More details

Now for more of the nitty-gritty.

As we explained before, E.'s new chemotherapy protocol consists of four different medications this time. Three are given via IV and one is taken orally via a pill. The doctor explained to us that the oral medication is typically denied by the insurance company, only to be eventually approved once everyone jumps through certain hoops. It seems the game is played like this . . . we take the prescription to the pharmacy . . . the pharmacy contacts the insurance company . . . the insurance company denies the prescription . . . the insurance company contacts the doctor . . . the doctor uses the denial code from the pharmacy and has to justify the necessity of the prescription . . . the insurance company gives its blessing and approval . . . and we finally get the prescription. I may have missed a few steps in there, but essentially, it's a big circle jerk. The end result though, after a week of going round in circles, was that we had the prescription in hand and chemotherapy could begin. Turns out, that particular prescription costs in excess of $2,000, which is probably why the insurance company balks at approving it.

Meanwhile, we received a call from the doctor's office on Monday afternoon informing us that E. had an appointment on Tuesday at the hospital to have a central port surgically installed. (We had specifically asked the week before if he was going to require a PICC line or a port and were repeatedly told it was not going to be necessary. Grrrr.) And an allegedly quick 30 minute procedure turned into an all-afternoon affair. You may remember that E. had a PICC line for his two previous rounds of chemotherapy . . . a long catheter inserted in a vein in his arm to make receiving IV's or drawing blood much easier. A port is a similar concept but in the chest rather in the arm. The "port" is a sealed chamber covered by a rubber disc that is surgically placed in a pocket under the skin on the chest. This chamber connects to a flexible tube that goes into a large vein in the neck. The tip of the tube rests in a large blood vessel in or near the heart. The port provides direct access to the bloodstream and can be used much the same way as the PICC, such as for drawing blood or infusing intravenous fluids and medications. The advantage of the port is that it is under the skin and so activities are not limited, including showering or swimming. If you feel the area on E.'s upper right chest, you can actually feel the triangular shape of the hard plastic port. If you run your fingers over the skin, you can feel three raised bumps arranged in a triangle. Hopefully the port will work as easily and as smoothly as it should. (This is a picture of the Power Port that is just like the one E. has, courtesy of Bard Access Systems.)

So, with the needed prescription in hand and the port in place, E. was ready to begin chemotherapy again.

S.