Because of the Methotrexate and swollen, painful lymph nodes, I sent a communication to Hemosapien. He called me, and asked me if I could come in that same day, 11/14/13, rather than wait until next week. I agreed and trotted down to his office, having the CBC and CMP done, which was ready when I got to his examination room.

He checked out the lymph nodes and was unsure if this was related to the Methotrexate or not. An infection was possible, but my blood numbers looked good, but the Methotrexate could be masking any increased WBC because it suppresses your WBC. Hmmmm!

I go for a CT scan next month. In the meantime, as is common with CLL, we watch and wait. I know that the shooting pains in the lymph nodes in my groin don’t seem to amenable to waiting…they are just proceeding on with whatever is is that they are doing without so much as a consideration for what I may think about it. They have lots of chutzpah if you ask me.

Of course, since I am always interested, and right after hunting and firearms, the talk turned to Obamacare. I told Hemosapien what I had found on the Healthcare.gov website, and that if I were forced on to the exchanges, a certain hematologist/Oncologist in Columbus, Mississippi, would be the only one available to me. I told him that I would not be able to keep any of my doctors, nor take the FCR chemo I had taken before should it be necessary, unless I was willing and able to pay for it 100% out of pocket.

“Junk,” he said. “Junk.” He shook his head.

“This makes me furious. FCR is the standard for treating CLL. It is not a new, experimental trial.”

It may not be experimental now, but it is still expensive, since Rituxamab and Fludarabine are still covered under patents, and they are not on the schedule of drugs allowed by Magnolia Health Plan.

Hemosapien and his clinic will not be participating in the Federally run Mississippi exchange. They are not interested in providing inferior services, nor in providing their normal standard of care for the level of reimbursement they would receive. Like everyone else, he is operating a business and is already spending money to comply with things contained in Obamacare that he had not heretofore seen. Since many cancer patients are older, the changes to Medicare Advantage, which they are being forced to implement, are already costing them more money without the ability to recover it. This is the nature of government…to force margins down by insinuating itself between your cost price and your selling price. This is easy for government to do, since most government bureaucrats and department heads view profit as a nasty word, having never run a business themselves. To the government and progressives, everyone is getting rich. But if the incentive is taken away, everyone will just stay home. A paradox not easily addressed.

Hemosapien’s clinic has no plans to accept The Magnolia Health Plan. He has no plans to treat any CLL patient without being able to offer them FCR, and the F and the R are two major components. The C (cyclophosphamide) is a generic drug, but unable to be used solo, though it multiplies the effectiveness of the F and R. He is not only livid about the bad level of reimbursement, but that his options on how he might best treat a patient are curtailed.

“Junk,” he said again shaking his head.

“Junk,” was my echo.

This is already affecting some of his patients with similar and other cancers. No responsible physician want to give his patients anything less than the most effective treatment, nor do they want to pay for it out of their own pocket. Who can blame them. One of the responsibilities of physicians is to ensure that their patients get the best care they are capable of giving. As professionals, they are allowed to practice, which means that there are no set rules on how they may approach the treatment for any given patient. Under Obamacare, their hands would be tied.

This is not an improvement, nor is it quality health care. Nor is it affordable. Nor is it readily available. It is the first step in health care rationing.

Have mercy!

One thing is certain! FCR chemotherapy has given me TIME. Because of a 4 year remission, I have had time to think about and write about many things, most of them unrelated to CLL. If the CLL was still blazng away, it is likely that all I’d have the inclination to write about would be my current experiences. Thank goodmess for the time. Thank goodness for FCR. Thank goodness for a caring and dedicated healthcare team!