Emergency Prep & Drugs

Flood, earthquake, tornado, hurricane, terrorist attack… The list of possible disasters isn’t very long.  That doesn’t mean it isn’t important to prepare.

One small line in most emergency preparation lists suggests including an extra month of prescription meds in your emergency kit.  I wondered idly how one might go about doing that, but when nobody in my family was regularly taking prescriptions it wasn’t an issue.  Now it is pertinent.

The problem isn’t with believing it’s a good idea to be prepared.  The problem is the difficulty of obtaining the extra month’s worth of meds.

1.  Insurance will not pay for early fills.  If you want to get an extra month, the cost will be entirely out-of-pocket.  That might not be a problem for one or two less expensive medications, but it’s a big deal if the cash price of your monthly trip to the pharmacy is nearly $3,000.

2.  Even if you pay cash so that you can have an extra month on hand, there’s still a problem.  Prescriptions allow a specific number of refills.  If you pay cash to get that extra month early, you run out of available refills at the pharmacy a month early.

I’ve jerry-rigged a solution.  I do not wait 30 days to refill my meds.  For a while now, I’ve refill my prescriptions every 27 days.  The first month, that got me three extra pills.  The second month, I added three more for a total of six extra pills.  The third month, I was up to nine extras, and so on.  For some weird reason, every now and then the insurance company says it’s too soon to refill and I’ve had to wait the full thirty, but this usually works.  Doing it this way, within a year, you’ll have a managed to stockpile an extra month’s worth of most prescriptions.

This doesn’t work with methotrexate, Enbrel, or anything else that’s filled for four weeks instead of one month.  Having skipped my Enbrel when I was sick, I know that when dealing with the stress of a disaster, I don’t want to be without that particular prescription.  However, since I was already well into the process of trying to accumulate an extra month’s worth for my emergency kit when I got sick, I filled the prescription at the regular time anyhow (despite not being out).

It’s a good thing I did!

Add insurance change to the list of potential emergencies

They had the audacity to send out a letter last month with instructions that we should refill prescriptions before the end of the month (on our old insurance) because it would take a while to get everyone into the new insurer’s computer system, and it probably wouldn’t be possible for the pharmacy to verify coverage for a few days.  I could picture getting laughed out of the pharmacy if I tried that, so didn’t bother.

Next the insurer said they should have everyone processed by the 10th, but we could just pay cash and then submit a request for reimbursement.  I didn’t think that would be needed, since I last filled on the 10th and would just be stretching things out to the full thirty days.  Unfortunately, the 10th came and went without new insurance cards.  My dear husband, concerned that I wouldn’t be able to get my prescriptions, was duly impressed when I said that I supposed this counted as an emergency, and explained my strategy to him as I dug into my emergency supply.

It was nice to be prepared.  It wasn’t nice to need it, but it worked out.  I had to pay cash to get my mtx last week, because there’s no extra stash on that one.  The rest of my prescriptions, though, I’ve been able to take normally, without the stress of wondering when those insurance cards are going to show up.  The tiny effort needed to be prepared was well worth it.

Do you include a month’s worth of prescriptions in your emergency kit?

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For more information on disaster preparedness:

 

 

Naps

As I finished vacuuming the upstairs and headed into the laundry room to fold clothes, my husband grabbed a basket of socks* and headed downstairs.  He grinned as he quipped, “Got any more naps planned for today?”

Funny man.

Make breakfast, take a nap.  Clean the kitchen, take a nap.  Vacuum and fold laundry.  Prepare the noon meal, and yes, take another nap.

It’s not that I planned it that way.  Some days, though, I’m just so exhausted that sitting down automatically means that I fall asleep.

Fatigue was probably one of my first autoimmune symptoms.  It went unrecognized, though.  I had four babies in five years, and a fifth a few years later.  I chased little kids all day.  Who wouldn’t be tired?  Somehow I had the idea that things would get better when the kids got older – when life got less labor-intensive during the daytime, and I’d be able to sleep all night.

I was wrong.  At some point, the fatigue wasn’t just a normal part of having a houseful of little kids.  Fatigue can indicate a problem.  I never talked to my doctor about fatigue, but once my RA was diagnosed and treated, I found that I had more energy than I’d had in years.

When everything is well controlled, I can go like the Energizer Bunny.  When things aren’t quite as well controlled, it’s more like my battery is about to die.

I’ve learned to pace myself.  A task that requires moving around can be followed by something that can be done sitting down.  Spacing the different types of jobs throughout the day, alternating periods of activity with periods of rest, allows me to get more done than if I push through all the demanding tasks and collapse before the end of the day.  When needed, I take a short nap.

Perhaps I should have been a cat.

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*I don’t fold socks.  They all get tossed into a single basket after they’ve been laundered, and everyone is responsible for finding & folding their own socks.

Learning How To Be A Patient

(A Good One – Nobody Wants To Be The Patient Whose Name On The Schedule Causes The Doctor To Groan)

Being thrown into the role of patient is frustrating and scary.  I’ve learned a ton in the past three years.  Information abounds on medical websites and blogs, plus the traditional paper & ink books.  Sorting through everything to figure out what’s trustworthy and what’s snake oil can be a challenge.

Right about the time I was diagnosed, our local newspaper ran a story on how to find reliable medical information online.  That gave me a starting point.  Don’t google medical terms.  There will be an overwhelming number of hits and no way to verify the accuracy of the information.  Go to reliable medical websites.  Search places such as Family Doctor, sponsored by the American Academy of Family Physicians, or Up-to-Date For Patients (listed as a patient-education site by the American Academy of Family Physicians, the Society of General Internal Medicine, the Endocrine Society, the American College of Rheumatology, the American College of Obstetricians and Gynecologists, the American Thoracic Society, and the American Gastroenterological Association).  Other sites like MedicineNetJohns Hopkins, Mayo Clinic, and even WebMD are helpful and reliable.

Those sites, however, are for researching diseases or symptoms.  I wanted more.  In addition to disease-specific information, I wanted general “how to interact with and understand doctors” information.  There was no shortage of patients offering advice, but that didn’t seem like the best source for learning how best to communicate with doctors.  As if to emphasize that point, one person in particular was extremely vocal about how patients ought to behave, demanding this and insisting on that, but it didn’t take long to discover that the person had bounced around from one practice to the next; she’d been through five different rheumatologists in seven years, firing one doctor after the other when she didn’t get what she wanted.  I decided that I’d rather get my information from someone who knows what they’re talking about.  It seems as though doctors are in the best position to provide information on doctor-patient relationships.

A very helpful book I discovered was Dr. Jerome Groopman’s How Doctors Think.  If I could only recommend one book, I’d choose this one.  I bought it when it was only available in hardback, and it was worth every cent.  After reading it the first time, I went back through it again and took notes.  Then I loaned it to a friend who lost it, so bought another copy because I found that I often wanted to refer to it.  It’s that good.  Every time I read it, I discover something I hadn’t picked up on previously.  Your public library probably has it, or can access it through inter-library loan, but it’s in paperback now so reasonably priced.  Barnes & Noble has the intro available online, so you can get a preview before shelling out the money.

My next find was You: The Smart Patient.  I bought it.  There were tons of good tips in there that I found very helpful; things like compiling a medical history, asking questions, and a whole education on things one should know when taking medications.  There were also a few recommendations that aren’t necessarily the best information.  Consider the source.  Since The Joint Commission (formerly JCAHO) had a large hand in writing this book, take it with a grain of salt when they recommend checking Joint Commission’s website for a hospital’s quality ratings.  When they insist that the way to find the best doctor is to only see someone who’s a member of the American Medical Association, you gotta wonder why; a significant number of physicians don’t belong to the AMA, and they’re highly competent doctors.  You can probably find this book at your public library if you’re inclined to read it.

Next I discovered medblogs.  Some have been incredibly helpful, both in providing a peak into how doctors view their interactions with patients, and in giving general tips.  Dr. Rob’s Musings of A Distractible Mind was the first blog I found.  I spent all my free time (and a good chunk of time when I should have been doing other things) for a month reading through his archives.  If you’re not already reading Dr. Rob, follow the link and search on the categories Physical Exam and Patient Education.

From Dr. Rob’s blog roll I discovered other blogs, and those led to others, which led to others…  One that I especially liked recently went private, much to my disappointment, leaving my current favorites (in no particular order):

Even if you only lurk without commenting, you can learn quite a bit about doctors and how patients can get the best possible care by reading what these doctors have to say.

Books about the process of becoming a doctor have been educational, too.  On Call, What Patients Taught Me, Intern, and The Medical Interview are still in my bookcase, but many others are available at the public library.  Yet other books, less about the training and more about doctor’s observations, such as Bedside Manners, Every Patient Tells a Story, and Anatomy of Hope have also been telling.

One thing I gathered fairly quickly is that while some things are universal, others are a matter of personal preference.  Not every doctor does things the same way.  Some doctors use social media to make general patient recommendations, but while every one of those people might be a doctor, they’re not my doctor.  I put together a short list of tips that I’ve found on various blogs and took them to my doctor to see if those are recommendations with which he agrees.  It led to a very good discussion, and now I know what his recommendations are.

Make no assumptions.  Five online physicians might state a preference, but if they’re not your doctor, you still don’t know what your doctor would like you to do.  I’m so glad that I finally talked to my doctor and got his perspective.

What do you think?