Wednesday, June 5, 2013

Two in a row

I just had a lovely experience at Kaiser.  It's been established that my persistent cough cannot be alleviated by flushing my sinus cavities with drano, or whatever the hell they put in those Neil Med Sinus Rinse packets you pay all that money for…  It can't be just salt, no matter what they say on the packet.  Salt’s practically free so somebody’s got a good deal going with that fifty premixed packets for $13.65 plus tax.

Having established that my persistent cough is not post-nasal drip-related, the doctor is now working on the theory it might be something even less flattering, like acid reflux, and he told me to get my butt down to the Kaiser pharmacy in the Fabiola building to get something they call Prilosec.  Start with twenty - ten days' worth - the doctor says, and see if there's any improvement.   So I go stand in line for twenty minutes at Fabiola, where they tell me the medication is a) not ready, and b) not at Fabiola in any case but at the Broadway pharmacy.  No problem.  It's a nice sunny day, so I walk around the corner to Broadway and stand in line where I'm registered, please take a seat, and sorry to keep you waiting for another twenty minutes, and did you know, the nice young lady says after ringing me up and getting my signature on the Visa charge, that I could get this medication over the counter for less?

Next time, when I get a refill, I say to myself.  I stand in line again for the consultation which is required so that I know to take the medication thirty minutes before eating and if I break out in typhoid-like symptoms stop taking the medication and call my doctor immediately.  The one who failed to tell me I could get an $18 medication for $10.

I say to the second cashier that I thought Kaiser had a policy of giving you generics if at all possible.  Why are they prescribing over the counter medicines?  Yeah, I know, she says, agreeing with me that life isn't fair.  "Would you like to cancel your order and buy the over-the-counter one?  It's right over there.  Three short steps away.  Right there on the shelf, I kid you not, three steps away.  Five bucks for 28 capsules. 

I do think it's always good to save eight bucks whenever you can, so I get back in line behind a man who is complaining that the name on his medication has the wrong middle initial, but the cashier can't help him with that - he has to go to the second floor in Fabiola (this was Broadway, remember, and he walks with a cane) and get them to fix the problem.  "I've been there several times," he complains.  "I've even written them twice, but they never fix the problem."  By this time the woman at the register is looking at me with a facial expression which says very loudly, "I'm so sorry to keep you waiting, but you see what I'm dealing with..."  I speak up.  I say to the man.  "I have had the same problem.  They misspelled my name on my records and I've complained in person about it twice and once in writing.  They have never fixed it."   We start a conversation to the chagrin of the twenty people behind us and I don’t want to be a jerk so we quickly agree that as long as he's getting his medication the wrong middle initial is probably not the end of the world and I move things along.  I turn to the cashier and I thank her profusely.

"It's only eight bucks," I tell her.  "But it will buy me lunch."  She smiles.  "First class service, you’re doing here"  I say.  "I appreciate it."  She beams.

I really want to ask what the difference is between Prilosec, which the doctor prescribed, and the omeprazole magnesium, which the helpful cashier said was the generic version, but because I’d already done so much to make the people behind me wait, I decided I’d just look it up when I get home.

Three weeks ago, when I went to see the nose doctor and the nurse was prepping me for the visit she gets my records up on the computer screen and says, with a look of surprise, “So you don’t use Kaiser for your medications?”

“What medications?” I ask her.  I don’t use medications.  My medications screen was totally blank.  I take vitamins and I have taken fosomax for my osteoporosis but I stopped when research began to show there was a possible connection with bone rot and all my teeth might fall out and I might need a gum transplant.

“Wow,” she says.  “You don’t see that very often.”

I have this irrational fear – I think it’s irrational – it might actually not be – that if I don't die in an airplane or from memory loss, it will be the side effects of medications that will do me in.   I’ve always been fascinated by those TV ads which tell you outright that the medication they’re selling might lead to erectile dysfunction, nausea and death, and I take such warnings seriously.

Besides, I didn’t think the cough was coming from post-nasal drip, somehow, and I don’t think it’s coming from acid reflux, either, actually, but I really like my doctor and we had the best doctor-patient conversation I think anybody could have when discussing whether to get chest X-rays to see if I have cancer and how many cancers they miss and maybe I’m right to worry about erectile dysfunction and death because you never know.  In any case, don’t take a CAT-scan, he tells me.  It could fry your brain.  (That’s not what he actually says, but it’s what I hear him say.)

I’m going to take these omeprazole magnesium tablets for a couple weeks, hair loss, crotch itch, hallucinations, suicidal tendencies be damned, because the doctor says you can have acid reflux and not know it.  (And now, of course, I worry about all the other things I’m running around with I may not know about.)

But first, I look up the side effects.

Here’s what Wikipedia says they include:

Systemic: Hypersensitivity reactions including anaphylaxis, anaphylactic shock, angioedema, bronchospasm, interstitial nephritis, urticaria, fever; pain; fatigue; malaise; hair loss [and you thought I was kidding!];
Cardiovascular: Chest pain or angina, tachycardia, bradycardia, palpitations, elevated blood pressure, peripheral edema
Endocrine: Gynecomastia
Gastrointestinal: Pancreatitis (some fatal), anorexia, irritable colon, fecal discoloration, esophageal candidiasis, mucosal atrophy of the tongue, stomatitis, abdominal swelling, dry mouth, microscopic colitis. During treatment with omeprazole, gastric fundic gland polyps have been noted rarely. These polyps are benign and appear to be reversible when treatment is discontinued. Gastroduodenal carcinoids have been reported in patients with ZE syndrome on long-term treatment with Prilosec. This finding is believed to be a manifestation of the underlying condition, which is known to be associated with such tumors.
Hepatic: Liver disease including hepatic failure (some fatal), liver necrosis (some fatal), hepatic encephalopathy hepatocellular disease, cholestatic disease, mixed hepatitis, jaundice, and elevations of liver function tests [ALT, AST, GGT, alkaline phosphatase, and bilirubin]
Metabolism and Nutritional disorders: Hypoglycemia, hypomagnesemia, hyponatremia, weight gain
Musculoskeletal: Muscle weakness, myalgia, muscle cramps, joint pain, leg pain, bone fracture
Nervous System/Psychiatric: Psychiatric and sleep disturbances including depression, agitation, aggression, hallucinations, confusion, insomnia, nervousness, apathy, somnolence, anxiety, and dream abnormalities; tremors, paresthesia; vertigo
Respiratory: Epistaxis, pharyngeal pain
Skin: Severe generalized skin reactions including toxic epidermal necrolysis (some fatal), Stevens-Johnson syndrome, and erythema multiforme; photosensitivity; urticaria; rash; skin inflammation; pruritus; petechiae; purpura; alopecia; dry skin; hyperhidrosis
Special Senses: Tinnitus, taste perversion
Ocular: Optic atrophy, anterior ischemic optic neuropathy, optic neuritis, dry eye syndrome, ocular irritation, blurred vision, double vision
Urogenital: Interstitial nephritis, hematuria, proteinuria, elevated serum creatinine, microscopic pyuria, urinary tract infection, glycosuria, urinary frequency, testicular pain
Hematologic: Agranulocytosis (some fatal), hemolytic anemia, pancytopenia, neutropenia, anemia, thrombocytopenia, leukopenia, leucocytosis

That’s about it.  It would never have occurred to me to worry about fecal discoloration and taste perversion, but nothing is without risk, I understand.

I skip to another section, and learn that this medication is called a bunch of different things.   The Americans invented it, evidently.  First it was Losec.  But people confused it with Lasix (don’t ask me how) so they changed it to Prilosec, which some people now confuse with Prozac, the antidepressant.  Apparently that’s not a problem, and I guess they figured changing the name once is enough.  Besides, AstraZenica, the same company that manufactures it also manufactures it by other names, to wit: Antra, Gastroloc, Mopral and Omepral.  The same product manufactured by Santarus calls it Zegerid.  Procter & Gamble calls it Prilosec OTC – and it took me an eternity searching for what OTC might mean when the light went on and I realized it meant “over-the-counter.”   In the Philippines it’s called Zegacid.  In Pakistan it’s Segazole.  In India, Russia, Romania and South Africa, Dr. Reddy’s Laboratories call it Omez.  In Bangladesh, you can get it as Opal, or as Aspra, or as Seclo.  In Spain it’s called emeprotón, and in Argentina and Ecuador it’s called Ulcozol.  In Indonesia it’s Ozid.  In Brazil it’s Lozeprel.

It’s an “antiulcerant” and that makes it “one of the leading class of therapeutic drugs, with sales worth $15.6 billion.”   Prilosec made $5.91 billion of that.  You can see why, when their patent ran out in 2001 they bought off some Congress people and delayed the introduction of the generic version I just bought today for five bucks.  “Through lawsuits and peripheral patent claims,” I’m told.

I don’t know if my doctor knows he was working for AstraZeneca.  He’s such a nice guy, I think it was probably just an oversight.

I do know that somebody at the Kaiser pharmacy on Broadway was on her toes, effectively sabotaging a sale and steering a Kaiser patient to an eight dollar savings.  I did note that AstraZeneca manufactures both the high-priced version and the generic version, so they don’t lose out that badly. 

In any case, after sharing with you my story of how an unknown postal clerk in North Pole, Alaska made my day the other day, I thought I’d share another act of decency close on the heels of the first one.

Two little people working in a giant world run by government agencies, corporate health care systems and pharmaceuticals, finding an opportunity to make the place a little more human.

Best part of it all is I came home and ate leftovers from last night's dinner for lunch, so I still have the eight bucks.

picture credits: Neti pot, dirty secret, acid reflux critters

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