Money schmoney! And a tiny bit of good news.

Warning: what follows is not a glowing recommendation. However, no actual names are mentioned in this post, so I guess it doesn't matter.

My current medical insurance requires that, for the best possible benefit, I order my prescriptions through a mail-order pharmacy. I have had previous plans require this, and while it is not and never will be convenient, it generally works okay with plenty of planning and plotting. So much of having ulcerative colitis seems to revolve around planning and plotting (whether it be meals, pills, or the strategic locations of toilets) that I find it a bit easier than I would have, say, before my diagnosis.

Anyway, so I went to a brand-new gastro, Dr. C, down here in Texas. So far, she's fantastic: very thorough, very intent and open to discussing my current state of illness, and she wrote me some prescriptions just before I left with the husband for the Christmas holidays. I told her about the mail-order pharmacy - we'll call them, oh, how about Schmedco - and she said, All right, I'll write you one for the local pharmacy, and one three-month prescription* for the mail-order that you can put in later, when you run out.

This sounded great to me. So I folded up the three-month scripp and stashed it away for later, and took the one-month scripp to the nearby CVS. Let me point out here that the scripps were written identically APART from the supply amounts requested.

CVS filled the scripps. I got what I had asked Dr. C for: the 50 mg tablet version of azathioprine, and a 750 mg capsule of balsalazide disodium. It was amazing. We had a spontaneous song and dance number around the wine aisle, and then my sweetheart and I jumped in the car and headed up to Minnesota and family for the holidays.

Deedlie-doo to the future: A. and I returned, I started running low on meds, I dug out the three-month scripp, filled out the Schmedco paperwork and mailed it in.

A week or so later: I received the pills in big mailers.

"Yay!" I said.

Then I opened the mailers. My jugs of balsalazide were all present and accounted for, and I set them aside. Then I looked at the other bottle. The label said: Azathioprine (Azasan), 100 mg, take one pill daily!

"Darn!" I said. It was the wrong type of azathioprine. I normally took 2 per day of the 50 mg pills; but maybe I could check with Dr. C and take this instead. They were probably interchangeable, right? I mean, azathioprine is azathioprine, no matter how it's processed into tablet form. Right?

Then I looked at the bill.

"FUCK," I said.**

Yes, therein lies the difference! How silly of me not to have considered that the handy one-pill nature of generic Azasan would necessarily cost a nice thirty dollars more!

Now I can hear what you're saying. Thirty dollars? Bitch, thirty dollars? Just pay it. You've got money, right?

Well, no. I don't have much cash. AND THAT'S NOT THE POINT, ANYWAY.

What's the point? Well, I called Schmedco. The pharmacist I spoke to said a lot of things, but her main argument she kept returning to was, "The prescription is written for 100 mg a day."

"Yes," I said, "but couldn't that be interpreted in multiple ways? Technically I take 100 mg per day, I just take it in two pills rather than one."

AND, I added silently while giving the phone the finger (also silently, I think), if you get a prescription where there could be multiple interpretations, wouldn't it make sense to call the patient and check? Since you have ample ways to contact me? Especially when there's a considerable (to my poor ass) price difference? AND HEY, isn't it interesting that I had this filled using my Schmedco card at a local pharmacy, and they managed to interpret the scripp in the 2 - 50 mg/day, CHEAPER way? AND ISN'T IT FUCKING FASCINATING that since you have access to my Schmedco record with all of my Schmedco history, you could have accessed this information and seen that I had previously had a prescription filled this way?

"No," she replied. "I'm sorry, but that is the only way we will interpret a prescription written this way. That is the only way we can interpret it."

I choked then. And I said I would have Dr. C send a more specific prescription. And that's when she asked me if I took the azathioprine only occasionally, for flare ups. #%&@^!$%^!~

Flash forward to today! I got a new scripp faxed in by Dr. C, and I emailed Schmedo, asking them how I could return the unwanted medicine. Yes, laugh, laugh, all of you, at my sweet naivete. Here is their response:

To [Peppery]:

Thank you for your online inquiry. I apologize for any inconvenience
this may cause. Once a medication has been dispensed it cannot be
returned to stock to be re-dispensed. If returned, opened or
unopened, the medication will be destroyed. If you would like to send
this back for disposal you can do so, or you can contact one of our
[pharmacists] to find out how to dispose of the
medication yourself. Since this prescription was filled from a valid
prescription from your physician and was billed in accordance with
your plan, there will be no credit if the medication is returned.

[Fuck you very much],

[redacted]
Schmedco representative


So. I am pissed. Man, it's a good thing I have this blog so I can expose those bastards and make them pay for their evil!

-

In the interest of common sense, A. suggested I just pay for it and keep it on hand for emergencies. I asked if he meant the kind of emergency where I don't have that vital thirty dollars I needed to pay the cell phone bill, so I miss a call from that institution regarding a life-changing job interview and thus work at my pitiful library technician job for the rest of my days.

"Well, yeah," he said. And then he got me a cookie. What a nice husband.

-

In the department of Good News, I heard back about a librarian position. I've got an interview scheduled for next week. Wish me luck!








<sup>*In case you're lucky enough to be unfamiliar with mail-order pharmacies, the ones I've come into contact with work this way. For example, Schmedco offers you a prescription copay of say, $10 for a month's worth of a certain drug at a local pharmacy, and then they also offer you a copay of $20 for a three-month's supply of that same drug, provided you purchase it through their mail-order setup, which is based...somewhere. That's it.

**This was probably never intended to be a family blog. There's just too much shit everywhere. But this FUCK is pretty warranted.</sup>

If it smells like sh**, it's probably just your pills. As usual.

image credit

Parosmia. Have I written about parosmia yet? PAH ROAS MEEE AHHH. Well, y'all are in for a treat.

To set the malodorous stage: in the last few months of A's. and my life in Central New York, I scheduled two final appointments with my gastroenterologist. Now, as readers of this blog will know (at least, have attempted to know since my posting consistency is heartily unreliable) my CNY gastro and I, we've had issues. We've had miscommunications. We've had ambiguous discussions. But when it comes down to it, we ultimately had a decent, successful doctor-patient relationship. I kept my appointments (except when I'd forget. Sorry about that, doc) and the doc would listen to my symptoms or lack thereof, and he'd prescribe me what I needed and discuss other options if necessary.

In our second-to-last appointment, Doc helped me set up our final appointment. He gave me a list of things I should ask for on my final visit to his office, so that neither of us would forget, including: a copy of all my medical records, any prescriptions for medications,* and Final Thoughts.** He asked how I'd been feeling, and if anything had been going on lately.

"Well, I'm stressed out," I said. (This was in May, so it was pre-honeymoon, post-layoff, post-graduation, pre-wedding, and pre-move.) "But I'm not feeling it too badly." HAH. I wish Doc could've come to the wedding, he would've laughed at me and dispensed some serious steroids.

"There is something I'd like to talk to you about, but it's a little embarrassing."

He made a moue at me. Seriously, it was a moue. If anyone could be French-pouty and make a living in CNY without being a pretentious academic, it was this guy. And I have to acknowledge that "embarrassing" to a gastroenterologist has to be taken with a grain of salt. I'm sure he's seen his fair share of explosive diarrhea and lived to consult about it.

So, I told him about my latest weird dilemma. For the past year or two, I'd been smelling excrement in traditionally-excrement-free situations, such as A) my work office and B) my bedroom and C) the corner grocery store/pizza parlor. Now, given my disease and the fact that one of my then-coworkers suffered from Crohn's Disease (she also had recently had surgery and had a colostomy done), I was inclined to accept I might have reason to smell shit, at least at work. But that didn't explain the randomness of it, or the varied locations.

My dear husband pointed out that, when I told him about what I was smelling, it wasn't as though I had the most sweet-smelling ass around town before my diagnosis. For the record, his ass is not too peach-blossomy, either***, so I worried that it too was skewing my sense of smell. We worked out a system, and one night while we were doing the dishes, I smelled the fateful odor again and asked A. if he could smell it. He couldn't. He stopped making fart jokes that night.

Anyway, so I told my doc. He gave me a funny look, and then pulled out the Physician's Desk Reference.

"Might be a side effect."

We looked up azathioprine. Nothing unfamiliar there. Then he turned to balsalazide disodium (my horse pill, Colazal) and we checked out those side effects.

"Parosmia," he said. "Now what is that?"

Not the most comforting thing for your doctor to say. But it can always get worse: his next stop was WebMD to look up what parosmia meant. A quick check to WebMD today showed that the definition no longer exists there. This proves to me that you gotta fight fire with fire; so I give you WIKIPEDIA. Woooohoo, Internet!

"Parosmia, also known as troposmia, is an olfactory dysfunction that is characterized by the inability of the brain to properly identify an odor’s “natural” smell. [1] What happens instead is that the natural odor is transcribed into what is most often described as an unpleasant aroma, typically a “‘burned,’ ‘rotting,’ ‘fecal,’ or ‘chemical’ smell.”

WHOOP. Love that fecal smell in the morning!

Questionable referencing aside, it's still glorious to know that I'm not fulfilling some latent psychological need by smelling crap, and that it's an actual side effect of my medication. A rare one, but still a side effect that I can't control.

It still doesn't help with the fact that my kitchen smells like crap to me right now. Grrrrrr, parosmia! Actually, in this case, I hope it's the parosmia and not mouse crap, because given our current digs, the latter is definitely possible.

Have any of you fellow UC/Crohn's sufferers out there experienced or had issues with parosmia? It's not a glamorous side effect or disorder, I know, but it's there. Trust me, when I develop super-strength or invisibility or the power of flight due to my meds, I will share that information equally so you all can jump on the mutant pharmaceutical bandwagon.








<sup>*I forgot about these. But you know what? After moving down to Texas, I called his office and asked if they could possibly set me up with some prescriptions, since I could not get a doctor down here until December 1st w/o paying through the nose, and he okayed it. He really is a great guy. I'd like to promote him, but I think I'd have to do it anonymously on CCFA's website, because I've been so critical and snarky toward him on here.

Just know that when it counted, Doc came through for me.


** We didn't do these. Probably because I think that he thinks I have some mental issues. Eh, see above *, I'm willing to be charitable when a guy comes through for me when it counts. Thanks again, Doc


*** SO THERE. TAKE THAT. YEAH I STILL LOVE YOU HONEY.

.</sup>

Can you take my pills? Can you take my big horse pills?

Tumeric! Or Turmeric! Either way, this Yellow Dusty Spice will soon be coming to an intestine near you! (and by you I do mean YOU -insert pointy finger graphic here followed by highfalutin diet advice that no one with a hearty chocolate addiction would deign to follow, much less read past the first "Sure, you can eat _____! In moderation-" and I mean me, of course.)

I would be interested to try this, but as I'm in remission and have been for over two years, I don't think I will wholeheartedly. It's hard to be open to new treatments when you can go to the bathroom and afterwards scream in abject, delirious happiness,
"Honey! Come look! It has shape, and density!" In fact, apart from the potentially mind-numbing side effects, I enjoy taking pills. According to my mom, when I was little I'd divvy up fruit snacks into different doses, take them all at once and make terribly solemn faces about my illness.

(Damn you, Genes. Is this how you get your kicks, or was this an early warning system, telling me that fruit would be a fickle friend in the future?)

My sidekick drug is Colazal. It is a sidekick in every sense. When taken alone, it does absolutely nothing for my gut; the big bad immune system ties it to a chair and dangles it off a skyscraper, waiting for the real shit* to show up. It is also the biggest pill, and doesn't quite know what to do with itself if Imuran dawdles. Unfortunately it does enough punching and kicking to help in the alley fight, so I notice if I forget to take it along. It comes in a giant bag (one that pharmacy workers can never find until I slip them some cash for their trouble) because of my 3-3xday dosing schedule. It's all about size, not stamina, with Colazal.

It also likes to melt in the heat of my hand. Like M&Ms, except disgusting and greasy and not chocolatey at all.

But it lets me eat chocolate on a regular basis, which is good for my stress-free lifestyle. If turmeric can offer a similar compromise, we might be in business.

If not, well, suck it up, liver.



*All off-color puns in this blog are purely unintentional and are sponsored by Baritop.