Grouch, Grumble, Whine....

A frustrating and tiring few days put me in a dark mood this week.

Acquiring a refill of my pain medication - a generic of the brand Norco - is becoming more difficult by the month. I obtained the paper prescription, signed in ink by my temporry oncologist, as required now by law when medications involving opioids are refilled. We took the prescription to the pharmacy we've used for the past 15 years. On being presented with the written prescription the rather unhelpful young lady at the drop-off counter told me "Sorry we can't fill that, we are getting a new wholesaler and we have none in stock. You'll have to go to another pharmacy." "Well", said I, "I could wait for a day or two, I still have a some tablets left. Would you have the medication available in a few days' time?" "No, we don't know when, or if, we'll have them". A bit fishy, that!

We drove to CVS pharmacy just across the road, to be told by a kindly young guy at their drop-off desk. "Sorry, we're all out of those tablets, people coming from the pharmacy across the road have cleaned us out. We might have some by early next week. I'd try Walgreens - not Walmart as they'd likely send you away as you're not a regular customer."

Onward to Walgreens. These pharmacy visits entail a fair amount of walking, and I, the painfully walking wounded one, was not delighted by the fact that pharmacy counters in the large stores are right at the back, farthest away from the entrances - so lots of painful steps for me. Even dosed up with the pain pills, using a quad-cane, walking far is not easy for me.

Walgreens, after checking my identity and Medicare details, seemed willing to fill my prescription. They were very busy - lines forming at the pick-up and drop-of counters all the time. They said to come back to pick up the tablets in around 45 minutes. We returned over an hour later. Medications not yet ready for me, so we decided to wait until the next day to collect - to avoid yet another trail to the back of the store that day. Later on, a phone call from the pharmacist at Walgreens told me that I would need the doctor's further authority for the number of pills required by the prescription. (I'd have thought that the prescription itself was that authority!) The doc had allowed for 8 tablets per day (for a month) instead of 6 per day. New regulations mean that extra authority from the doctor will be required for that amount of tablets. I told the pharmacist that, as I take only 6 tablets per day, could he please just fill the prescription for that amount? He agreed to do this, and changed the number of pills stated on the prescription. So, yet another trip to Walgreens the next day, though with rested legs.

At last, I had the tablets in my hot sticky hands. I say hot and sticky advisedly. It was around 95 degrees in town during these adventures, adding to my annoyance and discomfort.

I had hoped that Walgreens might deal with a different generic manufacturer than the one used by our usual pharmacy. Sadly no, that didn't happen - same generic manufacturer, who shall remain nameless. I am convinced, as are many people online, that the generic of Norco made by this particular manufacturer is not as effective as the brand medication itself, or pills made by several other generic manufacturers. It is thought, by regular users of this medication, that not long after December 2017, when panic erupted over deaths by addiction to opioids in the USA, especially in Oklahoma, the effectiveness of these tablets as pain relief medication took a nosedive. Those who had been taking the medication before and after the opioid crisis suspect that some manufacturers have adjusted make-up of these tablets, possibly by changing additional ingredients used in their manufacture. I suspect (a wild guess on my part) that the way the tablets were being used by addicts for purposes other than pain relief, may have been the reason for change. Addicts crushed the tablets. Perhaps some generic manufacturers added an ingredient to prevent easy crushing which, in turn, could also prevent proper digestion of the pain-relieving ingredients. So those of us who genuinely need pain relief go to the back of the queue, we don't matter!

Pain relief from the pills, for me, is minimal but better than nothing. Morphine at the strengths tried already brings even less relief. I'll be asking the temporary oncologist, next time I see him, if there's something else I could try. I'd buy the brand name Norco tablets, even just to try, if they weren't so ridiculously expensive - in the order of $500 + per month!

Whinge, whinge, grouch and grumble! A wheelchair beckons!

It's That Day Again + Medical Update.

Happy Indi Day - for me also - kind of. I have no radiation or medical appointments until Monday! Also, I'm happy because the course of radiation related to lesions on my hip and leg is done - for now anyway. The treatments on my chest wall will continue for a few more weeks - as a precaution - making the sessions shorter.

Pain pills are still necessary, but not working especially well. Dr K. kindly provided a refill prescription yesterday. Such prescriptions, for medications which include any kind of opioids, have recently come under a spate of New Rules, to safeguard those who would use opioids for purposes other than pain relief, sometimes accidentally killing themselves. That is all fine and good, but the complications involved in obtaining these medications now mean that even cancer patients cannot obtain refills without the requisite prescription, on paper (no fax or e-mail) signed in ink, by the ordering physician, and handed to the pharmacy. These rules were followed by us yesterday afternoon - to the letter. What did the pharmacy say? "Sorry these are not due until tomorrow (4th July) and we are closed for Independence Day so we'll have the refill ready on Friday". My response: "What am I supposed to do tomorrow, when I run out?" She: "Do you want to pay for a day's worth, the insurance will not pay until tomorrow and we are closed." Me: "So, as you are closed, should you not compensate for that by filling the prescription today?" Nope! If I had agreed to pay for one day's tablets it would have cost me $60+ for the generic. Ridiculous! I guess the fact that I'm English, and that Independence Day is the fly in the ointment, didn't help ;-)

Dang! I was cross and getting hotter under the collar! I'll manage, but some people in the same position might not. This is so unfair to those who need opioids for all the right reasons.

I do suspect that the generic of my pain medication, stocked by our pharmacy, doesn't work well, possibly due to certain cheaper "fillers" used. Comments online by those who have been taking the pills for years have indicated that this is the case - do I believe online commentary? Hmmm? I had, earlier, asked what the charge would be for the branded version of the same medication, not covered by insurance. One would, I was told, have to buy a full 100 tablet bottle of the original branded version, its cost, with discount, would be $500. Sigh. The generic, to be collected Friday, will have to suffice!

Tales of Woe (mine!)

I have tales of woe to relate. I'm telling them here as much for my own information and record, in weeks and months to come, as for the interest or otherwise of any passing readers.

Last spring, almost exactly a year ago, as any regular readers might recall, I had to undergo a lumpectomy for early stage breast cancer. There are relevant archived posts to which I can provide links, should anyone wish to read them. I've had three-monthly checks of various kinds since then. During the most recent check - at around the one year point - it was discovered, after mammogram, breast MRI and ultra-sound, that another cancer has arisen - still small, and not a recurrence of the old one. I'm now needing a left breast mastectomy, which might be done during the coming week - or maybe not.

There's a second issue. It is not related to cancer, thankfully, but needs to be dealt with. So - chapter two of tales of woe.

Since end of February I've experienced persistent diarrhea. After about a week I saw my GP who checked my blood and declared the cause to be not infectious. After a few more days with no improvement, I sent a stool sample to the hospital. All possible issues came back negative. My surgeon then suggested a colonoscopy, which he did on Tuesday this week. Surgeon took several biopsies of colon tissue. The colonoscopy itself was good - no cancer, no issues to be seen. However a pathologist told surgeon that he had detected evidence of lymphocytic colitis from one of the biopsy samples. Surgeon prescibed meds to manage this problem. There's no actual cure, or so it says online, but how management proceeds will differ for each individual. I guess much depends on the cause, which can range from bacteria, virus, allergic reaction, or taking too many NSAIDs (Ibuprofen and suchlike).

Tales of woe chapter three. After mucho paperwork my Medicare supplementary insurance denied me any help to pay for the 6 week course of meds prescribed - these are very expensive. For 6 weeks' worth of tablets I have paid around $1,400. This cannot turn into a regular thing! In the intervening time, after my surgery, I must find a way around this ridiculous price. The drug's name is budesonide 9mg. But that's a story for another day. I have in mind buying from Canada if and when needed in future (if my GP will provide a written prescription) - still expensive there, but much cheaper than in the USA.

All is at present unresolved. I'm pencilled in for mastectomy on Tuesday, but that won't be confirmed until Monday. If the new meds have not taken effect I suspect I'll be dosed with Immodium for the duration of the surgery and overnight stay.

The next chapter will appear in due course.