Medicare Gap Insulin and Surgery
Updated October 24th:
Wayne's foot surgery went well, although he is not permitted to use the pool for several more weeks (bacteria risk)
Bariatric Surgery is scheduled for November 19th (just before Thanksgiving, yes)
Cataract Surgery (the first one) will be in January sometime
His knee replacement... well as i expected the surgeon told him he CANNOT have knee replacement until he gets his BMI down to 40 or lower (about 100 pounds from now) since the artificial joint cannot handle his current weight. we expect that to be next year, possibly June.
We are in the medicare gap, despite our best efforts (by using donated and sample insulins0 to stay out of it, and that means his insulin goes from a co pay of about $300 a month, to a copay of about $1,000 a month.
yes its gone up.
the Bariatric surgery will reduce his need for insulin, no matter what, but comes with its own expenses... and we do not YET know if he can get off insulin entirely. his doctors have warned us to expect a reduction, not a complete elimination of insulin... but we can hope.
Owing to my neglecting my business, only my Legging Army online shop is active right now.
Thank you for sharing.
thank you for contributing.
and thank you for your prayers and support.
Having finally beaten back the foot infection Wayne is scheduled for foot surgery to prevent future toe infections on September 28th. we have to do this before anything else to avoid a recurrence of injury to the foot.
He has full clearance for Bariatric Surgery, and we are trying to get THAT scheduled for October....
because he needs cataract surgery as soon as possible and that is scheduled for November 28th
(Yes, all of these problems can be traced back to his diabetes as a cause or aggravating factor)
At the moment his meal time (short acting) insulin is running low and will be out in two weeks, which means that if we can't get a donation of more insulin, or scrounge up enough samples at the doctors, that we will have to pay about $600 to refill his prescription.
we have enough of his long acting insulin (the second type he takes) to last about 80 days.
Of course he will also need to be on a highly specialized medical diet to deal with the bariatric surgery, both before and after, which we also need to pay for.
Please do share this fundraiser, and also my two online shops, thank you.
THIS is why they tell diabetics to watch their feet.
(photo shows husband's foot, red with infection, in the local Emergency Room, and does NOT show the bottom of his foot because that was just icky)
we were lucky. we caught it early and he only lost a little skin and tissue. They think the oral antibiotics are beating it back (although these are some SCARY oral antibiotics)
initial X rays showed it hadn't progressed into the bone, and we have follow up x rays next week to be sure. His podiatrist did icky nasty things to his foot and pronounced it to be a good job of home care, and is monitoring it (and at this point the red has visibly receded.)
may i say for the record that i am SO entirely OVER having medical crises?
The basic story:
I'm a disabled veteran, and my husband is a disabled diabetic on Medicare.
We originally set up this fundraiser strictly for paying for insulin during the "Medicare gap" (when the co-pay for his insulin goes up to over $500 dollars a month- closer to 600 really, not counting all his other medication.)
and then he needed surgery... and more surgery...
Here is where we are now:
Wayne HAD emergency kidney stone surgery scheduled May 2nd Once they had him in the OR the surgeon found some issues. he had a stent put in, and was in a lot of pain as you might imagine. (better than risking a puncture!)
Wayne had a second try at kidney stone surgery May 16th. it was successful in that they removed a lot fo stones (three blocking his ureter) but he had to get a new stent, and is in a lot of post operative pain several days later.
He was in severe pain from May 16th through mid July- it only began to be controlled in July. Three urologists 30 days of levaquin and a Pelvic Floor Physical Therapist later, (bless the woman) we finally have things a BIT better..
Then he got a foot infection. and was on first clindamycin and then keflex before we beat it down.
He is currently scheduled for :
Foot surgery September 28
Bariatric Surgery to be determined
Cataract surgery November 28
obviously the bills are now skyrocketing... have already skyrocketed really.
Unfortunately i have had to cancel almost all of my sales events (like Maryland Sheep and Wool as well as local fairs and etc) to take care of him, so i don't have much chance to bring in any income other than my disability.
Friends did chip in to pay for my getting a Daith piercing in an attempt to reduce my migraines (it seems to be helping). Hopefully that will make getting everything done a bit easier!
(NOTE: the daith piercing is still helping markedly! not a cure, but certainly a help!)
I know a lot of people are on shoestring budgets, and believe me we appreciate all the help.
I also remind everyone that SHARING a fundraiser really helps, even if you cannot donate.
Thank you all for your support and generosity.
Wayne injured his foot when he got up overnight, and after looking at it in the morning (yesterday morning now) i insisted we have it checked by the podiatrist.
basically he kicked something (no we dont know what) and injured one of the toes that had surgery. in addition to impact damage he had quite a bit of torn skin despite the sock.
after a great deal of running around to get to the podiatrist (and road closures due to construction) we got in, and got it cleaned and re bandaged... and some "just in case" antibiotics.
we cannot afford an infection again, especially since it would delay his bariatric surgery. Sadly this means the pool is once again off limits until he doesnt have torn skin.
as to the pre-op diet (5 protein shakes and a lot of non starchy vegetables to try to get the fat off his liver)
he's fairly miserable, of course. its 800 calories a day (more or less) and both low carb and ultra low fat, which means he cannot eat ANYTHING but that very restricted diet (nope, not even fish, fruit, or yogurt)
he is doing better now (and has been very good at keeping to his diet) but he loses all his energy by mid-afternoon.
he is down almost 30 pounds, so hopefully his liver will be a lean, sleek, easily moved aside liver for the surgery.
he slowly dropped his long term insulin (as discussed with his endocrinologist) and is not using much short acting insulin since he isnt eating much in the way of carbohydrates.
as i suspected *I* am down quite a bit of weight as well... and back to eating a lot of vegetables and etc as i prefer...
actually its not as bad as i was concerned it would be.
hubby started his pre-op diet (bariatric surgery has a 2 week pre-op diet to shrink the liver and make the surgery easier)
he is permitted about 800 calories a day, mostly protein shakes, and extremely low carb and low fat. (aka protein shakes and non starchy vegetables)
as i told my own doctors and therapists, i expect to lose about 15 pounds this month because hubby is the cook and his preferred foods are not normally great for either of our waistlines.
he had an epidural for his back (spinal stenosis) just as the diet started, so his blood sugar has been high considering what he hasn't been eating (steroids spike your blood sugar) but we are watching carefully.
Because of his very limited intake, the main danger is OVER shooting his insulin, and low blood sugar (hypoglycemia) which can quickly become life threatening.
however bbecause of the steroid shots he has to be careful of not going high enough to cause damage, even now.
diabetes is not the easiest thing to manage.
he will have his cataract surgery in January, if all goes well, and his knee surgery when he has lost enough weight.
meanwhile the VA has scheduled me for a week long seizure trial in Maryland, sometime in January...
thank you again to everyone for your support
while the daith piercing i got this spring has helped immensely, it has not eliminated them. I have had a migraine for the last 3 and a half days straight, varying from 3 up to 6 (and far too often at 6) on the pain scale. with occasional spikes up to 8.
(it sounds like a weather report, doesnt it?)
anyway, i have just found out that after hubby's bariatric surgery i will be spending a week in a VA seizure lab in Baltimore, so hopefully we will get some good data.
No none of this has anything to do with insulin or anything, i just thought i should apologize for not keeping up and thank everyone for their help.
We have enough insulin to hopefully make it through to his surgery, and once i am up and around i will be asking his doctors about more samples.
First of all: Wayne is recovering well from foot surgery, although he still cant use a bike pedal and isn't allowed in the pool (bacteria) which limits his exercise options.
walking or standing too long is still right out, but that's his knees not his foot.
we are currently in the medicare coverage gap (the "donut hole") thats when the cost of his insulin jumps from $$ a bottle to $$$$ a bottle.
he uses 4 bottles of humalog (short acting)
and 6 insulin pens of lantus (long acting )
Bottles are cheaper- much cheaper- but pens are more convenient: its a quandary.
we started a gofundme specifically for his bariatric surgery needs, which links to his amazon wish list- at least in part because people look at this one that started YEARS ago, and think we raised all that money now... instead of "just barely enough to keep him in insulin"
He may be able to get off insulin entirely with the bariatric surgery... but his doctors tell us its more likely he will just reduce his insulin needs.
either would be good
of course insulin is only one of his medications- the single biggest expense- but if we can reduce his need for it it will be much better.
his knee replacement will have to wait for next year as his surgeon wants him under 40 bmi before he will do surgery (that is, about 100 pounds down)
so the current schedule is :
November 19th: Bariatric surgery (yes just before Thanksgiving)
sometime in January: Cataract surgery one
sometime in march?: Cataract surgery two
sometime probably June, but it depends on his weight loss: knee replacement surgery one
Thank you for sharing, and your prayers are always appreciated.
I had my first cataract surgery on July 25th. It was really no big deal. The other two are another story. Praying for both of you!
My dermatologist also told me a way to kill germs on the skin. Mix 3 parts water and 1 part white vinegar together. She told me to buy gauze and soak my skin for 5 minutes and then let air dry. Instead I chose to buy a spray bottle for $1.49 and put the splotion in it. I spray me leg, where I have an infection and let it dry three or four times in a row before bandaging. I'm not saying Wayne shouldn't take the Keflex, but maybe in addition?
Please make sure you give him probiotics or, if he can tolerate it, yogurt with probiotics. Anti-biopics kill off good gut flora.
Check also with his doctors. I have had doctors thrilled to be able to provide me with sample vials because they didn't have any other patients on they type I am on and they didn't like having to throw them out. You never know. Also, if you have not already, contact the manufacturer - some may help defray the cost. And one more thing to check is if there is a substitute by a different manufacturer that is lower cost. I don't know about medicare specifically, but I know on many insurance plans - including the "obamacare" plans - there is a tiered system for prescription meds and on some plans one manufacturer is on a lower tier (is, less cost) than the other. I am Type 1, so insulin is life-and-death, no other treatment options, so I have learned a few of these tricks along the way. I asked my endocrinologist and she switched me from humalog to novolog, which cut my co pay by more than half without any adverse effect. may not work for you, but it's worth asking. please hang in there!
What are the names of the insulins he takes?