A Very Near Brush With Death

Right. Step one is a special super thank-you to my bud Ernie Reardon, without whom I would probably not be talking to you all. I’m going to do something really nice for him. Of course he probably won't let me.

Earlier this month on 7 November, I went back to the Gastrointestinologist because my acid reflux was acting up again. He suggested I resume Nexium 2x per day instead of 1x per day. I had, as instructed dropped back to 1x per day after 90 days. His assistant, also an MD, suggested Claritin-D/24hr and he agreed. Not a big deal, especially since we know I’ve got allergies to dust and such. (See previous blog posts). I resumed the 2x Nexium 8 November.

I began taking the Claritin-D on 9 November before bed. It kept me from sleeping making me restless, so I started taking it in the morning instead, starting 11 November. Since it was a 24hr pill, this shouldn't matter. I also had left, on 10 November, for my trade show in Las Vegas (also a previous blog post). The Claritin-D worked remarkably well and my severe morning reflux issues almost entirely vanished after a few days.

Over the course of that week in Las Vegas, I noticed my heart seemed to be beating faster, but I thought it might be my imagination. After all, I was at a trade show in Las Vegas, where there are rumours people drink a bit more than they normally do, you're surrounded by smokers, there's a lot going on that might cause more excitement than you would normally get in a given day. That and all the wonderful food. The rapid heartbeet kept up even after I returned home. It slowly worsened -- coming and going both fast and slow -- and I wasn’t sure what it was. I didn’t connect it to the Claritin-D. A possibly nearly fatal mistake.

By 22 November, Thanksgiving Day, it felt like my heart was beating really fast, then really slow, and then back to normal for a few hours, but when it started going I thought it was going to burst right out of my chest. I had no way to confirm my feelings except putting my hand on my chest and feeling it – admittedly not very scientific. It was, indeed, very noticeable. I did not have the "heart attack symptoms" such as pain in the arm, blue coloured fingers and toes, chest pain, shortness of breath, and so on. So I didn't panic and think I was having a heart attack.

During this time, I became extremely fatigued, falling asleep often even mid-day, sometimes getting light-headed. As the week progressed my heart got louder and louder, so I could hear the pounding in my ears, and even see spots in front of my eyes in time with each beat. I realized something was amiss, but I didn't know what. I decided, perhaps, on Monday if it wasn't better I might get around to calling the doctor. As a guy, I wish to report that it's true: we hate going to the doctor.

It so happened the evening of Friday, 23 November, I ran into my friend Ernie on-line (AIM). We chit-chatted and he asked how I was. So, I told him. He said it sounded like an Arrhythmia. Ernie has a medical background and uses big medical words I don't know. So, I peeked at Google – Google knows everything, trust me. It so happened that several of the matches specifically mentioned Claritin-D. I followed the link and saw a mention very rare side-effect of which is not listed on the box.

So I stopped taking it, to see if I would get better. At that time, I also sent a fax to the doctor’s office letting him know what I discovered. I figured if it got worse, I’d call emergency. I exercised on Saturday morning for 45 straight minutes (ice skating) with no problem, though that’s about 1 hour less than normal. It didn’t kill me though.

The GI doctor called me first thing Monday morning and told me to see my primary care doctor and then have my doctor call him. I saw my doctor today (Tuesday) as soon as he got back in town. I decided I’d rather wait until today and see my doctor rather than some random doctor in the hospital.

He spent quite some time with me. We did x-rays, EKG, and all sorts of other tests. All these results were compared with the base-line tests we did after my 40th birthday when I had a complete physical. Happily, it appears I have suffered no serious damage and that all of this was a reaction to the Claritin as it built up in my system. We are awaiting (Friday) results of my blood spectrum and toxicology reports. He's checking my thyroid as well, but based on my weight we're pretty sure that's not it.

Irregular heart rhythms can also occur in "normal, healthy" hearts. But I first got mine a few days after starting the Claritin-D. According to WebMD, although arrhythmias may be normal in certain settings, they can be life threatening in other situations. This is because certain abnormal heartbeats that result from electrical dysfunction in the heart make the heart unable to pump enough blood to keep a person alive. In other cases, irregular heartbeats can lead to blood clots, which can cause a stroke or brain damage and other tissue damage.

This really sucks, too. You know why? The Claritin worked very well and reduced my Acid Reflux to negligible levels indicating it is indeed at least partially allergen related. However, both doctors insist under no circumstances may I take any allergy drugs of any type for at least one month and then, only after a full consultation.

Today's Medical Report

Today was my appoint with Dr. V. Alin Bottoman, who I saw because a friend highly recommended him. If you haven’t read my insurance saga, it might be appropriate reading. You may read that at: April 2007. My previous medical update is at March 2007 – and lastly if you don’t remember when it started there’s this blog post September 2006 and this post August 2006. That will get you up to date. Done reading? Good. Now, I can start where we left off. This bit will take you from the March 2007 post to today.

As you’ve seen, I spoke with Doctor Newman a few days later and he said the results were excellent. There were no tumours, ulcers, or any sign of any problem whatsoever. He said I had a very small hiatal hernia, which is normal in people my age and it was nothing to worry about and wouldn’t be the cause of the reflux. As you can also see, as evidenced by my anti-insurance posts, I went back to Doctor for my follow up visit. He used the camera through the nose device, said nothing was wrong, and referred me back to Doctor Newman who he said was my doctor for everything except the granuloma. Not overly happy with being shunted off, I called Doctor Newman who said to continue the twice per day Nexium and add a Zantac mid-day. I’m doing that, but I don’t want to take drugs long-term. Something caused this, and if we can find the cause we can fix it.

The simple fact is my acid reflux is not getting better despite all these medications. I can taste it in my mouth on-and-off on some days – a sour taste in the mouth. I have embarrassing large quantities of gas all day and all night. My throat is very sore, especially on my left side near the top and swallowing is a chore -- if I press the spot with my finger, I can swallow with almost no pain. I find that odd. My voice sounds terrible. The problem is worse in the morning, especially when I first wake up.

My stomach has a constant dull ache that has only started since the Endoscopy (though I don’t think that it’s related) – I suspect it’s the gas build-up. I am also getting sharp-stabby pains in a few very specific spots of my stomach, also which started since the Endoscopy. They don’t last long (2 or 3 seconds) but I sure as hell can notice them. One spot is worse than the other two. It happens 3 or 4 times per day, randomly and in varying degrees. And now, you’re up to today before Doctor Botoman. Aren’t you glad I had all this free time to type this for your reading pleasure?

The doctor’s office gave me a ream of paperwork to fill out: questionnaires, surveys, and the usual health crap. Then, of course, I waited. There’s nothing like a doctor’s office to wait in for the sheer boredom effect. Then they called me in and the nurse came in with a laptop and asked me many detailed questions, and typed them into the computer. Prior to my visit, I had faxed a two-page report on everything that happened to date (which, happily, was already in my folder). I also vented about my Aetna problem and she laughed (friendly) and said they’re all bad so I shouldn’t be too mad. Then she said the doctor would be with me shortly. She also informed me I look like him (I disagree) and I’d see when he came in.

A good 35 minutes later, he appeared. And he immediately apologized for the delay. I liked him already. No doctor has ever apologized for the wait. He explained the network went down and he needed all the stuff the nurse typed in so he had to wait for it to come up. He asked me lots more questions.

First, he agreed that there’s obviously something wrong despite the fact there was nothing on the Endoscopy. Second, he believes Nexium doesn’t always work in some cases and I may be one of them. He is postulating that my body is metabolizing the Nexium faster than it’s released from the capsules though he recommends I continue to take it 2x per day for at least 3 more months. He also said the morning dose is far more important than the evening dose which is against conventional wisdom.

(The part from here to the end of the post is heavily edited for on-line viewing. I've left most of it out; lots of gory details, and the bulk of the results. The report is available to friends and family by inquiring via e-mail.)

First up for me is a poop test. Once I pass that I get my first pH test which is done by inserting several electrodes into my nose and down into my esophagus which stay there for 24 hours. I then wear what looks like a purse for 24 hours (it contains the recording devices and such).

He feels there are several outcomes. If I do nothing, I have an extraordinarily high-risk of esophageal cancer, and can die from it. Associated with that, I run a higher risk of many other severe and possibly fatal medical conditions. As such, this is a very Bad Option, though some days it looks pretty good :)

There are several options: all of which involve surgery, none of it minor. There’s actually an even worst-case option, and that is the source is not found. Since the drugs aren’t working, this would present Big Problems.

However, he’s confident we’ll figure it out. My Acid Reflux suddenly changed and there has to be a cause. It’s a matter of systematically finding that cause. He doesn’t want to operate unless there is absolutely no other choice, and I whole-heartedly agree.

And if you’re not a doctor, please don’t offer advice. Some of the helpful advice I’ve received so far has seriously worsened my condition, so if you’re not a Gastrointestinologist, your advice is appreciated deeply but entirely unwelcome.

Aetna Blows More than Monica Lewinsky

I fucking HATE insurance companies. Today, I think I shall rip Aetna a new asshole in my blog because they so richly deserve it. They probably have plenty ripped assholes already, so one more ought not bother them. Aetna is comprised of incompetent, idiotic assholes. I think they hope I die before they call back so they don't have to pay anything.
I have an Open Access POS plan through Aetna. No big deal. It's basically an HMO with an open access option (for which I pay extra). It means you don't need a referral to see a specialist. You pay a double co-pay, so you don't save any money. What you do save is time because you don't have to go see your primary, pay a co-pay, and then go see the specialist.

I'm an adult. I know what part of me is broken, so I if I need an otolaryngologist (ear, nose, throat) because my throat is having troubles, I can go. I pay a double co-pay because he's a specialist, hence I've not saved any money, but I have saved at least a week in time, which is priceless.

They insist I'm on an HMO even though I'm on a POS. The billing computer has it right, my card is right, but the service-provider's computer (where they check if your coverage is active) doesn't. So when my doctor calls, it tells them I am on the basic HMO plan. So my doctors all want referrals even though I don't need one. If I don't have a referral, I am not covered. That might not sound so bad except when you don't have a referral the insurance doesn't cover the visit and you're looking at $400 instead of $30.

This bit has been ongoing. I have spoken to people at Aetna (as well as my independent insurance agent) all of whom have promised to call me back. Some have asked for faxes, for details, and my contact information. Aetna is comprised of incompetent, idiotic assholes. Like I said before, I think they hope I die before they call back so they don't have to pay anything.

The people I've spoken with all assure me their computer shows I am covered. However, from what the doctors say, I am not covered. One of my doctors even had the information faxed over to me which quite clearly shows I am not covered. I have faxed this to them, my agent, anyone who wants to see it. It matters not to them. I am a human and Aetna cares not one iota for humanity. If I were a dollar bill they would be fawning over me like a lecher over a sixteen-year-old cheer leader.

But wait, there's more!

But that's not all. So I'm on these drugs that the otolaryngologist prescribed and I have two days left. Last time I checked my doctor is a licensed professional. The drug (if you care) is Nexium 40 which is to treat my severe acid reflux, the cause still being under investigation. I am supposed to take two per day which is 60 per month. First time I went to get them, Aetna gave me a hard time and said this drug needed pre-certification. I couldn't get them and had to call the doctor's office who had to argue with Aetna. The prescription was issued and the label clearly says "take twice per day" -- okay, boys and girls how many pills is that per month? If you got "60" you win. If you got "30" you work for Aetna. So after two weeks with 30 pills, it's time to renew. I always renew online because it's easy. I go to pick them up. Apparently Aetna feels they know better than my doctor.

So the pharmacist at Walgreens – a very nice man – let me use his phone so I could call Aetna. I went through dozens of voice-activated automated menus. Everyone around me laughed because none of the menu prompts would recognize my group ID. After much aggravation, I finally got to the part where you say “operator” to get a human and I said "operator." It hung up on me with no explanation. I started about 4:55pm and got hung up on a little after 5pm. When I called back and went through the same hell again, it said, I had to call back between 8am and 5pm (what happened to 24 hour service for medical issues)? The pharmacist, being the masochist he is, thought he'd give it a try. That failed spectacularly as I found when I called him an hour later.

My pills will run out Saturday. Of course, I can buy them at $188.90 per bottle of 30 and I need two of them. What do you think the chances Aetna will pay are? I've had a number of insurance plans, but Aetna is near the bottom -- only inHumana was worse.

The worst part is, stress greatly aggravates my acid reflux condition. So Aetna's behaviour is actually harming me. I'm sure that's ironic or something. I wonder if I can sue them for attempted murder?

On Tueday, I will file a complaint with the State of Florida Insurance Commissioner. It won't do much good because I have little faith in that office based on what I see of our entire insurance crisis in the state, but if it makes Aetna suffer a little, it'll make me happy.

Hiatal Hernia

I have a hiatal hernia -- those are the results of the endoscopy. Because it's not too bad, they are not recommending surgery. They expect to continue to treat my acid reflux with Nexium. I am to follow up with the original doctor in about three weeks. The hiatal hernia is causing the acid reflux and the hyperlink to WebMd will explain it in detail.

I do not have any signs of cancer, ulcers, varices, tumors, or polyps. Nor do I have any serious signs of esophogal erosion. All of that is good news. The bad news is I must continue on my white, bland diet.

Thanks to the few of you who expressed support or actually called/wrote to see how I was.

Health Alert: Acid Reflux, Aciphex, Nexium, and Vocal Cords

Five weeks ago I reported about my health problems and the lesion found on my vocal chords -- we named him Fred in the previous post. Just in case some of you actually give a flying fuck, I have an update. Fred was supposed to be entirely gone now. Then I'd be happy and tell everyone life is good and move on.

I followed the restricted foods carefully and made perhaps one or two minor strays over the five weeks. Even the doctor agrees I did a fantastic job. I took the medicines every day -- missing one dose one day only (thank Ernesto). I adjusted my eating and sleeping patterns. The consequences were too dire to do anything else.

So when Doctor Kevorkian, er, I mean Doctor Foster, shoved the camera down my nose this time,not using nearly enough anaesthetic I might add, and said, "oh" I felt my heart slow down. Fred is still there -- that's the bad news, and make no mistake about it because it's very bad news. On the plus side, Fred is showing signs of improvement -- and by that I mean he's a bit smaller but not small enough. So, I am on my morning Aciphex and a double evening dose of Nexium* -- again with Tums as needed.

In early November I go back. If Fred is still there, I get a trip to the surgeons where the prognosis is good -- assuming I don't mind the fact I might not be able to talk ever again and a trip to a gastrointestinologist to find out why there's so much acid gurgling around my stomach.


* assuming the fucktards at Aetna can actually get their shit together. I have no fucking idea what gives an insurance company the right to override a doctor's decision and deny a prescription. I've already faxed my doctor the number to their appeals department, and pending that I'll be calling the state insurance commissioner. Life is a bitch, and then you die waiting for the insurance company to figure it out. (Nexium40 is around $200 a bottle for a 30 day supply).