Wednesday, May 01, 2013

Health Update

Life for me requires constant tinkering and modification. That's how it goes. At times, I feel like a perpetually malfunctioning machine. This is why I pause for a brief moment to provide an update.

Bladder surgery has been a success, for the most part. I seem to have completely healed from the incisions and the implantation of the pacemaker device. The constant irritation that necessitated surgery still shows up every now and again. Usually, it subsides with time, but sometimes it hangs around longer than I'd ever want. My urologist wanted me to cut a medication I'd been taking in half, but I found that I needed it at full strength. Within five days, the familiar burning sensation returned, almost as strong as it had been prior to surgery.

Due to the fact that my Testosterone levels were confirmed to be too high by a series of tests, I've been placed on a lower strength. I'm not sure if this decreased dose is going to be sufficient. My energy level is down, as is my sex drive. The only way to prove this to the endocrinologist is to submit lab work showing conclusively that my T levels are lower than the therapeutic threshold. I am willing to do this, even though I have a long time to wait to see any change. My next appointment is a month and a half away.

I'm thankful for the effective work of my therapist. We've built a strong relationship anchored on trust. She and I have met more or less weekly for the past two years. By now, she knows me and is able to hone in precisely into the most effective aspects of my thoughts and feelings. I appreciate being understood., taken seriously, and valued as a human being. Our sessions are playful, sometimes even fun, even in the midst of the heaviness that is part and parcel of the process.

Prior to her, I went through a few sessions with a Russian therapist. I did not like his approach. He was an old school Freudian with an ancient reclining couch in his office. Patients once must have lay down upon it as they spoke. Before my arrival, I wasn't even sure Freudian psychoanalysis was still being practiced. I found the process of talking for an entire hour without being answered even once hollow and isolating. I appreciate the give and take of a very different approach.

Psychiatry has been stable for several months. My main problems there have been squabbling with insurance companies, doctor's offices, and pharmacies trying to get particular prescriptions covered. As a means of saving money, insurance companies require Prior Authorizations from time to time before medications will be covered. They require extra effort from everyone and are a major pain to everyone actively involved. The insurance company hopes that the prescribing doctor's office won't want to put up with the hassle and will prescribe instead a drug that is usually cheaper for them.

Often, there seems to be no logic in what is covered and not covered. Prior to a generic alternative being developed, one of my medications cost over $1,000 a bottle. No prior authorization was ever required in that circumstance. Now, I've been told that a medication that millions of Americans use as a sleep aid requires a Prior Authorization, even though my total cost if I had to buy it out of pocket would be less than $40. No one ever bothers to explain why, though I suppose it must be serving someone's bottom line.

I'm sure that other people who cope with chronic illness have variations of this same story. My Rolodex will forever be full of appointments to make, pills to take, medical advice to take under consideration, and worries about drug-to-drug interaction. I counted it up the other day. I've visited seven separate specialists since I moved here to DC full-time in September of 2009. I've been placed on nine separate medications, which I take daily.

My response to this is mostly a shrug of the shoulders. This is the way it is. This is the way it always will be. 

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