Medical

Or, "My love-hate relationship with Zyrtec-D, Part 58".

Today I had my quarterly visit to the allergist. He is a real patient advocate and makes it a point to remember all kinds of things. For example, he actually has Jacob's birthdate memorized! And once when I was having trouble getting into another specialist, he called up a friend and got me in the next day! Because of all this, he is a stickler for detail and I think that he would be very difficult to work for. But, I'm sure glad he's my doctor!

He started me on a new nose spray. I noticed it working about 30 minutes after the first use! And I learned that I'm using the wrong type of OTC eye drops. I am NOT supposed to be using the eye drops for allergies or redness. (I am supposed to use a plain, lubricating eye drop.) Who woulda thunk it?

I shared a condensed version of all my issues with Zyrtec-D. Then he shared a little rant about the evils of insurance companies. THEN he personally called my pharmacy while I was there and fixed one of my largest issues. He gave me a script for Zyrtec-D and the pharmacy promised to give me a 30 day supply at one time, assuming they actually had Zyrtec-D in stock.

(My pharmacy says either the demand is much higher than anyone forecasted or Zyrtec-D is being purposefully undersupplied by the manufacturer. Either way, pharmacies aren't guaranteed to receive the quantity of Zyrtec-D that they order. What a nightmare!)

Yea to the doctor and the pharmacy! Now, if only he could fix the supply problem and the horrid packaging!

I have found another reason to be irritated with Zyrtec-D! The packaging. Each pill is in an individual plastic thing that appears to be designed for handing out samples from a doctor. You have to bend and tear the plastic in just the right way, then push the pill out of the foil seal. After doing this 14 times to fill up a week's worth of pill box, my hand and fingers are in pain. And, the extreme packaging waste leaves me feeling like I'm killing our environment, one pill at a time.

Why can't Zyrtec-D be in a regular pill bottle like the plain Zyrtec?

Also, now I read that the Kansas legislature wants to enact a law that would require a prescription for OTC drugs containing drugs containing pseudoephedrine. What a mess!

I've had a sinus infection for 4 days now. This isn't good because I have been on antibiotics for 8 days. I don't think that you're supposed to develop an infection while on antibiotics!

Thanks to the wonderfullness of allergy shots, I haven't had many sinus infections in recent years. I had forgotten just how bad they could get. This morning I got to experience feeling dizzy while lying down and sharp pain in all my upper teeth. Those symptoms almost made me forget to notice the nasty taste of the green post-nasal drip. Almost.

So, I called the doctor's office. The nurse answered the phone after just two rings and was pleasant. I am so grateful for nice office staff! She called me back about an hour later to let me know that a Z-Pack script had already been faxed to my pharmacy.

I could hardly contain my excitement. "Really? The Z-Pack!?!"

The nurse: "Yes, is that okay?"

Me, regaining composure: "Um, yeah. Thanks for your help."

I love the Z-Pack. I know it has been overprescribed, but it has been at least 2 years since I've had one. Picking up the script was like being reunited with an old friend. I know my reaction is a little over-the-top, but does the Z-Pack ever work! You don't have to mess with taking something three times a day and you're pretty much guaranteed to feel better within 24 hours. What a wonderful medication!

(Jacob illness update: He is now on week #5 of an ear infection, and also has pink eye and a sinus infection. True to form, he's still as happy, busy, and personable as ever!)

On Friday Jacob woke up from his nap and felt extremely hot. I took his temp - 102.3F. That's hot! But, in my memory, 105F was when you should panic. (Did I read this somewhere? I have no idea!) After Jacob sat perfectly still staring into space for 30 minutes, I decided to panic. I counted his respiration rate (13-14 breaths every 15 seconds) and tried to get a pulse (no luck, but I could see the vein in his neck pulsating).

I emailed John who nicely asked why I was wasting time contacting him instead of the doctor. Um, I don't know! I called the doctor's office and of course had to leave a voice mail. I also left a voice mail for Jacob's favorite pediatric nurse practitioner (aka Grandma). The doctor's office called back and told me to go to the ER because 1) it would be after 5 until I could get to their office and 2) Jacob's breathing was faster than you want to see in a 17-month-old.

Let me stop here to say that I've been lurking on too many medical blogs. One of my favorites is written by an ER doc. Now I'm afraid of being that patient who shows up and doesn't really need to be there.

I get to the ER and my least favorite ER doc is working. Great. We'll probably get a diagnosis of "fussy" and be sent home, which recently happened to Jacob's sick friend. (How exactly do you code "fussy", anyway?) Just the thought of dealing with this doctor almost gave me a panic attack.

The registration person talked to me for about two minutes and then called back to the nurses desk, "I have a 17 month old who is lethargic and in respiratory distress!" The nurse comes rushing out and looks around, obviously trying to find such a child, and looks questioningly at the registration person. "(motioning toward Jacob) Well, I wasn't sure how to describe him." "Hyperventilating. Well, bring him on back."

Jacob had a temp of 104F and a heart rate of 210. He got a big dose of ibuprofen from the nice triage nurse and was sent back out to the waiting room since all the exam rooms were full. This gave me plenty of time to encourage myself that I could tell this doctor that he was an idiot and demand that they contact the peds doc on call.

We must have been there over a shift change. Or maybe Dr Idiot remembered my name from the complaint letter we sent his boss after our encounter 4 years ago and he decided to make us wait until the shift change. Either way, we got another doctor who was polite and attempted to establish rapport with Jacob. Her diagnoses was a double ear infection. I think he probably also had a virus, but hey, Jacob was significantly better when we left the er 3 hours after arriving, so I wasn't going to argue. It's not like they could do anything for a virus anyway.

Due to my blog lurking, I had a better understanding of what the staff was experiencing and that helped me have a better experience than I would have otherwise. They had one patient with an overdose that slowed things down for a while. But, most of the staff were sympathetic to me having this toddler to pacify and several people apologized for the long wait. They happily gave him snacks, and the receptionist gave him a match box car when we left.

At one point when Jacob started feeling better, he started screaming extremely loud. I really loved over hearing this conversation: Person 1: "Ugh, he keeps crying. Why won't he be quiet?" Person 2: (in a very condescending tone) "He's sick. That's why they're in the EMERGENCY ROOM."

I also loved that the hospital data base had an employer listed for Jacob. The receptionist said, "Wow, Jacob! You must be very smart!"

Jacob continued to run a low grade fever all weekend, but he's doing much better.

Today was a big day – my first time purchasing Zyrtec-D OTC. After writing my last Zyrtec post, I thought that I was all done complaining. I thought wrong.

Regular Zyrtec is available off the shelf. Because of all the idiots making meth, Zyrtec-D is kept behind the pharmacy counter. You have to ask the pharmacist for Zyrtec-D. After they enter your driver’s license number into a data base, then they’ll let you have ONE box of Zyrtec-D. That’s a 12 day supply for one person. Since two people in my house take Zyrtec-D, this one box was really like a 6 day supply. I asked for a second box, and the cashier tried to sell it to me, but apparently the computer refused the sale.

Am I supposed to go back to the pharmacy every SIX DAYS to buy more?

I know that the cashier was trying to be nice and that there are good reasons to limit availably of meth ingredients. But, I really wanted to ask if I could have more if I brought in notes from my allergist and dentist. I did manage to behave myself, since I didn't want to raise any false suspicions about my actual Zyrtec-D usage goals.

Now Zyrtec-D OTC is not only more expensive in dollars than the prescription form, it’s also extremely more expensive in terms of my time. As soon as I figure out who to complain to, I'll be writing a few letters.

I wrote this a couple of weeks ago. Somehow in between caring for a sick son and a sick husband, I forgot to post it...

Three weeks ago I saw a sign in WalMart that said, "Zyrtec Coming Soon!" I thought that was odd. Surely the pharmacy had been able to fill Zyrtec for a long time, since it has been on the market for many years? I didn't dwell on it and continued on my way.

Also three weeks ago, I asked my PCP for a refill for my Zyrtec-D prescription. She provided one, no problem.

Two weeks ago I received two letters in the mail on the same day. One from my insurance company and one from my mail order pharmacy company - both informing me that Zyrtec-D is now available over the counter and my insurance will stop covering it starting February 1.

"Well golly gee, " I thought. Actually, no, that's the complete opposite of what I thought. How is it that I see so many medical professionals on a regular basis and know so many medical professionals very well, and I had no idea that Zyrtec OTC was looming on the horizon? I asked a couple of friends about this. They had assumed that surely I knew since I generally am a well informed consumer of health care. A logical assumption.

Next I went back to WalMart to see if they had Zyrtec in stock and hoping that the cost of this new version would be cheaper than my prescription costs. WalMart was out of stock of Zyrtec-D OTC and the equivalent store brand. I did learn that the store brand cost of Zyrtec-D OTC is $19.95 for 24 pills. 24 pills = 12 days.

I did some quick math. The price I paid for Zyrtec-D prescription was $99.79 for a 90 day supply. $20 for 12 days versus $100 for 90 days. Great. An extra $50 every 90 days. For both John and me. We already pay about $200 per month for prescriptions, so this price increase for an over the counter medication feels defeating. That one-time $5 off coupon from the insurance company just isn't going to offset the increase in price!

I held off buying the new OTC, hoping that I would get a last filling of Zyrtec-D prescription from the mail order pharmacy. Today I received a package from the pharmacy. They had filled two other scripts, but there was not even a mention of my Zyrtec-D script.

added today: The pharmacy did eventually mail back my now-useless script. Next week John has an appointment with the allergist. I wonder what he'll say?

I’ve been feeling tired. I assumed it was because I get up in the middle of every night to nurse Jacob.

About two weeks ago I noticed that I was getting big circles under my eyes. Then there were racing thoughts keeping me up, though I was exhausted. I assumed that was stress about our impending move.

I haven’t been feeling very hungry. I assumed that was because Jacob often interrupts my meals and that I’ve been snacking on Christmas candy.

This morning I realized that I have been taking the wrong dose of Synthroid for two months. Oh! I even have a script for the correct dose that is dated 11/2006. OH!!! (a light goes on) Guess I’ll get that filled this afternoon. And I’ll assume that I’ll be feeling much better in 3 weeks.