Making the switch

I took the plunge yesterday and started making the switch in pharmacies. As of the firts of the year, our insurer Anthem Blue Cross and our pharmacy,Walgreens, will no longer do business together. I delayed switching over hoping these two companies would reach an agreement and my little life boat would not flip over. Seems that will not happen.

When they redid our neighborhood Safeway, they put in a pharmacy. We've never used,it, but figured that made the most sense. Maggie and I walked over to Safeway early Sunday morning. I picked that time on purpose, because I knew it would take a while and at that hour the store is not crowded and the pharmacy is practically deserted.  The pharmacy department is right behind the wine section of the store, so that's a win. There was one pharmacist working alone and he came over to the window to help me. I smiled and said," I'm either going to make your day or ruin your day right now."

He was well aware of the Anthem/Walgreens issue. I gave him a list of Maggie's medications and the pharmacy slips from almost all of the drugs. (I have one or two that weren't in the pile.) He busied himself going through the paperwork listing all 14 current medications. He asked my name, Steve's name, and then stopped, eyes wide and said, "Wait, are these all for one person?" I smiled and gestured toward Maggie. Yes, they are all for her.

I brought Maggie with me  on purpose thinking that might make it a little easier for them to grasp the situation if they had a visual of the patient. When I turned around to introduce her, though, Maggie was sitting in profile with her hood pulled over her face. She looked like a reclusive woman of mystery.

I said, "Oh, Sorry" and turned her around and fixed the hood.  She gave this guy the biggest grin you have ever seen and, though he was flummoxed by the task I had dumped on him first thing in the morning,  he smiled right back at her.

I am not looking forward to the transition, but I can see that it just might work out all right eventually. It's only a few blocks away and I'm in there all the time anyway to get groceries.

Maggie will just have to charm them one at a time.

War on Drugs

There's a wind blowin and I live in a house of cards. The powers that be are messing with my imperfect but functional and very tenuous setup for getting Maggie what she needs. Somebody needs to FIX THIS and SOON!

About a month ago we learned that our health insurance carrier Anthem Blue Cross was Walgreens have not agreed to new contract terms and when the current contract expires on January 1, 2012 we can no longer get our prescriptions at Walgreens. 

WHAT?!?!?!? This cannot be.  I have been using the Walgreens at California and Spruce streets since Maggie was born over  17 years ago.( I used them before that too, but just for the occasional prescription we needed when we were a four healthy person household.) I know all the pharmacists and assistants and over the years have gone through more techs than you can count. I know that I can get a refill when I need it, even if it's impossible to get a hold of the doctor. They know all 16 of Maggie's medications and now have most on an auto-refill basis. Just this morning the night nurse told me we were out of Atravent and I said, that means there is a box sitting at Walgreens waiting for me to pick it up. And indeed there was.  It works.

Walgreens is pretty much the only game in this town. San Francisco is 49 square miles and by my count there are 63 Walgreens locations. (count for yourself here). When I talked to Anthem Blue Cross about this today I asked where we are supposed to go. He suggested Target - nope there isn't a single one in SF. CVS? I know there's one downtown, but it's not realistic to drive 5 miles and pay an arm and a leg to park every time I need to get some meds because it can be three or four days a week.  Anthem does have a mail order service for prescriptions, but that requires using one service for her "specialty medications", a separate service for her regular medication and a local pharmacy for her antibiotics and urgent care meds. I cannot have three separate pharmacies.It will be impossibleto keep everything straight.  I already have three medical supply companies to deal with, but if somethign screws up there I can purchase most of the stuff over the counter. I can't do that with regulated medications. Wehn he asked if I was interested I said, "No. That makes my life more complicated and it's complicated enough already."

I don't know who is at fault here, but one of these two giant corporations needs to blink so I can  keep things straight and get Maggie what she needs without increasing the burden.  I want to continue to get her drugs from my neighborhood pharmacy, even if it is part of a giant corporation. I know all the cogs in that part of the wheel. I don't know a single cog in the Anthem wheel, which may be by design. Every single time I have to deal with them I have to re-invent the wheel. For that reason alone, I believe Anthem needs to blink. Walgreens actually provides some service to the policyholders along with the medication. That's a concept Anthem seems to have lost along the way. 

This is a hassle for every anthem Policy holder that uses Walgreens and I'll bet in San Francisco that's 99% of the policy holders. FINALLY Maggie's with the majority on a health issue.  

It's time to occupy someplace because we ARE the 99%.  

Cultural Exchange

We spent yesterday morning up at UCSF getting some tests done. Maggie has been having trouble keeping her oxygen levels up and i was worried about pneumonia. It looks like a slight lung collapse. She is on antibiotics and should be ok in a day or so. Hope so. I'm supposed to go to out of town tomorrow for 24 hours.  We shall see. 

We were waiting to get her meds at Walgreens. I just sat in the chair because they kept telling me it would be "just a few more minutes" (we left after 45 min). Maggie was worn out and looked quite peaked. She had the oxygen hooked up but the was still smiling and talking with her dynavox. 

A  woman went by and gave me the puppy dog eyes. and I groaned silently to myself, thinking "here we go." She walked by several times looking at Maggie, clucking and looking sad. I ignored her. She got in line to pick up meds and stared, waiting to catch my eye. Finally I looked up and smiled at her. She was well dressed and I would guess from her accent that she was  South American. She asked with a thick accent how old Maggie was. I told her, " she just turned 17". She clucked."17, ohh my"  I waited. She then asked "Is she your daughter." I smiled and said yes she is. She sighed heavily. I  knew the pity was there and she just had to express it. I waited, but not too long. She then said in the saddest possible voice, while slowly shaking her head,  "It just breaks my heart."  

There it was.

I tried to say nothing at all because it didn't really warrant a response. She was talking about herself, not Maggie. She's entitled to feel and say whatever she wants.I don't have to agree with her.But the clucking continued and  she clearly wanted me to tell her how hard Maggie's life is.  I just met her gaze, smiled thinly and said politely but with very little warmth, "You know, she's just living her life." I busied myself looking at my phone because I did not want to continue the conversation.

The woman was perfectly nice and she undoubtedly meant well, but ... please. I cannot handle pdp. (public displays of Pity). Have questions? I'm happy to answer them Want a place to dump your pity party? No thanks. There may be a cultural element at play in this particular exchange, but I cannot be responsible for that.

I suppose I COULD have said, HEY, DON'T CRY FOR ME ARGENTINA" but that might not have been appropriate. Of course I laughed at the thought of that all the way home.  

Cross your fingers that Maggie decides to get better today. 
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Where do you want it Ma'am?

Part of managing Maggie’s life is dealing with the supplies. She has a TON of medical supplies to be ordered, delivered or picked up put away and replenished both for home and for school use. I suppose we all do, but I cannot get what Maggie needs at a grocery store or even a drug store for the most part. I have to deal with medical supply companies, pharmacies and warehouse stores. Receiving every batch of supplies comes with at least one phone call, but generally requires several.

There are at least three medical supply companies in my life at any given time. Each has its own specialty and its own set of rules. The liquid oxygen is refilled every two weeks at the most, and that means someone has to be here to let the guy in and keep the dog from eating him He’s a nice guy and comes from the company that hands all the respiratory supplies. They are very easy to deal with. I call, tell them what I need and it comes in a few days via UPS, unless they can coordinate it with the oxygen delivery. Just yesterday, the suction catheters, nebulizer kits and oxygen tubing arrived.

Yesterday I was also expecting a delivery from the company that supplies her food, tubes, feeding bags etc for her GI needs. They too are very easy to deal with but they use a private delivery service that has some strange characters in its employ. They inevitably come well after dark and leave nine boxes of food and supplies in my hallway. One person left it in the driveway and drove off. Fortunately, I saw him and got the stuff before someone took it or the rain started. Last night all those boxes arrived just as dinner was coming out of the oven. I was helping the nurse with a procedure and had to leave the bedside, corral the dog and greet the strange man warmly as he piled up boxes. (see picture above) All this was happening while the timer was ringing on the stove. It was like a bad sitcom.

The third company handles the diapers and catheters and that stuff. That means two more HUGE boxes, which should arrive next week. This company is more annoying, but improving every month. On the other hand, maybe I am just getting better at complying with their rules. Unfortunately, the diapers they send are just short of what Maggie needs in a month and I have to order a case every other month from a local medical supply store. You would think I could just increase the order from this company, but no can do. They send the amount approved by the state under this program not the amount Maggie actually needs. They are not allowed to send me more, even if I pay for them. It is stupid, but that is not their fault. If I want more, I would have to go to a hearing. I would win, but at what cost? It is easier and cheaper to go to Clement Street and get them from the local dude.

On top of that, there are the meds that I need to get from Walgreens. I am a regular at Walgreens. Maggie is on eleven prescriptions when she is healthy and more when she is sick. Right now, it is thirteen. Over a period of a year, I managed to work it so they all renewed at about the same time, or at least in two batches a month. That cut my trips to Walgreen down considerably. Of course, the two antibiotics throw a wrench into that. I am going back today for the fourth time in a week. I love the people there, or most of them. I have definitely learned to avoid certain employees.

Then there are just the regular over the counter meds and supplies like wipes, gloves etc. Those suckers are expensive. I get as many as I can as Costco. Giant bottles and boxes of things are great prices.

Juggling and chasing all this is a pain, but it is part of the deal. The real problem is storage. I wonder if I can get economic stimulus money to rent the house next door to store Maggie’s supplies.

Drug Wars

The first full week of 2009 is almost over. It’s been a wild one in Maggie’s world. We started with no night nurse on Sunday night and I have been discombobulated all week long from staying up all night. I am fine and rested, but today is the first all week that I do not feel like I am operating in an altered universe.

However, the universe is a bit altered. Maggie is still not well. There was the overdose to consider and the underlying issue itself.

Which witch is which?

I hope that there are no lasting effects from the overdose, and that yesterday’s blood work will establish that. Nevertheless, Maggie continues to fight this stubborn bug. It seems resistant to every antibiotic, which is, of course, not good news. She is not “that sick” but she is not herself either. The doctor gave me the name of the bacteria. I should know better than to Google medical and scientific terms. Yikes! Scary stuff. But even though I’m a fairly sophisticated medical consumer, I don’t understand half of what I’m reading there and cannot make the very important distinctions between Maggie’s situation and the gruesome things that get published.
Therefore, I clicked off that and played free cell on the computer for a while. That always relaxes my brain. There is something about the order and planning of the game. It has the same effect as crossword puzzles. But I can win at free cell. I always do a crossword puzzle half way and stop because I have other things to do (oh … and it gets too hard)

I have been to Walgreens about six times this week. There are refills of some prescriptions and two new antibiotics to retrieve. One was ready one was not so I will go back again today. I believe there are currently 15 or 16 prescriptions for Maggie. She uses all but three every day. The antibiotics are (relatively) temporary and the other three as “as needed”. Any way you slice it; there are a lot of drugs going into her body.

Believe me when I tell you: You do not want to get behind me in line at Walgreens.

I have run into a friend there a couple of times and she marvels at the service I get. She says they all run around because “Mary Margaret’s mother is here.” To be honest, I don’t even notice. She told me she is surprised they don’t just let me behind the counter to help myself, and I responded that my life would be SO MUCH EASIER if they would. I could just sweep the drugs off the shelves and into my giant shopping bag.

I have to say, though, I do get excellent service from this store. They are compassionate, caring, and very efficient with my unusual insurance situation. I have developed a nice friendship with one of the women and always look forward to seeing her. On the other hand another woman there will do anything possible to avoid having to wait on me. She sees me in line and waves me over to the “drop off” window. If there is any type of delay or issue with the RX, which happens often, she does not want to deal with it. While there may be a problem with one med, I am generally picking up several. I did it once, the “drop off” people explain the issue, and then I have to get back in the "pick up" line, at the end, to get the rest. Now I just smile, shake my head and stay put because I am not falling for that again. Even that is entertaining at this point. Aside from her, everyone that works there is great.

I am very aware that I could not care for Maggie at home without the support of everyone, including the helpful folks at Walgreens.

Even the one who doesn’t want to wait on me. She makes my (almost daily) trips to the pharmacy fun.