Bent Corner

I thought I had my psoriasis licked. I was taking Raptiva, a medication I inject myself once a week. After taking it for two months, my hands were finally clear of psoriasis. It was in full remission.  It felt so good to have normal hands for a change.  I felt like a normal human being. No pain, no thick scaly areas, no cracks, no bleeding.

It was great.

All that changed when my former primary care doctor withheld a referral to continue seeing my dermatologist. When he originally referred me to see my dermatologist, he wrote a referral for 20 visits. Unbeknown to me, my insurance company refused to honor the referral for 20 visits. They required on a new referral after every four visits.  I never knew this.  My dermatologist was contacting my doctor after every four visits to get another referral faxed to them.

To the best of my knowledge, the initial referral for 20 visits was still in effect.

When I arrived at the dermatologist’s for my appointment to gauge the success of the Raptiva, the person at the front counter asked me for my referral.  She proceeded to tell me about needing a new referral after every four visits and that my doctor said he would no longer issue a referral over the phone.  From now on, he would only issue them in person.  She told me that someone from my doctor’s office should have contacted me and told me this.

Nobody bothered to tell me.

This meant I could not be seen by my dermatologist.  This meant I could not continue taking the Raptiva.  I needed another prescription if I wanted to continue taking it.  That’s something I could not get without seeing my dermatologist.

I immediately went about looking for new doctor.  One that wouldn’t screw me over like that.  By the time I found one taking new patients and got an appointment to be seen and got a new referral to see my dermatologist, the psoriasis was back.  If anything, it was worse then ever.

I don’t understand why I need a referral to see a dermatologist. Psoriasis is a life long, chronic condition that I will have for the rest of my life. Seeing a dermatologist is something I will be required to do for the rest of my life. My insurance company knows this.

By requiring me to get a referral from my doctor, they are in a sense having him re-diagnose my psoriasis.  That’s something he is not qualified to do. If he was skilled and knowledgeable enough to diagnose psoriasis, he would be skilled and knowledgeable enough to treat psoriasis and I would not need to see a dermatologist.

It’s middle-man medicine.  Putting my primary care doctor in the process adds absolutely no value. It doesn’t make for better care.  All it does is drive the cost up.  By requiring me to come in and be seen every time I needed a refferal, he gets to charge me a $30 co-pay along with whatever he bills my insurance.  It becomes an unessissary obsticle to recieving quality medical care.

I woke up yesterday morning not feeling well. I couldn’t stop shivering. No matter how many layers of clothing I put on, I couldn’t stop feeling that I was freezing to death. I took my temperature and I had a slight fever of 100.3 degrees. Sheri talked me into going to the Washington County Hospital Emergency Room and I’m glad she did.

It turns out I have pneumonia.

I’ve never had pneumonia before. What I find strange about it is that I don’t have any pain in my chest. I don’t have a cough. I seemingly have no respiratory problems whatsoever. The chest x-ray told a different story.

The folks over at the Washington County Hospital could not have been any better. I was extremely impressed with the level of care I received from everyone there.

They gave me an I.V. of something when I first got there to put fluids into me. When they diagnosed me as having pneumonia, they gave me a dose of Avelox by I.V. I have to continue taking the Avelox by pill for the next 10 days.

The doctor seemed to think that I got this way from going back on Raptiva for my psoriasis. It’s a highly effective drug for treating psoriasis on your hands or feet, but like most psoriasis medications, it lowers your immune system. I’m supposed to take another injection of Raptiva tonight, but the doctor in the ER told me to skip this week’s dose.

I’m now on week #4 of a new drug for my ongoing battle with psoriasis. It’s called Raptiva. Unlike the other medications I’ve taken, this is something I have to take by injection once a week.   Also unlike all the other medications I’ve tried, I think this stuff is actually working.

My psoriasis seems to be better.

This is the first time in a very long time that I can remember having the ability to make a closed fist with either hand. Normally the skin on my fingers is too thick to allow me to close my hands into fists.

I often have trouble using my hands at all.

My feelings about this is somewhat mixed. On one hand (no pun intended) I’m glad that I can bend my fingers and that they aren’t cracked and bleeding. For that I am very thankful. The problem is that Raptiva is extremely expensive. Though I only have to pay a $50 co-pay for a month’s supply, my health insurance is paying over $1,600 a month for me to take Raptiva.

That is a lot of money. I don’t feel comfortable taking such a pricey medication. If I continue to take Raptiva, I worry about my health insurance eventually dropping me.

I woke up this morning and felt like total crap. I’ve been taking the chemotherapy drug Methotrexate for my psoriasis. I take two pills Monday evening, two pills Tuesday morning, and two more pills Tuesday evening. I don’t take any more until the following Monday evening. The side effects of Methotrexate include among other things, anemia. I don’t know if that’s what I have now. I only know that I feel like shit.

I had to call in to work this morning and take 8 hours of personal time. To say this has been frustrating is a complete understatement.

My hands are still a complete mess. They aren’t getting better. I don’t feel or see any improvement. They are still severely cracked and the skin on my fingers is hard and inflexible. Some days at work I can barely hold tools. Yesterday I was installing a ribbon cable into a connector when I noticed red marks on the ribbon cable. I quickly realized it was my own blood. One of the fissures on my hand had begun to bleed.

This actually happens a lot.

I’ve read that the worse place you can get psoriasis is the soles of your feet. When the skin cracks, it becomes painful to walk. I’m not disputing that, but I honestly believe the worse place to get it is on your hands. At least if it was on my feet, I would be wearing socks and shoes. Nobody could see it. I wouldn’t have the never ending fear of bleeding on something. I wouldn’t worry about situations where I am expected to shake someone’s hand. I wouldn’t worry about a sales person reacting with revulsion when they hand me my change. I am just getting extremely tired of it.

I want to stop taking the Methotrexate. It’s not even working. Even if it did work, it’s not a long term, permanent answer to psoriasis. I can not take Methotrexate forever. From what I can tell from reading the literature, it would eventually destroy my liver.

My psoriasis hasn’t gotten any better.

My dermatologist took me off the Soriatane. Monday I start taking a medication called Methotrexate. The cool people call it MTX. It’s a chemotherapy drug. It’s used to treat breast, head and neck, lung, stomach, and esophagus cancers. I didn’t even know you could get head cancer.

It’s been around for awhile, but only recently has it been used to treat severe psoriasis. I guess they noticed psoriasis sufferers who were taking it to treat their head cancer ended up killing two birds with one stone. I would not even think of taking it if the psoriasis wasn’t on my hands.

I has some nasty side effects. Chemotherapy has side effects? Who would have thought? One of the side effects actually made me laugh. No, it wasn’t diarrhea or mouth sores. It was something called poor appetite.

I’ve never had that.

I will take two pills Monday night, two more then following morning, and two more that night. I then wait till the following Monday to take them again.

I don’t think I can drink Guinness on Methotrexate either. Both drugs are extremely hard on the liver. That’s why I have to wait till Monday to start taking Methotrexate. To make sure the Soriatane has fully left my body. If I take the Methotrexate for a long period of time, I will have to have a liver biopsy.