Tag: Navy (Page 40 of 45)

The ExpressScripts Libre 3 CGM Saga Continues

Bright and early this morning, almost at 0800, I received a direct real person phone call from a pharmacist at ExpressScripts. He attempted to explain why the script for a Libre 3 Continuous Glucose Monitor from my GP was not being filled by them. The reason he stated, was that ExpressScripts does not yet carry the Libre 3; they could however fill a script for a Libre2. Hummmm?

I attempted to relate that I received a letter from ExpressScripts stating that the reason they refused to fill the order was that my GP was just that, a GP and not a diabetic specialist. He apologized and stated that was not correct. When I told him I was buying Libre 3s directly from an online supplier, not a problem but at an out-of-pocket cost of over $200 per month he essentially wished me luck.

Keep what’s going on here in perspective. ExpressScripts’ contract with the government started in January 2023 and runs through 2029. It has value in the billions of dollars and serves over 9.6 million active-duty service members, their family members, and retirees.

It would appear we’re in deep kimchi!

CGM & Tricare-ExpressScripts: Their Rationale

Yesterday I received a letter (included at bottom of this blog as a PDF) whose logic totally escapes me. My request for Tricare to provide me with CGMs to aid in the treatment of my diabetes was turned down BECAUSE the script came from my GP, not an endocrinologist or diabetes management expert. Seems that they maintain that such people are “experienced in the management of insulin-dependent diabetics…and familiar with the operation and reports necessary for proper management of continuous glucose monitoring systems.”

The logic in this approach is totally counter to the PR the manufacturer, Abbott advertises as to how simple the CGM is to deploy and use. What operation and reports are they speaking of?

This appears to me to be just another instance of bureaucratic BS hiding behind obfuscation.

ES & Cycler Saga Continues

Over the weekend I received a couple of robo-calls from ExpressScripts. Recall I am having a go at them attempting to have Continuour Glucose Monitors covered. The calls asked me if I wanted to continue to wait on my doctor to get back to them on some unnamed prescription which I assume to be CGMs. Same set of scripts they told my GP rep they would not cover? What is the logic in this?

Second continuing sage is that for the last 12 days, I have had exactly five nights without any alarms. Recall this is after Fresenius tech support told me to solve the problem of nightly alarms on their Liberty Cycler to shut them off which I did. So much for their wisdom when 58% of the time I’m still experiencing alarms.

How would you like to have to get up out of bed with a line sticking out of your gut to assuage an incessant screaming of an alarm?

ExpressScripts Saga Continues

Yesterday was an eventful day for me, but not in a good way. Started at the breakfast table with a call from ExpressScripts (recall my military-provided pharmacy) stating that they needed to talk to my GP about two related items concerning my recent request for the Libre 3 CGM to help with my diabetic control. First, they had to confirm that no drug interaction was present. How a device that measures glucose interacts with medication is beyond my Ph.D. understanding. Second, they wanted to confirm insurance coverage. Get this: ES, which administers the military’s pharmacy program, wanted to know if the government’s pharmacy program (Tricare for Life) covered CGMs. This also escapes any logic known to humans.

So I called my GP and explained the situation to them, and they assured me they would contact ES and resolve the problem. I left home and traveled about an hour north to where our son is building an ICF (Integrated Concrete Form) home to help him install temporary electrical service in the basement/ground floor of the building where they will live until the upper stories are completed. We went to Mineral Wells, TX, for a TexMex lunch, during which I received another RoboCall from ES. This time ES stated that they had not received any contact from my GP, and if they did not hear back by the end of the business day, they would unilaterally cancel the CGM script.

I went back to calling my GP’s office, where luckily, I got hold of the nurse who had been handling my requests previously. We reviewed all past conversations with her office, by now at least five, and again she assured me she would contact ES and resolve the matter and get back to me.

Get back to me she did with the news that the ES insurance would not cover CGMs for me. So here I am, a 100%+++ retired USN Naval Officer who served at the pleasure of the President of the United States and, while doing was subjected to Agent Orange and, as a result, is on Dialysis. They denied coverage for a CGM to aid in the exact diabetes that they, the US Government, were directly instrumental in subjected me to conditions where the probability of becoming diabetic was greatly exacerbated.

The “logic” of all of this escapes me. I’ll cool my jets and see what is under the next rock. Meanwhile, my GP will contact CVS to ascertain if they will accept Tricare coverage for CGMs for me. Stay tuned. I’m certain the saga will continue.

Doctor and Pharmacy Frustrations Continue

The purpose of this blog is to vent my frustration with the medical community and its support group, pharmacies.

Since late March, I have been trying to get a prescription for the Freestyle Libre 3 filled by the pharmacy required to be used by my insurance company, ExpressScripts. As you know from the lead to this blog, I am a retired Naval Officer and ExpressScripts (ES) is our “pharmacy.”

In good faith, my GP honored my request and sent a script in to ES. ES acknowledged receipt of the script, and within a day or so, my tracking app on my phone informed me that something called prior authorization was required, and they had contacted my prescribing MD. A couple of days later, the app informed me that all was good and they were “Working” on filling the script. Then I was informed that everything was canceled. I called ES and was informed that everything was on track and shipping would occur by 4/14/23. Then my app informed me that everything had been canceled. On 4/11/23, I again called ES and was informed that my GP had been faxed a “Critical Criteria” form to fill out and submit, and had not done so in the few days ES allocated, so the script had been unilaterally canceled by ES. Called the GP’s office, and of course, they had not received and/or were unaware of this Critical Criteria form.

The Libre3 lasts for but 14 days. Usually, a script for a year is prescribed for pills, with three months’ worth, or in this case, 6 Libre3 is delivered once every three months. Instead, my out-of-pocket would be every two weeks instead of the same cost for a three-month supply. Another screwup.

Another unsatisfactory situation with ES is their two-factor authentication process. They require a username and password to log in, then send back a six-digit number via email for the second authentication. Sounds good in theory, except the 15-minute timer on completing the second step often times out before receipt of the code. Regardless, who has time to stare at a screen waiting seemingly forever for a stupid code?

Yet another hindrance to goodwill is having to talk to a stupid computer when you call ES. Trying to bust out of the Ai’s scripting is daunting. I’m certain management is patting themselves for all the money they’re saving on CS calls, but they should get on the other end of the phone call and experience how frustrating it is when your call does not meet their canned expectations. Bummer!

As I write this, I await a call from the GP to resolve this dilemma.

Update. No callback. Called the GP script person again, and we agreed that she would send in a new script to ES for a year’s supply of Libre 3 every three months. That’s the latest. Stand by as the saga continues.

Phone Call from Fresenius Corporate?

Yesterday afternoon at 1:34 PM CDT, I received a call from a 781-699-5405 number. Area code maps to Boston. A Google search on the number resulted in Fresenius numbers. Their corporate office in Waltham, MA, is 781-699-9000. The female voice on the other end of the call inquired about the “dialysis problems” I was having, and the thrust of her call seemed to be whether I could complete my nightly dialysis treatment. I attempted to fill her in on what has been happening, and her response was had I discussed the matter with my dialysis nurse?

This is insulting! I assured her I had discussed the matter with my entire team and anyone else who would stand still long enough for me to relate, including our Golden Retriever Dickens. She was disinterested in anything else, which was obvious when I attempted to explain my interfaces with tech support. All the call managed to do was piss me off!

How did someone from Corporate know that I have been having severe problems with drains on their Liberty Cycler – and I’m NOT the only one! While I have blogged about it, anyone with a slight amount of brain cells from reading the blog would know the full history of my drain problems. If corporate had troubled themselves to reach out to my local Fresenius facility (if they can find me, they could find them), they would have received an in-depth briefing. I have exchanged emails with corporate about the new cycler, and believe I included my contact info therein. Perhaps this is the source of the phone call?

Whatever it is, a phone call out of the blue from corporate that even hinted I have not been in close contact with my local Fresenius Dialysis Team on this, and ANY aspect of my treatment is an insult to both the people who support my treatment and me. I’m so close to the team, that they even know the color of the skivvies I wear.

Nine Phrases to Inhance Your Dialysis Marriage/Relationships

On March 19, 2023, I wrote a blog titled “Impact of dialysis on marriage: Does dialysis correlate with divorce?”My research found at least five areas directly impact marriage+dialysis; 2. Emotional Impact and 5. Intimacy & sexual health. Anything we can do and/or embrace for improvements in these two areas should/could lead to a more optimum dialysis experience – without the expenditure of much time and/or money on our part in this instance.

-I recently read an interesting article by Dr. Cortney Warren “If you use any of these 9 phrases every day, ‘your relationship is more successful’ than most” Dr. Cortney S. Warren, PhD, is a board-certified psychologist and author of “Letting Go of Your Ex.” She specializes in marriages, love addiction, and breakups, and received her clinical training at Harvard Medical School. She has written almost 50 peer-reviewed journal articles and delivered more than 75 presentations on the psychology of relationships. Follow her on Twitter @DrCortneyWarren, according to the article which is linked here.                                       

It is so important that readers of this blog can take on the full impact of Dr. Warren’s wisdom, that I am including verbatim the bulk of the text from the article for your edification. From here on in the blog is a direct quote from the article by Dr. Warren linked above. The lead graphic is also from the article for full attribution. These are the nine phrases to incorporate into your daily interfaces with your partner.

1. “I appreciate your effort.”

It’s tempting to become overly focused on things you don’t like about your partner and to point them out at every chance you get.

But it’s important to highlight the good in their actions. Happy couples express gratitude for each other’s efforts. It’s a great way to make everyone feel valued.

Similar phrases: 

  • “I appreciate that you work so hard to support our family.”
  • “I’m grateful you take the kids to school because it helps me get things done in the morning.”

2. “I like you.”

The healthiest couples don’t just love each other, they like each other, too. Loving someone is an intense feeling of affection; liking is about seeing them for who they are and acknowledging the attributes you enjoy about them.

Similar phrases:

  • “I like that you are so passionate about staying healthy.”
  • “I like how devoted you are to your hobbies.”

3. “Help me better understand this.”

We all have different upbringings, vulnerabilities, values, and beliefs that shape how we think relationships should work.

If your partner reacts to a situation in a way you don’t understand, telling them that you want to know them better is key to resolving conflict and bonding at a deeper level.

Similar phrases: 

  • “I don’t know why this is so upsetting to you. Please help me see your perspective.”
  • “I want to work through this together, and I need to understand you better to do that.”

4. “I’m listening…”

Disagreements are inevitable, but it’s important to still support each other through active listening.

You have to be willing to suspend your desire to be “right” or to get your point across — long enough to hear and empathize with your partner’s perspective.

Similar phrases: 

  • “I’ll stop talking now and really try to listen to your point of view.”
  • “I want to hear your side of things, even if we ultimately disagree.”

5. “I’m sorry.”

When things don’t go right or as planned, healthy couples know that both partners play a part in the situation.

Taking responsibility for our role in those conflicts — and genuinely apologizing — is critical to repairing rifts.

Similar phrases: 

  • “I didn’t communicate my feelings in a respectful way to you, and I’m sorry for that.”
  • “I didn’t like the way you acted last night, but I also need to apologize for lashing out.”

6. “I forgive you. Can you forgive me?”

Forgiveness is hard. It requires being vulnerable, letting go of something that caused you pain, and changing your feelings toward your partner.

But studies have shown that couples who practice forgiveness are more likely to enjoy longer, more satisfying relationships. 

Similar phrases: 

  • “I know we can’t change the past, so I’m actively trying to let it go and move forward.”
  • “I made a mistake and I’m trying to forgive myself. I hope you can forgive me, too.”

7. “I am committed to you.”

Being in a relationship is a choice. Reassuring your partner that you’re still choosing to be with them and to work through challenges will help create a sense of safety and stability.

Similar phrases:

  • “Even when times are tough, I still choose to be with you.”
  • “I’m here, and I want to make this work with you. We’re a team.”

8. “Let’s have some fun!”

If you can find humor (or playfully tease each other) during tense moments, your relationship might be stronger than you think.

The happiest couples are able to break tension and recalibrate the mood by finding room for an authentic smile, silly banter or a lighthearted joke.

Similar phrases: 

  • “We should get some fresh air. Want to do something fun today?”
  • “I know I’m a lot sometimes. Let’s take a breather from the tough topics and watch a comedy.”

9. “I love you.”

This one is simple but always worth reminding. Verbally expressing your romantic love for one another keeps the relationship alive. And when you say it, make sure you truly mean it.

Recent Lab Results from Fresenius re Dialysis

The past week I had my monthly and quarterly meeting with my Dialysis Nurse. I collected a 24-hour urine sample – yes, still making some yellow fluid, and four collection bags for discharge from the Cycler wherein only 2.5 solutions were used. All the typical attributes of my dialysis health were checked – she listened to my heart, inspected my feet – some swelling, drew a blood sample, injected me with iron, and asked me a battery of questions, plus provided me with the Fresenius monthly educational packet. Took about 30 minutes and after collecting the bag of replacement dialysis support items provided by Fresenius – tape, and soap this cycle, I was on my way. As usual, the following day preliminary lab results were available via the Fresenius Patient Hub, and the following day detailed lab results were available. My detailed lab results in PDF format are available below for your download and/or viewing.

There is no concise or easy way to present a graphical representation of some of the lab results. I’m going to list 11 results followed by a screen capture of the same from the PatientHub. You can cycle down and visually ascertain what’s going on. I am not upset by any results. I would like to explain what’s going on with A1c. I started gaining weight and as I result I noticed via my CGM that my morning glucose reading was rising, not bad, in the 120+ range, but still up from my normal 90-110 range. I know that I am extremely sensitive to weight gain from a diabetic control perspective. I increased my Lantus by one unit to 9 from 8 as a result. This brought my morning/fasting glucose back down – it was 94 this morning and explains the full one-point drop in A1c.

Second comment, my Creatinine at 6.60 is up from 6.27 in the last lab. Inputting age=84, Gender=M into my eGFR app yielded an eGFR of 8 which it has consistently been over many months. You can refer back to the eGFR graphical analysis I blogged about a couple of days ago for an additional check.

Last comment: Note that my Hemoglobin at 11.6 continues to be high from the stated goal of 10-11. I would think that more red blood cells are good but intend to discuss this with my nephrologist meeting scheduled for later this week. BTW, Fresenius provided me with a full box of high protein bars at my lab meetup also. Thanks to them for this.

User Input Fresenius Cycler and Business Model Improvement

Fresenius hosts a Patient’s Hub through which many aspects of Dialysis support are provided. Examples are the ability to order supplies monthly, daily input dialysis info from the night before, and a forum for supported members to post and respond to other inputs from fellow dialysis patients. Recently, a rlbecker posted what is quoted below. After this input, I included a few of my own. These are inputs to improve the Fresenius experience from a user’s perspective.

rlbecker asked a question.                                                                                              

April 4, 2023 at 11:23 AM

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I am a newbie. Only on PD for 4 months. But I have some thoughts on potential improvement of the experience which are in the details below.

1. Catheter insertion.

If we need an x-ray to see where the catheter is, something is broken. The surgeon knows where it is placed right after the surgery. In addition to saying “everything went well” and prescribing pain medications afterwards, he/she should show on a diagram the angle of the catheter and the depth of the insertion. Even better, the surgeon should ask the patient how he/she sleeps (back, side, stomach) before the surgery, to guide the process for the best outcome.

2. Modem power.

The cycler cord is 10 feet long, but the cord on the modem is a couple feet less. This makes it difficult to manage the cords from the cycler to the wall. If both were the same length, one could tape the cords together to make a less cumbersome attachment. Even better, just like amplifiers, tuners, etc., the cycler could provide a through power outlet on the back for plugging in the modem (which could have a very short cord), eliminating one cord from the cycler to the wall.

3. Display on the cycler.

At this point, you have two options: always on; and on for x minutes, then off. There are times when you just want to see where things are in the process, so you tap on the display to see, and are then burdened with an additional period of light in the darkness of the bedroom. Since the sensors are already there and programmable, why not treat the light like the infamous “clapper” from TV ads: one tap to turn the light on, two taps to turn it back off?

4. Treatment complete.

When treatment is complete, why not turn on the light with that screen showing? One should not have to wonder whether or not the cycler has done its thing and you can get up and do the aseptic disconnection.

5. Helpful chart for new patients.

Setting up can seem a little daunting in the beginning. I am suggesting a chart to help demystify the process. On the chart, columns would be: display, time, you must do, and you can do. Rows will contain the displays that appear on the cycler as you go from step to step. As the cycler is going through its various setup steps, you could see what you can do in parallel and how much time you have to do that before the cycler will be ready for you to review and press next. This could shorten the time required to set up the cycler in the beginning while one is learning.

End Quote:

Hank’s comments follow:

H1: Several technology companies have virtual assistants that are now ingrained into users’ fabric. Apple has Siri. Google has Google Assistant. Amazon has Alexa. Fresenius should incorporate technology into the Cycler so that patients can query the Cycler while at a distance and/or in bed. For example, they could inquire how many more minutes the cycler has on dwell, drain, or where in the total treatment. Instead of getting up to quell a drain alarm, they could reset it from bed and, in response, reposition their bodies, etc. They could verbally enter parameters into the Cycler upon completion of dialysis instead of getting down on their knees to enter the same digitally – the old fashion way, BTW.

H2: Excessive non-recyclable debris must be disposed of after a Dialysis course. There are the boxes in which the dialysate is delivered. There are plastic wrappers from dialysate bags and the bags themselves. There is the cassette to be disposed of. And more odds and ends.  This adds up to a 64 Galleon trash can just about filled every week. Certainly, German engineers can do better than this.

H3: Why do we even have an external modem at all? Most newer appliances are connected to the IOT (Internet of Things), including television sets. Using current technology, all of the hardware to gather data should be housed within the cycler.

H4: And speaking of data gathering, why, if I am inputting data into the Cycler every morning after my dialysis? There is a USB Thumb Drive that is also gathering data that I am required to “Sneaker Net” to my monthly meeting with my Dialysis Nurse. Why, when I call Tech support, do I have to go through countless screens of data and verbally provide the same to tech support before they even attempt to address the problem(s) that initiated my call? Shouldn’t such data already be in the system via the modem?

H5: My initial loadout of dialysate in no way matched the initial prescription my Nephrologist ordered. So I’m stuck with thirty-plus boxes of 2.5 dialysates that I have to eliminate since Fresenius has a policy of not accepting boxes of dialysate to return once they pass the patient’s portal.

Fresenius Cycler, Sleep Interruption and Secondary Aliments

There is an article in the 4/3/2023 issue of CNN Health by Madeline Holcombe titled “These 5 rules for good sleep may also impact the development of asthma, experts say.” “Bad sleep quality and quantity may put you at greater risk for developing asthma, according to a new study” the study concludes. It is linked here: The picture above is from the cited article.

That got me thinking about what other ailments might be lurking in the background related to lack of sleep caused by the Fresenius Cycler Drain Alarms for which Fresenius may be found to be culpable. This line of thinking springs from my dealings with the Veteran Administration and Agent Orange. In my instance, a primary prima facia fact is that I served boots on the ground in Vietnam. Given so, I was exposed to Agent Orange. I subsequently developed Type II diabetes which became my primary ailment from such exposure. As documented herein, up to 40% or more diabetes patients become Dialysis patients. Dialysis is secondary to diabetes in the VA way of thinking. The same logic probably follows herein, but I am NOT (thank God) a lawyer!

So we have the Fresenius Liberty Cycler interrupting sleep (Primary) and “causing” what possible other “secondary” ailments among Peritoneal Dialysis patients?

So doing what I am trained to do, I asked my able AI for assistance in this manner, in this case, openai.com’s GPT-3.5. The Prompt I used is listed below, followed by the AI output I edited and a few short conclusion comments.

Prompt: It is a well-established fact from users that the Fresenius Liberty Cycler interrupts sleep because of alarms on the drain cycle. Interruption of sleep can lead to a lack of sleep on the part of the dialysis patient. A recent article in CNN suggested that lack of sleep can lead to asthma. What other ailments could be secondary to lack sleep possibly caused by drain alarms on the Liberty Cycler?

Many potential health problems can result from a lack of sleep caused by interruptions, such as those caused by the alarms on the Fresenius Liberty Cycler during dialysis treatment. Here are a few examples:

  1. Cardiovascular disease: Lack of sleep has been linked to an increased risk of heart disease, stroke, and other cardiovascular problems. Interruptions in sleep caused by alarms on the dialysis machine could exacerbate these risks in dialysis patients who are already at a higher risk for cardiovascular problems.
  2. Diabetes: Poor sleep has been linked to insulin resistance and impaired glucose tolerance, key risk factors for diabetes. Dialysis patients with diabetes may be at a higher risk for complications related to their condition if they are not getting enough sleep.
  3. Depression and anxiety: Sleep deprivation has been linked to depression and anxiety in many studies. Dialysis patients already dealing with the stress of their condition may be particularly vulnerable to these mental health problems if they cannot get enough sleep.
  4. Immune system problems: Lack of sleep has weakened the immune system, making it harder for the body to fight infections and other health problems. Dialysis patients already dealing with weakened immune systems due to their condition may be particularly vulnerable to infections if they are not getting enough sleep.
  5. Cognitive problems: Sleep deprivation can lead to problems such as difficulty concentrating, memory problems, and impaired decision-making. Dialysis patients not getting enough sleep may have trouble managing their treatment regimen or other aspects of their daily life.

This looks like a real pickle for PD patients using the Liberty Cycler. On the one hand, the Cycler is totally supporting their very life. On the other hand, it CAN be related to other life-threatening medical challenges. In this case, it boils down to the lesser of all evils. I’m sticking with the Cycler and holding on to the sincere hope that Fresenius rolls out the new and improved version in my lifetime.

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