UPDATED

I’ve been seeing my current general practitioner every six weeks since November ‘07. He is a very kind and compassionate physician but there are a few, um, issues: first of all, he services the South and North Las Vegas community, which is to say that his office welcomes the lower-income classes and those, like myself, who are dependent on Medicare and social service entitlement programs for their health care. People in this demographic suffer from illnesses that are disproportionate to the rest of the community, which means the waiting room to my doctor’s office is always packed to the rafters. If I schedule a 10:00 AM appointment, I am lucky to be seen by my doctor before 11:30 or noon, one of the reasons for this being that he accepts walk-in appointments from regular patients so the walk-ins and the appointment holders are at odds with each other. When I am sitting in a cramped waiting room amid children with whooping cough when I have cracked and exposed skin from severe psoriasis, I tend to get a wee bit cranky and uncomfortable, not to mention the fact that my joints are swollen most of the time from psoriatic arthritis (PA) so the prospect of sitting in a hard waiting room chair for an hour and a half to two hours is almost out of the question and borders on masochism.

Living in Summerlin, on the outskirts of downtown Las Vegas, creates quite a costly predicament when it comes time to honor my appointments every six weeks. With no car, I have to pay a neighbor to ferry me to and from the doctor’s office to the tune of $30.00 (a cab would cost $50 each way). Then there’s the matter of my office visit co-pay ($25.00) and the office manager always tries to squeeze at least an additional $40.00 out of me on my past due Medicare co-pays for treatments and procedures. So, overall cost of a doctor’s appointment every six weeks, after my co-pay for prescriptions, is approximately $100.00.

My last appointment with my physician was a week before Christmas. I’m long overdue for a visit but right now I cannot afford the extra 100 clams. I take eight medications daily and six of those are what are called “maintenance medications”, i.e., meds I need every day so I can function like something resembling a living and walking human being. My hypertension is controlled by 40 MG of Lisinopril in the morning and 100 MG of Atenolol at bedtime. 15 MG of Meloxicam every morning keeps my gout under control, 20 MG of Omeprazole works on the GERD (gastroesophogeal reflux disease), and I take 2.5 MG x 5 of Methotrexate every Friday (a dangerous oral form of chemotherapy) for my psoriasis, which must be balanced with 1 MG of folic acid daily because the MTX robs my system of folic acid. Two other RX meds I take are on an as-needed basis: Hydroxyzine, an anti-anxiety med that controls the inflammation and itch of psoriasis, and 500 MG of Vicodin for joint pain from the PA.

So here’s the deal: I have run out of refills on five of my meds and am fast running low on the others. It may be at least another week before I can afford a doctor’s visit and in the interim my doctor has absolutely refused to refill my meds, even my daily maintenance meds, until I pay him a visit. I can understand no refills on the Vicodin and the MTX but my blood pressure meds? My GERD medication? Does this guy want to see me in the hospital? I’m already suffering a slew of effects from being off these meds for going on two weeks now. Is it just me or does this behavior border on being unethical and demonstrate a severe disregard for the patient’s well-being?

UPDATE

Well, now the situation has worsened. I called the local Wellness Clinic sponsored by Walgreen’s Pharmacy but they cannot refill medications. “We’re only here for flus and colds and sprains, that type of thing,” the nurse informed me.

Fine.

So I called the health care division of The National Psoriasis Foundation in Portland and explained my situation to the kind lady who took my call.

“I understand him not refilling the MTX,” she said, “because you need a blood test to check for liver damage and it sounds like you’re long overdue for a blood test.”

“I am,” I said, “and I can get by without the MTX for a few more weeks but if he can’t treat my ‘normal’ chronic conditions — high blood pressure, gout, GERD — then those conditions will most certainly worsen and cause the psoriasis to also worsen.”

In short, the NPF couldn’t offer anything but sympathy.

And then Miss L found a doctor’s office within a couple of miles of our home. Cool. Let’s call and make an appointment. But …

… not so fast. A check we were expecting did not arrive in the mail today, which means I will not have the cash this week to meet a co-pay with any frigging doctor I can set up an appointment with.