Mystifying Contraindications

My designer drug came today.1 It’s actually called Pennsaid2 and has the same active ingredient as Voltaren, which the orthopedist didn’t tell me when he prescribed it. Actually, he didn’t even tell me the name of the drug. I have been twiddling my fingers3 since the appointment wondering what this miraculous anti-inflammatory that he assured wouldn’t put my can’t-take-NSAIDs body at risk of going batshit when it encountered the drug.

I knew when I saw the name that this was definitely an NSAID.4 And guess what? It has the same big boxed “fyi-this-could-kill-you” warning that all other NSAIDs have. It even says that if you have asthma5 or have issues with NSAIDs6 that the drug might not be safe to take. It goes on to say that despite being a topical drug and having absolutely nothing to do with the digestive tract at all, it can cause ulcers. Well, that’s just grand.

I was so proud of the orthopedist for finding something that I could take that might help my leg.7 Clearly that pride was misplaced. I know that I’m more prone to adverse reactions than most people.8 I know that it says that it’s not likely to happen, but that doesn’t mean that it is safe to give it to a patient who has clearly told you9 she CANNOT take NSAIDs. When I tell a doctor I can’t take something, I mean that I cannot fucking take it. I’m not playing around. There are some drugs that I don’t like the side effects of, but will take anyway. NSAIDs are not one of those. I list them with my allergies because I know that they are not just unpleasant, they are contraindicated given my history of stomach issues1011 and the gastric bypass surgery.

So now I’m on alert. I’ll try the stuff a couple more times to see if it’s actually safe. If I don’t react, I’ll keep using it, but I will always be on watch. I don’t think that I’ll be taking it long, though, since I’m already having some nausea, acid-filled burps, and some of the most intense upper abdominal pain that I have ever felt.12 I’m hoping that maybe the pain was me psyching myself out and that the nausea/HCl burps were a result of a little too much of my turkey tacos. If it happens again tomorrow13 then I will know that it isn’t the food. I don’t want to stop taking it and realize a long way down the line that it wasn’t actually making me sick. I also don’t want to end up with a perforated ulcer like Jenn, so I’ll be cautious about taking it.

Anyway, I guess I could start blogging more at night. Some of the other medicine I’m on for the knee issue and for other issues has been keeping me up to 4 AM lately. If I’m up, I could do something sort of productive. Of course I’d have to be careful because the meds do make me a little more loopy-brained than I usually am.

Oh, btw, I want to apologize to anyone14 who got annoyed by all of my tweets today. Over the weekend, I saw that #DefundPP supporters were planning a tweetfest to promote their hatred of Planned Parenthood and their related ignorance of abortion, birth control, etc. I decided to join in, except I would post facts, quotes, personal stories, etc. Basically, I was trying to help give people on Twitter some legit information instead of some bullshit propaganda. I also wanted to piss off the #DefundPP supporters. Considering the tweets that they sent me, I’d say it worked. Between being called evil, being compared to Nazis, being compared to Jim Jones/Jonestown, having my head called fat and ugly,15 and some other pleasant remarks, I’d say that the mission to piss them off was one that I clearly accomplished.

There were some real assholes who decided that because I support access to abortions that I must hate babies and that I must have had an abortion. I think people who jump to that conclusion are like homophobic individuals16 who think that if you’re pro-LGBTQ rights that you must be in the LGBTQ community. Anyway, they determined that I was a baby-killer and that they would encourage their followers to harass me for killing this child that I don’t ever remember conceiving let alone aborting. That was the only tweet that I reported to Twitter because people in that movement can go a bit above-and-beyond on that scary, dangerous behavior.

What was I talking about? Oh, yeah. I’m sorry for flooding some of your Twitter feeds with my #DefundPP tweets. It was for a good cause, but if it was annoying to you, and I don’t think that you’re a horrible human being, then I am sorry for my behavior.

If I think you suck: Who the fuck cares what you think about my tweets? I certainly don’t.

I guess that’s all. ‘Night, y’all.17

  1. My dad got me started on calling it a designer drug

  2. I see what you did there, pharmacology people. 

  3. Or, you know, something else that’s fidgety. 

  4. If it hadn’t been, then I would give the company major props for their attempt at trolling. 

  5. Check. 

  6. Double check. 

  7. It doesn’t work well either. 

  8. Yay genetics! 

  9. As I typed this I thought of Willy Wonka–of the Willy Wonka and the Chocolate Factory film version–in his office at the end of the movie saying, “It’s all there, black and white, clear as crystal!” 

  10. My father also cannot take NSAIDs without having his acid issues flare up. He’s where I get the 80 mg Protonix + maxed out Gaviscon = still bubbling with hydrochloric acid stomach from. He also passed along his caffeine allergy. 

  11. Though it’s worth noting that Nana, mom’s mom, goes into anaphylaxis with anything, including skin creams, containing aspirin. 

  12. Considering that I’ve had GERD for around 20 years, gastric bypass surgery, and gallbladder failure that led to gallbladder surgery, I have plenty of experience with upper abdominal pain. Hell, it even ranks up there with the cramps from hell that no other woman in my family has. 

  13. technically, later today 

  14. that I don’t dislike 

  15. and some weird comment about homemade yogurt 

  16. They tend to be homophobic as well as “pro-life” so it fits from that perspective, too. 

  17. Heh. That rhymes. 

Some Days Even My Lucky Rocketship Underpants Don’t Help

Late last week, I rescheduled my appointment with the UAB OB/GYN clinic to get my Depo Provera shot on Tuesday to Thursday afternoon at 2:30.1 I asked that the nature of the appointment also change, since I had done some reading and found out that Depo Provera increases the chance of bone loss. I was told that since I wasn’t dude for an annual visit until October 15 that I would have to make it into a birth control consultation. I said that was fine.

On Thursday afternoon, I was in a pretty good mood. I knew that it was possible, if the doctor took too long or there was some unexpected wait going on, I was going to have to stay at the clinic longer than usual because my mom had a dentist appointment, I still felt relatively optimistic. That should have made me nervous, but it didn’t. I was even joking around.

That changed after I started signing in.

The receptionist started by saying that someone should have gotten in touch with me. She asked if I was on Medicare. I told her I had Humana Medicare and Medicaid. She said that the Business Office had told them that Medicare wouldn’t cover my birth control consultation. I thought that there must have been some misunderstanding. Medicare has never denied a birth control consultation that I’ve been to, including the ones that I went to when my gynecologist was trying to come up with a treatment for the Polycystic Ovary Syndrome, but my hormones weren’t taking to the ring or the Seasonale or any of the many hormonal birth control methods that I tried. And I knew that, as a Medicaid patient, there shouldn’t be a rule against birth control access.2 I asked if she could appeal it and she said not today. That might seem like a perfectly reasonable statement for her, but I’m on a clock. Depo shots are only effective for so long. And once the progesterone has gotten out of my system, my dysfunctional uterine bleeding or, more specifically, my menometrorrhagia3 will act up again. I will bleed for days, weeks, or months on end until my iron stores are depleted and my anemia comes back with a vengeance.

Birth control is life or death for treatment for me. Even if it weren’t, denying access to it would be wrong. So I started drafting tweet after tweet of how horrifying the situation was.

Since I had no access to the internet until I got home, I accumulated around 50 tweets. And I started posting them once I got home. It wasn’t long before some of my friends and followers responded. It was another 18 hours or so before someone from Humana did.4

I wasn’t just sad, I was also pissed.

Lately, we’ve had some major budget cuts in Alabama’s social programs. Those cuts plus the misguided #DefundPP movement (and other anti-reproductive health crowds) are part of why birth control isn’t easily accessible to people who need it. For. Whatever Reason.

And I started thinking about how people think that defunding reproductive health intiaitives will save taxpayers money. It won’t. Birth control actually saves these whiny people a lot of money in other social programs. It saves them thousands of dollars in treatment costs for each menstruating person who uses them as part of their care for anemia, endometriosis, PCOS, etc. It saves money by doing its original purpose: contraception.

And I started thinking about how the current #DefundPP aren’t the first group to promote defunding the service. Some of those were successful, leading to clinics closing around the country. One of the clinics that closed was Huntsville’s. That closure directly impacted my life yesterday. I wouldn’t be wondering if I’ll get back on birth control in time to prevent the anemia’s return if that clinic was still open. I got even more angry as I came to that realization.

I started thinking about the consultations that my mom has to go for with her diabetes, kidneys, blood clots, bones, and blood pressure. This sort of thing never happens when she needs a medicine changed. Keeping patients away from treatment is negligent.

And I drew my line in the sand on Twitter.

I wouldn’t even apologize for all of the tweets because I knew that the tweets were the result of someone, somewhere fucking up. And that person was not me.

And I wondered if advocates for reproductive rights had ever even heard of this sort of thing happening.

The last line of this pretty much summed up my feelings:

And, as I wrote the 50+ tweets, I waited for my mom’s dentist appointment to be over.

As a result of chronically dry mouth (partly from the diabetes, partly from medications), most of her teeth have cavities. Her insurance (also a version of Humana Medicare and a secondary dental insurance from another company) is so great that it may cover $14 on a $108 appointment. And she needs over $3600 for treatment of 3 of those teeth. Only one filling is covered per year, and it even isn’t covered completely. The longer her cavities wait, the worse they get.

My dad and I haven’t gone to dental appointments in years because all the money for dental treatments goes to mom’s because she’s got the worst ones. Dad has cavities and teeth that break. He needs a lot of cavities filled.

At my last dental appointment, I was told I had an abscess of the nerve in a tooth that I had crowned in middle school. I also need tens of thousands of dollars in orthodontic work and even pricier surgery to correct bite problems.

So these are the joys of the healthcare system and the dental care system of this country. Fun, right?

  1. Because of the MRI appointment being scheduled for Tuesday. 

  2. Medicaid in Alabama promotes itself as a service that works with family planning and that birth control consultations are part of that package. 

  3. Menometrorrhagia is prolonged or excessive bleeding. For me, it’s both. 

  4. I still haven’t gotten that part sorted out yet. 

Oh, How It Resonates

Last Monday, I went to the orthopedist with my knee. As usual, for me,1 somehow my file got misplaced until his nurse realized that maybe that girl who had been sitting out in the waiting room for a while was there to see the doctor. I told her my name & who I was there to see. A few minutes later, she was taking me back to X-Ray.2 By the time that I was out of X-Ray, the room was open.

The standing x-ray of my knee. Maybe Rachel Cooper, the troll of Nottingham, can explain why my kneecap is where it is. It wasn’t long before the physician’s assistant came in. He asked me if it hurt when he pressed different spots. Then he started pushing my kneecap around and rotating my knee and leg in different ways; it was very similar to the things the physical therapist had done during her exam, except this PA dude pushed a lot harder than she had pushed. I told him about the knee buckling/going out that had gone on & and how it had started as a painless thing before morphing into a screaming in pain situation. He asked if it hurt when I went down stairs and I told him that I didn’t know.3 I also told him that I’d gone through about two months of physical therapy because I’d thought that that would help. He also asked if I had taken any anti-inflammatories/NSAIDs over the last few months. I told him that they upset my stomach and he was kind of like, “Oh, okay.” Then I mentioned that I’d also had gastric bypass surgery and he was like, “Yeah, you should never take NSAIDs.”4

When the orthopedist came in, he did some of the same manipulations of my knee that the PA had done. He told me that he was going to order an MRI because he couldn’t tell what was going on without it and that the knee buckling worried him. He was glad that I had tried the physical therapy, but he didn’t like that it had gotten worse during the sessions.567 He suggested that it could be a tear in the meniscus, but he couldn’t be sure without the MRI.

If Dottie had ever gotten around to doing the requested referral,8 I could have gotten the MRI scheduled on Monday. Instead, I had to wait until Thursday for a prior authorization to come in. It came within an hour after I’d sent my name, phone number, zip code, and email address to Humana’s social media team.9 My MRI is scheduled for Tuesday evening at 6:15. When the scheduling/referral person from the orthopedist’s office called, she said that it was at 6:15, but didn’t say AM or PM, so I had to ask. She laughed & promised they would never try to send anyone that early for an MRI.

My appointment with the orthopedist to find out the results of the MRI is set for the next day after 3.10 I’m looking forward to figuring out what is going on and finding out what I need to do to get better. Hopefully, this is the beginning of the end of my knee hurting like hell.

Keep your fingers crossed.11

  1. This has happened to me a few times. 

  2. There wasn’t an exam room open at this point. 

  3. My old orthopedist, who is old enough that he’s now retired, told me as a teenager to avoid stairs. I told the PA this. 

  4. Told you so, UAB. 

  5. I didn’t like that either. 

  6. Neither did the physical therapists–pool and land. 

  7. Or my family. 

  8. Let’s face it. Everyone involved, including Dottie, knew that she wasn’t going to make that referral. 

  9. On Wednesday evening, I had asked how long it would take for the prior authorization to be approved. They responded Thursday morning asking for those bit of information to look up my case. 

  10. Dad is a bit bitchy about having to go on a Wednesday because that’s grocery day and nothing is allowed to interfere with grocery day. But the next appointment available was the next Tuesday morning and he hates morning appointments even more than he hates Wednesday ones. 

  11. And not behind your back. 

It Doesn’t Even Go There

Ladies and gentlemen and everyone else,

I am seriously alarmed by the diagnosis that my doctor, now a second-year-resident, made the other day. I thought that she said I had popliteal tendinitis. The diagnosis on the patient summary was pes anserinus tendinitis. These are very different tendons. Now, if you don’t want a bit of an anatomy lesson, I’d say go now. I’ll only use tables and not cadaver images,1 so if you’re interested, but worried you’ll see some limb of a dead dude, there is no need to worry. I promise that I won’t be really gross about it, but if anatomy just isn’t your thing and you want to skip this entry, that’s totally fine.

Since all good anatomy lessons start with the basics, maybe we should start at what a tendon is. A tendon is a type of connective tissue that connects the muscles to the bones or to other muscles. Ligaments connect bones with other bones. Bones are the things that you drink milk for, unless you’re lactose intolerant or have a milk allergy.

the popliteal I present the popliteal tendon, which sits right at the “knee” above the fibula in the back. ┬áThe fibula is the bone on the outside of the calf. It’s the bitty bitty, in width,┬ábone that keeps the ankle stable and holds the muscles in place. Injuring this tendon is pretty rare unless you injure other things in the knee. Symptoms of popliteus tendinitis are inflammation, pain, swelling, or tenderness outside of the knee. The more the patient does before it is treated, the more likely the patient is to build up scar tissue and that causes pain every time you move the joint.

pes anserinusThis is the pes anserinus. The pes anserinus is a group conjoined tendons of three muscles that insert onto the front and inside part of the tibia. The symptom of this type of tendinitis is pain that develops on the inside or center of the shinbone about 3 inches below the knee.

Now, where does the pain happen to reside? The worst pain is on the outside of my knee. It is toward the back of my knee. It hurts when I bend my knee. It hurts the more I used it. The minor pain on the inside of my leg and on the front of my leg is actually above my knee. I’m not diagnosing myself. There are tissues of different sorts making up the area in and around the knee. I’m not going to say it’s one or the other, but I am going to say that if it’s the pes anserinus, then it’s probably a case worthy of some peer-reviewed studies. It would have to be the weirdest case ever.

The diagnosis is why I am alarmed.

I told the doctor exactly where it was hurting. She even examined the outside, back area. But she not only suggested a part that is in a totally different area, she officially diagnosed it. And the attending2 signed off on it without actually examining the joint. I shouldn’t have to know the actual make-up of the knee joint because that’s their job. Doctors spend all of those years in school studying anatomy. When they get to the Residency program of one of the best medical schools in the country, they should know the structures of the knee and what sides those structures are on. She only has this year and next left in her residency, and this is something she should have known before she even became a resident. Even as a family practice doctor, she should know this stuff. If she was planning to be a psychiatrist, I wouldn’t be so scared, but family practice doctors deal with joint injuries. Mistakes made in treatment could cause grievous injury to otherwise healthy people.

This is scary stuff.

  1. Cadaver images would be what you would see in an anatomy textbook, so consider yourself lucky. 

  2. AKA the main person my family is calling “the idiot” for prescribing NSAIDs to a GERD + Gastric Bypass patient. 

Aleve-iate Your Pain (Or Maybe Not)

I saw the family doctor today about the ongoing knee pain.

The family doctor thinks it is a tendon1 or, more likely, a group of tendons in the back of my knee that are inflamed. She wanted to either put me on a round of steroids or send me to the orthopedist for a cortisone shot. 

Her attending told her to do a round of NSAIDs first, despite having NSAIDs listed as drugs I cannot take.  ((He told her that if they sent me to the orthopedist now that the orthopedist would do two rounds of NSAIDs before doing a shot. And they didn’t want to do the shot too soon–8 weeks of sharp pain in my knee doesn’t exactly seem like it’s all that short of a time period.)) They felt that the 80mg of Protonix2 could keep the ulcers from forming. So she wrote it for prescription strength Naprosyn two times a day for three weeks. My extra-reflux-y,3 post-gastric-bypass stomach & the brain that controls it decided that prescription would not be getting filled.4 I definitely did not want to risk an ulcer.5 She said they might send me to the orthopedist in 3 weeks6 if the pain was still going on. 

Anyway, I came home and was a bit disappointed because I knew that I couldn’t take the espresso-esque dose of Aleve and that that meant the pain would continue for the next 3 weeks. I realized that it could even get worse. And then the realization that I’d have to wait another few weeks for an appointment and that might mean an even longer wait for treatment. I started breaking down and sobbing. I couldn’t see an end in sight and I think my crying worried my mom. We decided I should skip the wait & call the orthopedist.7 I have an appointment for the 14th. Two weeks instead of three somehow leaves me feeling more optimistic. 

phyllis giving financial advice Once I was back into the less-overwhelmed-by-pain mode, my dad told me about Aunt Phyllis’s response to my GoFundMe page to help with my overdraft/unexpected bill issue. I think she meant to be helpful, but her advice really was, well, unhelpful. Missing one payment of most of the bills would just lead to badness. I saw my parents do the “just one month”/deferral thing. Debt stacked up. Debt collectors harassed us regularly. The reason I own the house we live in is that their bill situation got so bad that they could have lost the house. My debt isn’t that bad.

If I skipped a payment, it might get much worse and I don’t want it to get any worse. Besides I have a “don’t take financial, moral, or legal advice from the Morris family” rule. Their solutions can range from bad to sociopathic. I really don’t want to follow in those footsteps. So I may overdraft again this month, but I’ll get caught up soon & figure out a way to pay for what I need and save a little money as I do. 
Oh well. I need to start working on the grocery list since tomorrow is Wednesday.

  1. She also mentioned that I would need to avoid fluoroquinolones–Cipro, Levaquin–because of the risk of tendon rupture. I told her I couldn’t take those because of the neuropathy issue, so I wasn’t really worried about encountering that issue with them. 

  2. A dose that requires maximum doses of maximum strength Gaviscon to back it up. 

  3. Thanks, Dad! 

  4. Even the pharmacist knew I wouldn’t be taking it. When the scrip got to her, she called my house and said she would not fill a medicine we all know I cannot take without endangering my life. 

  5. Especially not after reading about everything that Jenn has gone through with her ulcers. And, no, that doesn’t mean I wanted one before. I’ve also seen the pain they’ve caused my dad. I don’t want to experience that, even if it would mean less pain in my knee. 

  6. My recheck was scheduled for September 21. 

  7. The family doctor said I didn’t actually need a referral because I’ve seen an orthopedist that specializes in knees on another referral recently.