednisone. Prednisone is often given to RA patients to give the other treatments a boost to get them started or during a flare to help get it under control. Not for me.
I also said that I can't take the organics like Humira, Enbrel, etc because of my cancer history. And I'm allergic to benadryl and the cillins as well.
He laughed and said 'oh you are a great patient to treat!'. I have multiple ailments, can't take many regular treatments, and have allergies that pop up all the time.
Yes I could see the humor in it. But at least I didn't have to scrape a new doctor off the floor for once upon hearing all my medical history..
I was unenlightened
I broke down and called my rheumatologist's office yesterday about the bump on my arm (not on a log). The problem was who to talk to.
The nurse practitioner I saw a couple of weeks ago is on vacation.
The rheumatologist I saw first left and I have not yet met with my new rheumatologist
I ended up talking to the physician's assistant who has never met me. We will meet on Thursday afternoon.
He did tell me it sounds like a rheumatoid nodule - I said that I am rheumatoid factor negative and statistics say I should not be getting nodules. But I did switch to injectable methotrexate which could be what caused it so I might need to switch medications. But with my medical history I can't take a lot of them.
He did also say it could be a ganglion cyst which could be drained or removed. Oh but since its my lymphedema arm there may not be any treatment options for me.
Which means I may be SOL. Crap.
I am focusing on this because I am ignoring next week's assorted tests that I would prefer not to think about.
The nurse practitioner I saw a couple of weeks ago is on vacation.
The rheumatologist I saw first left and I have not yet met with my new rheumatologist
I ended up talking to the physician's assistant who has never met me. We will meet on Thursday afternoon.
He did tell me it sounds like a rheumatoid nodule - I said that I am rheumatoid factor negative and statistics say I should not be getting nodules. But I did switch to injectable methotrexate which could be what caused it so I might need to switch medications. But with my medical history I can't take a lot of them.
He did also say it could be a ganglion cyst which could be drained or removed. Oh but since its my lymphedema arm there may not be any treatment options for me.
Which means I may be SOL. Crap.
I am focusing on this because I am ignoring next week's assorted tests that I would prefer not to think about.
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