Controlling healthcare costs

Despite trying to engage in distractions and diversions during every waking moment and engaging in supposedly cognitive and memory stimulating reading (I can’t concentrate, can’t comprehend and can’t retain much info, so consider everything I write with a healthy dose of skepticism), I am increasingly experiencing noticeable memory lapses and episodes of confusion.  The memory lapses are annoying and disheartening.  The confusion is frightening.  Because no one was interested in learning about those problems and instantly dismissed them as “due to the depression”, I am left to my own devices to manage them. Enter Google.  There are self-assessment tools which purport to distinguish between dementia and depression in memory loss.  I tried them out and came away with a 100% alignment with depression.  However, these tools, and the physician feedback I received, conflated correlation with causation.  The real answer is that no one knows. After a winter of experiencing much more back and joint pain, the inability to self-plan and perform even a basic yoga practice, and a months long stretch of not leaving the bed except for bodily functions needs, I find myself so fatigued, dull, and slow that forcing myself to stay alert, attentive and mobile is a monumental task.  And really, since I do not have any obligations to work, socialize or contribute in any way, no one cares or is affected, which brings me a perverse sense of relief of not failing anyone.  When all of society yanks those away and sends you off to a life of dying and social death, this apparently is the benefit. (For all of you psychiatrists who found your “EBM” on that most medically scientific principle of false hope and optimism serving as a default component of “insight”, this is it for optimism and flexible thinking.  Insight I’ve got in spades.) I have struggled to attend scheduled volunteer activities.  But I think I am bringing a poor benefit/risk ratio to the organization.  I can’t perform much of the physical work, and sometimes I can’t remember the very simple instructions to carry it out. The people I’ve met are seriously smart, wise, witty, knowledgeable and committed to the goals and work.  The leaders lead well (coming from me, that’s the equivalent of the Nobel Peace Prize).  Two of these people are dealing with immediate end of life issues, and I try to be a reliable and comforting presence.  That, at least, I can offer and carry out. So back to self management.  I started looking around again for resources and strategies to try.  Because I root around in PubMed, am located in a city where a vast amount of clinical research is occurring, and have a sense of what I need in the way of outcomes, I called the HMO and asked to speak with the mental health case manager.  The marketing and sales people weren’t happy with that.  The person I spoke with was sullen and only after repeated requests and my refusal to give her clinical info was I transferred.  And I got the same woman who when I first called to find a psychologist with expertise in both PTSD/trauma and depression gave me four names where either the person was no longer in the plan or was outside my ability to travel. When I called to report this and ask for appropriate options, she became belligerant and defensive, and so I ended the call since I had already been through the provider list and discovered that there weren’t any at all who met the above criteria. This time, I asked her if she knew of any research or clinicians who dealt with ketamine for severe depression, or with rapid responses to severe depression.  She started in on the spiel that it wouldn’t be paid – it was experimental.  After a few minutes of this abuse – no referrals, no answer,  I told her I’d had enough and hung up. Ten minutes later the police were at my door.  Luckily, my computer screen was on and open to the complaint and disenrollment line, the coffee pot was full, and no weapons were    in sight (that last one is a joke).  The sergeant grilled me about what I had said that “would make her call”.  I explained about inquiring about the ketamine research.  I offered him the phone number to call the woman.  He couldn’t get past the telephony.  I had to sign a form declining emergency transport to the ED. The officers declined coffee, inquired as to the rent I pay for this attic dump, rolled their eyes at the response, and then changed the conversation to “we have to do our jobs.” I replied that experiencing public humiliation (lovely lights, multiple police cars and ambulance in the drive and street) and terror (nothing like having 5 uniformed and armed men on your doorstep banging on the door and demanding to be let in.  NOW.) was obviously what the HMO’s objective was, and they agreed. Which is just the latest experience which illustrates why I still have no health support, no trusting relationship with anyone, and no hope of finding same. What I ended up doing was perusing the research studies for chronic pain and finding several that are non-pharmacologic and low risk to enroll in. I was assigned to the treatment arm of two, and two more are simply looking at different biomarkers and immune responses.  I’m an easy stick, so I’m happy to donate a little serum to that cause.  However, one study requires a combo PET/MRI along with an arterial lineinsertion.  Having been on the managing end of those before as a critical care nurse, I think receiving one (they are uncomfortable at best) is a dose of my own former medicine. I wasn’t permitted to disenroll from the HMO.  The abusive case manager is still a “valued employee”, and I effectively have no health insurance, because there I will not provide any information to, use any provider affiliated with, or voluntarily use any aspect of that HMO’s products and services.  They really have the keeping costs controlled portion covered.  Abuse, terrify and threaten enrollees, collect their premiums and watch the profit margin soar. And the research compensation (for “subject “expenses”) will pay for dental and vision exams.  At least those don’t come with threats of imprisonment and assault and battery. (Optimism and hope, psychiatrists.)


15 thoughts on “Controlling healthcare costs

  1. Holy S..t, aek. I am sorry I feel like I post too much here. Maybe because folks have not yet found their way here. But they should and probably will. You write well. I can’t believe what ahats you had to deal w/ re the insurance. One time I made a flip comment about something I would ‘like to do’ to a lady on the phone at the tax office and she warned me that she’d have to call the cops if she thought I was serious. My shrink reamed me out for saying it to her, I think in warning more than anything as she didn’t have me carted off, thank god. I am sorry you are struggling so much – but when I read what you write, I realize that struggle as you might, you are clearly intelligent, articulate and have important things to share. I don’t know about dementia and all that, but I doubt someone who is demented could write and post as you do, and hold their own with the shrinks at TB, etc. I can’t, but I don’t give a crap, I say what I want to say. If you were really demented, you would just lie in bed while reruns of soap operas and game shows blared all day. Further, the demented (and I know – my aunt had alzheimer’s) aren’t able to assess the situation, overcome roadblocks and find a solution – perhaps an imperfect one, but a solution just the same. Good on ya, aek. Keep it up!

  2. p.s. just reread my comment – the comment about ‘what I’d like to do’ was to myself, not to HER! Just to clarify! And no, I did not ‘mean’ it. I was just expressing frustration. But I sure learned right quick not to say that anymore within the hearing of a psychiatrist!

      • Glad to hear it. I do like to think that I am learning something by coming here – although I enjoy some of the lighter pieces, e.g. the ones about the collies, etc., I don’t come here to play – I realize that this is a very serious endeavor for you and I have said, more than once, it ‘matters.’ I do, however, hope to continue to learn from reading here.

        • I apologize for coming off glib. I was shorthandedly referring to wordplay. I appreciate your very wise and insightful comments, and of course you are always welcome here to write freely and without sanctions.

          • Thanks… wordplay I do like. I just thought I came off as sort of slow, given my lack of scientific knowledge. I look forward to more of both the ‘scientific’ articles and also the lighter pieces, which are a nice balance.

          • Slow? Au contraire! And I think I’m leading toward the notion that there isn’t any science underpinning extant treatment. But plumbing the literature keeps me distracted, so that will probably continue. If you want insomniac pastimes complete with a real owl, check out the Cornell Labs Great Blue Heron cams on Livestream. 5 newly hatched herons who look like Schultz’ Woodstock and sound like him, too. A great horned owl has periodically done flybys at the female while she’s on the nest. Always between 1-4 am.

  3. The objective of the current study is to investigate the safety and efficacy of a single dose of intranasal (IN) ketamine in treatment-resistant depression (TRD).
    Contacts and Locations

    Please refer to this study by its identifier: NCT01304147
    Overall Contact Backup
    Sarah Pillemer

    Mount Sinai Medical Center
    New York City, New York United States
    Contact info
    James W Murrough, MD
    Detailed Description

    This study examines whether Ketamine can cause a rapid-next day antidepressant effect in patients with Major Depression/Bipolar Disorder . Purpose: This study will test whether a single dose of ketamine – a drug that blocks a brain receptor called NMDA – can cause a rapid (next day) antidepressant effect in patients with major depression. Several medications are effective for treating depression; however, they take weeks or months to achieve their full effects. A more rapidly acting antidepressant would have a significant impact on the treatment of depression. In a previous study, ketamine produced a rapid antidepressant effect within hours, but the effect lasted less than 1 week. Understanding how ketamine works may lead to a better understanding of the causes of depression and the design of a longer lasting rapidly acting antidepressant.Patients between 18 and 65 years of age who are currently experiencing an episode of major depression of at least 4 weeks duration and have not responded to two treatment trials may be eligible for this study. Candidates are screened with a medical and psychiatric history, physical examination, and blood and urine tests.Participants undergo the following tests and procedures:Medication tapering: Patients who are taking medications for depression are tapered off the drugs over a 1- to 2-week period. Ketamine/placebo trial: Patients are given a single dose of either ketamine or placebo (an inactive substance), administered intravenously (through a vein) over 40 minutes. After 7 days, patients are given another dose of study drug in crossover fashion; that is, those who previously took ketamine are switched to receive placebo, and those who took placebo are switched to ketamine. Oximetry (measurement of blood oxygen), pulse, and blood pressure are measured continuously for 1 hour before and 4 hours after each ketamine or placebo dose to monitor safety. Interviews and rating scales: Patients complete a series of psychiatric rating scales to assess the effects of the study drug on mood and thinking. The rating scales are repeated up to 18 times during the study, with each time taking about 15 to 20 minutes. Physical examination and laboratory tests: Patients have a physical examination, blood tests, weight measure, and electrocardiogram (ECG) at the beginning and end of the study.
    Contacts and Locations

    Please refer to this study by its identifier: NCT00088699
    Overall Contact
    Carlos A Zarate, M.D.
    (301) 451-0861
    Overall Contact Backup
    Nancy Brutsche, R.N.
    (877) 646-3644

    National Institutes of Health Clinical Center, 9000 Rockville Pike
    Bethesda, Maryland United States
    Contact info
    For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)

    You can find more related to ketamine at patientslikeme as a whole there are pro med and pharma funded, but do have a good list of clinical trials, I am waiting for one to be available to me as my doc is skeptical, but one dose, I’d like to try link directly to that page (hopefully it wont make you log in

    you may delete this if you wish, but wanted you to have the info, most are done near maryland or NY but take a look, something may be nearby for you.
    Good luck. yeah the depression is more than likely causing the confusion, you put words together and understand more than I have been able to do lately. Former RN here also, slowly coming off my meds because for sure they are making me worse ! Good luck and take care


    • Thanks so much, Amanda. I hope you find some relief through that. If you would care to share your experiences here, that would be terrific.

      • aw I live to far away with no means of transportation and no on to go with, so I will just wait and see if it becomes semi mainstream, then I will go for it! If you happen to get in a trial let us know how it goes! For patientslikeme, a good view of brainwashed chemically imbalanced folk that can’t understand why they aren’t getting better and not open to listening to other views , was refreshing to find 1boring old man. Dr Healy and Mad in America, vindicated what I was
        feeling. Hope you feel a least a little better soon.

  4. The article you posted about the Japanese and their changing attitudes toward suicide was very interesting. I am not surprised that the person they equate with increased suicide is a ‘burnt out salaryman,’ given that one’s work is apparently central to a Japanese person’s identify and sense of self worth. Having been married to someone who is Asian (but not Japanese), I am also well aware of the concept of ‘face’ and of ‘saving face.’ It is, at least in my opinion, not an easy trick for psychiatrists, who practice Westernized medicine, to really understand how these concepts affect their patients and what actions they take (including committing suicide). However, it seems, with the increase in litigation, in Japan, that depression, and suicide, has become ‘medicalized’ and institutionalized, and the fixes that are provided for us will now be provided for them: meds, psychiatry, public benefits, and most of all, a removal of a traditional sense of ’embarassment,’ now that it can be said that they suffer from an illness. Not sure if I have all that right, but that’s how it appears to me. Ironic, though, in a country where suicide has traditionally been considered a positive, even honorable act. As a Westerner, although I understand the self-determination part of that, I would have trouble standing by without wanting to stop them.

  5. Good. Thanks. Keep your blog comming. As much as possible, contribute elsewhere. You write stuff folks need to see.

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