May 31, 2006

Roof repair

Today I’m seeing Dr. Two-Fifty (as in hundreds of dollars per session). She’s not my new therapist; she’s the shrink the therapist is sending me to for meds for the Other D.

I’ve thought and read and fretted a lot about taking this step. This kind of internal debate is a cliché of postmodern American life, yes? Medicate the problem vs. staying with it (whatever that means) in search of personal growth or insight or at least some nonchemical cure. There’s a faction out there that posits the choice of medication for depression as the easy road, a turning away from the harder, worthier path of dealing with one’s shit head-on and with authenticity.

I thought about personality (what is it and why and whether medicating my brain will undermine some essential Violetness that I won’t want to lose and whether, if I do lose it, I will be able to get it back). I thought about how, before resorting to medication, I should probably explore exercise or yoga or at least not lying around on the couch all the time. I thought about how an antidepressant could mess up my BGs--from what I can learn, almost all of 'em have the potential to do so, though they often don't. (Cymbalta, one of the newer ones that does not, is a "step" drug on the NIP formulary, meaning that Dr. Two-Fifty has to try me on other drugs first and turn to Cymbalta only if they don't work.) I read about the myriad other side effects to which I can look forward, depending on the drug of Dr. Two-Fifty’s choice and my body’s personal, idiosyncratic response thereto.

Then I thought about my other thoughts, the nonbloggable ones, and I came to understand that sometimes you reach a moment when you have, say, a large and gaping hole in the roof of your home, caused maybe by the antics of squirrels or your roommate's fondness for illegal fireworks or the mediocrities of bargain-priced shingles or the little kid next door who likes to hit his baseball up onto your roof several times every Saturday--the cause is not the point; the point is that the hole is there--and outside the thunder is clapping and the lightning is sparking, and you know that the rain on the way is not just any ordinary storm but the kind that generates Significant Media Attention. At such a time you do not look into your toolbox and say to yourself, I will work alone, using only the small nails and the small hammer to repair this hole because by doing so, I will grow immeasurably in my knowledge of carpentry, and that will make me a better person. No, you pull out every tool that might help, small, large, and in between, and you give one to your roommate, another to the kid next door, and whatever remains to the squirrels, and you all go to work on the damn hole.

In other words, you Take. The. Freaking. Drug.

May 25, 2006

Of nickels and NIPs

First, my thanks to the commenters who offered feedback below on the Naomi Berrie Diabetes Center. I really appreciate the input. I'm looking at other options, though in the meantime I may end up there for a maintenance appointment. Foggy, Peculiar Violet also entertains a vague hope that her doctor there will be Miraculously Different.

Meanwhile, my company has changed insurance providers. A very strong plus is that I now have a network here in NY, whereas previously all my medical stuff was out of network and had to be paid up front, then reimbursed. (Ow.) Some of the other changes are more complex:

1. The highly-recommended-by-multiple-trustworthy-persons Dr. Carol Levy is not in the network. Rats. I could pay her up front, but I'll only get 60% back from the New Insurance Punks (NIPs). Multiply by 4x a year, and you see why I may end up at Naomi Berrie (whose providers are NIPpers).

2. I have a deductible now of $300. (Previously, I paid a higher premium to avoid a deductible, but that option is no longer available.) It doesn't apply to office visits or prescriptions, but it does apply to test strips and pump supplies. That means my first batch of strips, normally $90, will cost around $330, every year. After that, though, I will have 80% coverage, same as I previously did.

3. My current test strips aren't on the formulary. So I need to change to a different brand. That's okay; my meter is a piece of crap anyway. But now I need a new prescription. Maybe Dr. Reassurance will give me one. Hopefully this will be okay even though Dr. Reassurance is not (you guessed it) in the NIP network.

4. Luck of the diabetic: my current insulin, Novolog, IS on the formulary. Woo hoo! If I were still on Humalog, I'd have to change. It's not the end of the world, for me, to change between those insulins, but I do need more H than N, so I'd have to rework all my ratios, using many of the precious $330 test strips.

5. Lab work is 100% covered if conducted within the doctor's office. If not, it is 80% covered. Huh? What difference does it make where it happens, as long as the doc has ordered it? To NIP, the difference is apparently critical. (I think this is a ploy to get patients to come to the all-in-one NIP clinics, which adorn the city and suburbs of Minneapolis much as Starbucks coffee shops adorn Manhattan.) Of course, there are no NIP clinics in New York, and as noted below, it seems to be rather unusual to have blood work done in a doc's office here. Maybe they will do it at Naomi Berrie. Otherwise, I'll be paying 20% for my A1C, thyroid, cholesterol, etc. etc.

6. That said, if I keep my diabetic butt properly NIPped by remaining in the network, my annual out-of-pocket max is $1500 (plus my premiums, of course). Hey, that's not bad! And easier to attain with the jumpstart offered by the $330 test strips! Throw in some pump supplies and a few prescriptions (plus some lab work), and I should hit the max around September or so--not this year, when I'm starting at $0 on June 1, but in the future. Then it will be freebies through New Year's, huzzah.

My quiet ranting aside, this is good coverage based on what I know so far. I don't think I have much to complain about, assuming (major assumption) that I can get acceptable care from the NIPpers. One of the first experiments will occur next month, when I will visit a gynecologist whom I chose based on her office location, gender, and the fact that we have the same first name. (I had to draw the line somehow...)

All this makes me terribly curious about the diabetes costs incurred by the OC. How does your insurance treat you? And if you don't have insurance, how (the hell) do you manage?

May 11, 2006

Plan C

I can’t get into the Naomi Berrie Diabetes Center until the end of August. Ouch, but no surprise to Realistic Violet, who makes an appearance only rarely these days, and usually after the fact of some disappointment or other. (Foggy, Peculiar Violet is the star of the season; she was somehow sure that the clinic would welcome me with open arms within 2 weeks.)

I guess I’d better get that bloodwork done at Procrastination Lab in the meantime. Hmm.

Meanwhile, the OC has revealed its graciousness yet again, this time in the form of Lyrehca, who has offered a referral to a therapist who has type 1 and works with many PWDs. Said therapist is actually fitting me into her schedule tomorrow. Score five automatic points for therapist. Double points for Lyrehca.

(Wow, I managed as a New Yorker for 7.4 months without requiring mental health services!)

I can’t afford this, of course. But even more, I can’t afford not to go. So: off I go.

May 6, 2006

Plan B

For the record: I tried.

My sense of sheepishness about the neglected bloodwork finally caught up with me. I trotted myself to the lab early this morning, only to discover that the information sheet I'd been given did not match the actual hours of the facility. It's not, in fact, open on Saturdays.

Bemused, hungry, and annoyed, though not necessarily in that order, I returned home, ate some toast, and put myself back to bed. I accidentally slept until almost 1 P.M.

It's occurred to me this week, finally, that a number of my behaviors and feelings of late--difficulty coping with the demands of daily life, insomnia and/or oversleeping, thoughts of worthlessness, extreme mood swings, etc. etc. etc.--align perhaps more than coincidentally with the symptoms of depression.

And are we all aware that there is a higher than average association of diabetes and depression? Yes? Good. If not, take a look here.

This isn't to suggest that anybody who's having trouble handling self-care is necessarily suffering from depression. There's more than that going on with me, as noted above. These issues run in my family, too. So I think I need to seek more information, evaluation, blah blah blah.

In her comment on the post below, Julia mentioned the Naomi Berrie Diabetes Center. Anyone out there have experience with this clinic? I've had my eye on it for a couple of months, and I think it's time to make an appointment. The staff includes a psychologist, so maybe they can advise me in a manner that doesn't require my rechecking each piece of information in triplicate. (Though--who are we kidding here?--I probably will anyway...)

May 2, 2006

A confession

One of the several quirks of the office of my new endo, Dr. Reassurance, is that it has no laboratory for drawing blood.

Actually, I really can't judge whether this is a quirk in the larger scheme of medical care in the U.S., or whether I was just lucky/spoiled in Minnesota. My old endo had a miniature lab with a trio of technicians who could draw blood faster than I could sit down in the chair, almost. My old primary care doc did too. The blood was sent elsewhere for analysis, but it was drawn then and there, on the premises, no escape.

Dr. Reassurance, whom I saw in March, gave me a form with orders for the bloodwork she wanted done and a list of the places I could go to make my donation of bodily fluids. One of them is 8 blocks from my home. It's even open on Saturday. All I have to do is call the day before, fast that morning, and show up.

The form is still sitting on the kitchen counter. It's been 7 weeks.

What the hell is my problem? I haven't had my A1C done since November. I know better than this. I'm mortified and ashamed.

Am I afraid of the number? A little. Not a lot. It will be somewhat worse than the last number, and Dr. Reassurance will probably call. I know a lot more about pumping than she does, though, so I rather doubt she'll have much to tell me that I haven't read or heard before.

Am I resistant to entering New York City's draconian new diabetes tracking system, in which my a1C will be reported to the city health department, which will monitor my results and conduct voluntary interventions of its own devise? Yeah, somewhat. That whole deal pisses me off more than I can articulate at this hour of the night. Others in the blogosphere have already said it better than I can, anyhow. (Hint to NYC: if you want people to control their diabetes better, put some fucking blood labs inside the offices of health care providers so that patients don't have to make 4 (or more) annual trips to the lab PLUS 4 to the endo PLUS 1 to the primary care doc PLUS 1 to the OB/GYN for chicks PLUS 12 to the pharmacy.)

That's a grand total of 22 health-related voyages I'll be making per year as a New Yorker, if anyone's counting, assuming I have no problems of any kind other than diabetes. Oh, wait. Forgot the eye doctor. Dr. Reassurance also wants me to see a podiatrist. (Yeah, right. Suck my toes.) So now we're up to 24.

And therein lies the real reason, I think, that the damn bloodwork form is nesting so comfortably on my kitchen counter. Am I lazy? Yes. Whiny and ungrateful too. Also just damn tired of marching myself all over creation for the sake of the disease, even after only 20 months.

I guess I'm a little burned out right now.

I didn't have this problem during my first year after dx, when I poured endless energy into self-education, self-help, self-everything. I was a little diabetes-managing machine.

Year Two has lost that shiny, luminous glow. I'm still two+ years from trying for a baby, so my A1C is not currently the magic beacon to motherhood I once imagined. It's not that I don't care. I do. I'm testing and watching the sugars and the boluses and all that daily stuff, with reasonable success. I just can't seem to manage this lab thing. And now I'm mortified that the date on the form is almost two months old. They're going to yell at me at the lab, I just know it. Or else Dr. Reassurance will.

Maybe I can find a new endo and start all over, with a clean slate and a pure soul. And maybe I can relocate my sense of humor, which I think I left behind on the F train a few weeks ago. (It's really hard to check your blood sugar while standing in a packed and moving subway car.)

Meanwhile, maybe I can use the back of the form to chart my recent blood sugars. Err...that is...I could if I'd been writing them down. Ahem.