Wednesday, June 30, 2010

Looks like Shingles Vaccine is Covered after all

Rick did a heroic job of dealing with his medical insurance company.  They will cover the vaccine, great news.  We do, however, have to go to an "in network" pharmacy, which was the problem with the second place we tried.  I guess we'll go back to Walgreen's tomorrow and give them a second try.  I am sure my patience will be more intact if we can go before noon.

Today's breast surgeon visit and trying to get a shingles vaccine

Wow, a long day for sure!  And we have so much to think through before making a decision on the next steps.

Here are a few facts:

Stage 2, Grade 3, left invasive ductal carcinoma.  This is the most common form of breast cancer.  It is positive for estrogen and progesterone receptors (that is good).  There are other portions of the pathology report TBD.

We met with the breast surgeon, Dr. Christa Balanoff, and she presented the following options:

1.  Chemo first to shrink the tumor (sometimes down to almost nothing, then lumpectomy and Sentinel Node biopsy, then radiation.  In this scenario, the lumpectomy preserves the most breast tissue and gets the worst part of the treatment out of the way.  It also means I need a wig sooner rather than later. Need to think about my "new look" and I'm open to your humorous suggestions :>)

2.  Lumpectomy first and Sentinel Node biopsy, then chemo, then radiation.  In this scenario, it's a pretty big lumpectomy because they have to take enough tissue to get "clear margins" - another 3 - 5 millimeters.  I'll be lopsided, for sure, probably lose about 1/3 - 1/4 of the breast.  Hmmm...permanent reminder.

3. Total mastectomy - with or without reconstruction, then chemo, then radiation. Seems a bit radical, given the other options.  But some people just want that breast "out of here".  After all, it's trying to kill you!  So I understand why people choose that route.  But I'm thinking not...

We will have meetings in the next week or so with the oncologist and the radiologist.  Unfortunately, the tumor is just a bit too big to have the Mammosite radiation (2 times a day for 5 days).  They want it to be under 3 cm and I am right there at 3.  So radiation will probably be the normal external version - something like 33 sessions.

Also, just to be sure, I am having another ultrasound tomorrow of my left armpit lymph nodes to be sure nothing is lighting up the screen.   We have to be at Menorah's Breast Center at 7:30 a.m. - which works only because both of us aren't really sleeping well at the moment.   Let's hope they don't find anything else.  She doesn't expect anything, this is just "due diligence."

It is a lot to digest and we will take our time to plot the right course.   For now, we are leaning towards Option 1, chemo first.  Well, I really don't want chemo at all; but then, no one wants to do chemo!

Now on to the most ridiculous part of our day - trying to get my shingles vaccine.  So for those of you not familiar with this, it is recommended for anyone over 60 who's had chicken pox.  Shingles has a bad habit of erupting in people with a compromised immune system.  Chemo will put me there.  I know people (including my mom) who have suffered through this nastiness.  So, I decided to ask my doctor for the vaccine.   But our lovely government does NOT allow doctors to administer the vaccine.  They can write a script, then you take the script to the closest pharmacy, they give you the frozen live vaccine and you rush back to your doctor's office and have them inject it.  Or, you go to a Walgreen's Clinic, they charge you for an office visit (your co-pay), then the Nurse Practicioner writes the script over to their pharmacy, you wait for the pharmacy to deliver it to the NP and then she does the stick.  So, we tried the Walgreen's thing first (because we didn't know they would charge for a visit or how all this would work).  But after about an hour of messing around with their forms and their check in process and waiting and waiting... I told Rick I was done with it for the day.  So then we went over to a pharmacy that would dispense the vaccine to us, we were going to run back to the doctor's office and have them do the stick.  But it was 5:30, I kept getting the doctor's office auto-attendant and waited for about 10 minutes.    And oh, it looks like our usually fantastic insurance doesn't cover "vaccines."  Huh???  This stuff is $202!  We need to check with BCBS...maybe there is a special code that needs to be used.

We finally completely gave up, said tomorrow's another day, and went to Texas Roadhouse for bloody Mary's and dinner.

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