Desolation of Dragons

1) My PCP feels that I do not have thyroid cancer. Hooray. He also feels, given that my thyroid function is falling off the cliff, that I should be taking a thyroid hormone, levothyroxine, to replace what it was supposed to be doing for me. Today I started on it.

Iiiiiiii don't think I can be compliant with this. It has to be taken on an empty stomach, with no food in the four hours before and no food or drinks except water in the hour after. Consequently, most people take it on waking and then have to wait before eating or, more crucially, drinking coffee. And you're supposed to take it with a big glass of water. And, no, you can't take it with other medications. In general. And something like half my specific medications (and supplements) have interactions with it.

My doctor said I only have to wait a half hour after taking it to have coffee with milk and sugar, but could take it with black coffee, which is absolutely not what reputable sources on the internet say. See this discussion of "Altered Intestinal Absorption of L-Thyroxine Caused by Coffee" [2008, Thyroid, S Benvenga, L Bartolone, et al] which found (N=8) black coffee reduces the effective dose up to ~50%, and is the basis of the standard recommendation to wait at least an hour after taking the levothyroxine.

But even if I only wait a half hour, I really don't have a spare half hour in my schedule to add to my wake up routine so I can continue to have my coffee and morning meds at an adequate time to get to work on time. And I forgot that drinking water on an empty stomach gives me a stomach ache. And sitting around for a half and hour after I wake up, woozy with a stomach ache waiting to be able to take my wake-up pills (or any NSAIDs for pain) and have my delicious, comforting cup of coffee (which Mr. Bostoniensis has been bringing me in bed) is even more miserable than it seemed in prospect.

The internet tells me there's an alternative, Tirosint, which can be taken with coffee and food, though not with all meds. It's allegedly more expensive, but apparently not that much more expensive, and I would argue I have medical justification.

Weirdly, there's a lot of advice not to take it within 4 hours of taking iron supplements, but none of that advice mentioned multivitamins, which is where I get my supplemental iron, nor using cast-iron cookware, which is how lots of people get their supplemental iron.

2) I checked my email before I was going to settle in to write, and discovered I was the victim of credit card fraud and maybe identity theft. Somebody ordered a ~$12,000 balance transfer from my personal credit card, so I got to spend the afternoon on the phone with my credit card company cleaning that up.

I've heard people say bad things about Elan, but I've only had really good experiences with them. Especially when dealing with problems. There's been times their customer service has dipped down to merely perfectly adequate, but mostly it's been legit fantastic.

They were able to tell me the fraud was perpetrated by someone calling in and representing to be me. So the perp doesn't have my online password. I said, "So they had my SSN?" (because authenticating on the phone typically requires the last four of the SSN) and she said no, not necessarily, there's other ways to authenticate. Which: hmmm.

She's canceled my card and is sending a fresh one. I'll get to spend however long updating all the places I store it online. I also await a call from the fraud department.

This is the card I had as the payment form of record with my life insurance when it was compromised, so that might be where it got got.

3) The biopsy I am getting in November comes in two options. It can be done as an office procedure without anaesthesia, or you can have it done in the hospital under anaesthesia, where while they have you under, the gynecologist can do a more thorough assessment and maybe remove obviously cancerous bits if they present on inspection.

My gynecologist was upfront about this: the office version is much cheaper. I asked her, given I had awesome insurance, what, if price is no object, she would recommend on clinical grounds, and she promptly said the hospital version, observing she would be able to do a more thorough job and also having anaethesia would be much nicer for me. I said I would lean towards the anaesthesia version, but would need to know how much more expensive it was.

Well, I got the estimate today. The nice estimate office – whose vmail has been full for a while and whom I ratted out to the billing deparment – finally got back to me. My share, according to what they could tell of my insurance, is estimated to be about $1,300. I can do that. It is 2x what she said the office procedure is, but it's way less than the $3,500 presently between me and my out-of-pocket-max which I was emotionally bracing to pay. And it seems worth it to me to do it under anaesthesia, if only because of my back.

Also, the total amount estimated to be billed to my insurance is the eye-watering $17,000.

Maybe more if the procedure runs long. If I understand correctly, the anaesthesiologist is paid by the 15 minutes.

The worst-case estimates I found online said $12,000. I'm kinda glad I asked, just from a morbid curiosity standpoint.

Like I said, the estimate is that I only wind up paying about 10% ($1,300) or so of that. Since my co-insurance is 20% and I'm not going to meet my OOPM, I assume that means that on average the allowed was half what they intend to bill.