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A Health Insurance Rant

health-insurance-rantTearing up over a headline on the cover of People magazine, which I happened to glance at when I walked past it at the pharmacy, was the telltale sign that depression symptoms had returned. I was already pretty sure they were back, it’s why I was at the pharmacy.

Although I was perfectly mostly happy with Wellbutrin, I had to reduce my dose because, thanks to a migraine attack, my brain is now so sensitive to Wellbutrin’s side effects that I am massively dizzy on the dose that manages my depression. Cutting my dose back, the dizziness finally became manageable (though still present) on Monday… at the same time it stopped keeping the depression at bay.

I’m already frustrated by the needs of my ever-changing brain, but I was hopeful a new antidepressant would help me balance all my competing needs. Or I was until my insurance denied coverage. Now my doctor has to jump through constantly moving hoops to prove that, yes, this is the drug I need.

While I wait to see if her appeal will be approved, I can either be so dizzy that I can’t move my head and can’t look at the computer or I can let my depression symptoms build so that I have no motivation to get out of bed and cry at everything. Either way, I can’t work, can’t run errands, and can’t do anything around the house. I could try another yet another generic antidepressant, though I’ve already tried many, and would have to decide which I prefer, potentially gaining a ton of weight or losing interest in sex.

I don’t have much faith in my doctor’s authorization being accepted. Since the first of the year, Hart’s been working on a getting a doctor’s authorization approved for a drug that I was told would definitely be covered under our plan. It’s a drug he’d been taking for months, paid for by the same insurance company, until the rules changed with the turn of the calendar page. Now he’s without a drug he needs. There is a replacement, a replacement that he’s already tried. Last time it increased his migraine frequency so much that I lost sleeping worrying that he was developing chronic migraine.

I miss the days when my doctor and I got to weigh all the relevant medical factors and decide which medication was right for me. Yes, I could pay for these drugs out-of-pocket (assuming I could afford them), but I already pay a small fortune for health insurance each month. Being told a service will cover what I need, tethering myself to that service for a year, and still having to wheedle and cajole to get what that service supposedly includes is absurd. Especially when all that time spent on the phone and submitting paperwork is unlikely to result in me getting the coverage I thought I was paying for. Tell me up front whether the treatment I need will be covered so I can make a fully informed decision, don’t lock me into something then change the rules.

That’s what I’m angriest about. I understand why insurance companies don’t cover certain drugs or treatments. Yet I did everything I could possibly do to make an informed decision, including 17 hours of research, questions for my insurance broker, and hours on the phone with the insurance company. Now I have a yearlong commitment to a health insurance plan that’s not providing the coverage I was assured they would provide.

I get that health insurance is a mess right now. I get that companies are scrambling to make a profit now that they have to provide coverage to people like me. And I am grateful to be able to have any insurance coverage for my entrepreneur/freelancer household. But how is that companies are able to provide only basic information for a consumer to use to choose a plan, give half-truths (or lie outright) when asked questions, then delay coverage for months? I can’t think of another consumer service that operates this way successfully. Certainly not one that requires a commitment to paying thousands of dollars over the course of the year, then telling the customer, “Oh, wait, we’ve changed our minds.”

How is this OK? How can that happen without repercussions?

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Sensitivity to Drug Side Effects Increased by Migraine Attack

Nine days of dizziness following four days of migraine. That’s what I’ve been up to these last two weeks.

The migraines made sense. We had rainstorms that week and I’d blown off my diet a couple times. The dizziness, however, was surprising. Wellbutrin has been to blame every time I’ve been dizzy in the last 16 months, but it didn’t make sense. I haven’t changed my dose in a few months months. I’d eaten plenty before taking it each time and hadn’t missed a dose. Maybe I accidentally took too much one day? I skipped a dose intentionally, took it at different times, took 300 mg instead of 450 mg. When the dizziness did lessen, the reprieve never lasted long. It was as if the migraine attack had made me more sensitive to Wellbutrin’s side effects.

It seemed unlikely that one migraine attack would change how I reacted to medication I’ve been on for more than a year, but my headache specialist told me he’s seen it happen with other patients. As he put it, the brain you have after a migraine attacks is not the same brain as you had before it. Any medication that acts on the central nervous system, like antidepressants, could interact with this new brain in a different way than before, causing an increase in side effects. My dose hadn’t changed, my brain had.

The changes to your brain after an attack are not permanent, so please don’t let this scare you. It’s more like a storm with high winds came through and there’s still dirt and debris in the street. The street sweeper will get to it eventually, but it may take some time. (I live in a place with haboobs and dramatic thunderstorms. You can liken it to a snowstorm if that’s more familiar.)

I’ve been taking 300 mg of Wellbutrin for the last week. Today I can look at the computer without feeling like my head is melting as if in a psychedelic video, but I still have to be careful to minimize the chance of side effects whenever I take a dose. My fingers are crossed that this part of the change to my brain lasts and that I can keep the depression at bay on this lower dose.

My naturopath/therapist believes that my depression is directly tied to migraine attacks. Since I started seeing her almost two years ago, every increase in depression has followed a long migraine attack that didn’t respond to acute medications. This fits with my headache specialist’s explanation. I haven’t waited to see if the depression abates without medication, but I wonder if it would. Not enough to find out, but I will ponder it.

My fingers are crossed that I have the internal mess from this latest storm cleaned up. Now it’s time to attend to everything I haven’t been able to attend to while weathering it. I’m going to read and approve a slew of comments now, but it will take me a while to respond to all of them.

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Broken Bodies, Beautiful Imperfection

“Implicit in the experience of being disabled and living with chronic illness is the inference from society that you are broken.” –Karolyn Gehrig, #Hospitalglam

We don’t hear this just from society, but from ourselves. I constantly see people with chronic illness refer to themselves as broken. I used to do so myself until I realized how I was limiting myself with this rigid view. My body doesn’t work like I want it to, nor does it work like the bodies of the healthy people I know. But it works. I can breathe and walk and laugh. A body that can do those things is amazing, no matter what its limitations are.

It’s hard to not hate illness, but that often extends to hating the body where the illness resides. This obscures how truly incredible these bodies are. Their tremendous strength carries us through pain and illness, they allow us to awake to each new day. Our bodies are imperfect, but they also achieve astonishing feats every day. This is cause for celebration, not denigration.

#Hospitalglam, which is dedicated to “taking the shame out of being in treatment one selfie at a time,” and #Hospitalglam Shows Body-Positive Campaigns Work for Chronic Sickness Too have similar messages. As Jon Kabat-Zinn wrote, “As long as you’re breathing, there’s more right with you than there is wrong, no matter how ill or hopeless you may feel.” I scoffed the first time I read those words, but now I can see their abiding truth. When I stopped seeing my body as broken, I could begin to recognize all the amazing things it does. I began to love its beautiful imperfection.

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Migraine Research Underfunded

U.S. medical research funding is decreasing and some diseases are horribly underfunded, according to a report published in the Journal of the American Medical Association (JAMA) last Tuesday. When it comes to migraine research, The Washington Post’s headline on the report is telling: How the U.S. Underfunds Research for Migraines, Asthma and Depression. As headache specialist Robert Shapiro, M.D. (@headachedoc) pointed out on Twitter, no major disease is as underfunded as migraine is. It’s “almost off-the-charts.” Literally. Take a look at where migraine appears on this chart.

In a related tweet, Dr. Shapiro notes that although migraine and schizophrenia have the same disease burden, NIH funding for schizophrenia is 12 times higher than it is for migraine.

It’s impossible to read those numbers and not get angry. Especially knowing these numbers:

  • Given current population statistics, nearly 38 million Americans have migraine.
  • As many as 15 million Americans have chronic migraine.
  • Migraine costs the U.S. more than 29 billion dollars a year in medical expenses and lost productivity.
  • Migraine is by far the most disabling of all neurological disorders.
  • Migraine is the third most common disorder on the planet.
  • Migraine is the seventh highest cause of disability worldwide.
  • Severe, continuous migraine is as disabling as quadriplegia, active psychosis, and dementia and is more disabling than blindness or paraplegia, according to the World Health Organization’s disease burden assessment.

Migraine is not a measly little headache. It is not inconsequential. I have lived with the devastation of severe, continuous migraine. I often wondered if it was a life worth living. Too many people with chronic migraine decide that it isn’t. Will lawmakers ever see our desperation and need? If so, will they ever act on it?


References for migraine stats:

 

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Keep Trying

I’m celebrating using the last class on my 20-class yoga pass. It only took 10 months to go to 20 classes! Each card is good for a year and the last one expired before I got to use all the classes on it.

I mention yoga so much that it probably seems like I go to classes all the time.  I have all five classes I like most on my calendar and try to go to almost every one. About an hour before class starts, I begin assessing whether or not I’ll be able to make it through the class. The answer is far more often “no” than “yes.” It’s frustrating and sometimes infuriating to not be able to make yet another class, but I love it so much that I keep trying.

Hmm, that pretty much sums up my approach to chronic illness. Can’t do the things I want to do? Keep trying and every once in a while I’ll get to. Had another treatment fail? Keep trying and maybe I’ll find one that helps. Feel like there’s nothing good in a life with chronic illness? Keep trying to appreciate even the smallest things and I’ll notice some of the goodness that surrounds me.

I know few things for certain, but am positive that I feel better than I have in ages because I kept trying when all I wanted to do was quit. I threw myself pity parties (sometimes for months) and took treatment breaks; I yelled a lot about how much it sucks to have chronic illness. But time after time, I picked myself up and tried again.

Giving up is a great way to stay exactly where you are — or to get even sicker. That wasn’t an acceptable choice for me, so I kept trying. It often felt like I was going nowhere, like my symptoms would never improve, that all the work was for nothing. But when my options were keep trying, stay stuck, or feel even worse, there was only one way I was willing to go.

My diet has the same frustrations as chronic illness on a smaller scale. Sometimes it’s good, sometimes it’s terrible. Most of the time, it’s something I really don’t like, but accept that I have to live with it for now. While a diet of 40 foods is wonderful compared to a year or two ago, it’s not enough. I won’t stay here forever. I see no way out of the current restrictions, but there has to be something. Despite not knowing how I can possibly expand my diet (preferably by reducing my reactivity to foods), I keep trying. I can’t not.