From the monthly archives:

April 2010

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After my farewell to the radiation oncology department, I take the elevator up to the lobby and meander through the hospital complex to meet with Dr. Weary, my oncologist. (My heart feels heavy because Dr. Alpha is no longer my guardian angel and in my purse I have reams of computer print outs about the side effects of Arimidex, Dr. Weary’s drug of choice.)

Dr. Weary is late. I study my computer print outs for more than an hour, sitting alone in the small exam room. I feel clammy and light headed as I read other women, my cancer sisters, enumerate the side effects of Arimidex:  joint pain, bone pain, loss of concentration and memory, dizziness and insomia, hot flashes, nausea, hair loss, aging skin, vaginal dryness, trigger finger, loose joints,  anxiety,  leg cramping and  fuzzy brain. One woman writes: I hobble out of bed like a 90-year old, I will quit taking this pill. I’d rather die than live like this.

I  am about to fall off my stool and faint when Dr. Weary finally appears. He looks, well, weary. He apologizes profusely about letting me wait so long. But in the middle of his “I- am- so- sorries,”  his cell phone rings. He sighs. At first he looks like he plans to ignore it then glances and the number and answers. It is clear to me, it is another physician calling. And it is clear to me it is about a serious matter. “Go ahead, don’t worry,” I tell Dr. Weary has he excuses himself and leaves to continue the call out of my ear shot.

When he returns, I waste no time. I hand him the two-inch thick ream of Arimidex complaints. And just so he won’t have to read all the pages, I verbally high light the awful side-effects. Dr. Weary sighs again. He reaches out and takes the pages out of my hand, but instead of reading them, he dumps them in his waste basket with a thud, sits down and stares me straight into the eye: “You read too much,”  he says calmly.  “The only women who will go on  the internet are those who have complaints. For every woman you have read about, there are a thousand with no complaints.”

Dr. Weary scribbles my dreaded Arimidex prescription on his pads, rips it off, and hands it to me. “Here, the pharmacy is across the hall. If you don’t feel good, call me and I will put you on something else.” His cell phone buzzes again. Our session is over. Normally I would feel dismissed, not validated, and mad as a hornet. But somehow Dr. Weary makes me realize that his primary concern are those patients of his who are in immediate danger. Right now, I don’t need him all that much. As far as he is concerned I am making mountains out of mole hills,  and loosing sight of the real reason for the medication in the first place: To stop the spread of cancer. And if, or when, I do need Dr. Weary, he will be there for me.

I leave a bit befuddled, but calmer. I will be eating Arimidex pills for five years. The University Medical Center oncologist suggested Tamoxifen for 2 1/2 years and Arimidex for another 2 1/2 years. According to the National Cancer Institute the benefit of tamoxifen as a treatment for breast cancer is firmly established and far outweigh the potential risks of blood clots, uterine cancer, and many of the same side effects as Arimidex. Over thirty years, Tamoxifen has shown effective on pre-menopausal and post-menopausal alike.

Arimidex, on the other hand, is a fairly new drug without the same track record. So why am I on Arimidex only? Dr. Weary never explained why.  On the other hand, Tamoxifen works by binding up estrogen in a woman’s breast so it cannot feed the caner. But Arimidex prevents estrogen to develop in post menopausal women.  Somehow Arimidex makes more sense in my un-scientific mind. I buy my first jar. It costs $35 because I have health insurance. The cost is $378.70 for 30 pills  if I did not have insurance. Time will tell how I will feel and how much good they will do. By the way AstraZeneca’s profits for the first quarter of 2010 were on the order of  $3.73 billion.

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When do you buy a car without inquiring about cost? Probably never. Chances are you carefully research different brands of cars, repair records, gas mileage, safety records, dealer cost (so you know how low you can negotiate)  or you read used car ads for a good deal until your eyes bleed.

When it comes to your health, shopping for the best deal usually does not enter into your equation. If you are told that six weeks of radiation is mandatory following a lumpectomy, you just say: When do I start and where? You don’t say: how much would that be? Usually you pick the facility closest to you and one that is covered by insurance. You do not call around and ask how much others may charge. (They probably won’t even tell you.) Also, you’d like to think that  you chose a radiation oncologist on his skills and a facility based on its equipment, not on price. Most people go to the radiologist recommended by  their oncologist.

The reality is that even with good insurance, you will end up paying between 10-20 percent of the bills yourself. And here is the reality check: My bill for one month of radiation comes to $44,681.00.

This amount does not include the whole six weeks. It does not include the bill for radiation set up, initial consultation with the radiation oncologist nor does it include the cost of a CAT scan.

Of course the total amount of $44,681 is what people pay who don’t have insurance. I will pay a percentage of the adjusted rate negotiated by my insurance company.  If I did not have insurance, could I have asked for “an adjusted rate?’ Probably not. I would have been stuck paying the whole thing.

When your life is in the balance, the price becomes irrelevant. Yet when I write the checks, a few thousand dollars at a time, for my part of the bills, I cannot help but think of people who simply do not have it. I think of people who have to put it on a credit card and pile up high interest rates. I think of people who don’t even have the ability to put it on a credit card because they don’t have them or their available credit would  not cover their medical  bills. Combine this reality with the fact that a woman with breast cancer usually sees her income go down by an average 26 percent. In my case it already looks like my income for the year will be down by close to 40 percent. For one reason I work a lot fewer hours, and when I am at work I am distracted. And I have not even had to have chemo therapy, a major stumbling block in anyone’s work schedule.

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Farewell to Radiation Oncology

April 23, 2010

“Dr. Weary, my oncologist, called me yesterday,” I tell Dr. Alpha, on my last day of radiation. “Please note that yesterday was Sunday.” Dr. Alpha nods, waits to hear what I have to say. I tell him how sad and disturbed Dr. Weary seemed when I nixed chemo. I admitted to Dr. Alpha that the […]

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“Probaly Nothing” Was Breast Cancer!

April 18, 2010

Whatever it was that showed up on my friend Elise’s mammogram, it needed a biopsy. A different doctor might have said “Let’s wait and see. Come back in six months.” But not Dr. Guru, he claimed that a biopsy was “the medically prudent thing to do.” So Elise went ahead and had her biopsy “just […]

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My Friend Found a Lump – Again!

April 3, 2010

My friend Elise, who had breast cancer more than 30 years ago, sends me an email. Back when she had her first breast cancer bout, she was a law student with two young children. She had a mastectomy. No implants. No chemo therapy. No radiation. Now she has discovered something in the breast she has […]

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