Friday, June 12, 2020

Medical Cost of Aging


For the first half-century+ of my life I was pretty healthy. Apart from an occasional Tylenol for a headache or a Band-aid for a minor cut, I had no underlying health conditions (at least that I knew of). But over the last 20 years that has changed significantly. I now have a number of different conditions, all of which have ongoing costs associated with them. Here are my conditions and the associated costs. (Note that I have given each one a letter that I will reference in the writeup below.)

(A) Kidney Stone – In 2001, I had a kidney stone that turned out to be a uric acid stone. I’ve written about that here (*1). Since excess uric acid is also the cause of gout when it builds up in your joints (usually the knees and ankles), that is not something that I want to have to deal with – never mind having another extremely painful kidney stone. After 10 years I no longer need to have any medical review, but still need ongoing medication.

(B) Heart Attack – In January 2005, I had a massive heart attack that could have easily resulted in my death. Survival rate is only 5-10%, so I’m one of the lucky ones. (*2, *3) I have had no long-term effects, but there are number of medications that I take to prevent another one. I meet annually with my cardiologist. There are also some interesting issues related to this that I will discuss in more detail below.

(C) Diabetes – for several years I was pre-diabetic, but as time has passed, my blood sugars have slowly crept upwards so that now I am in the diabetic range. Diabetes has a number of side effects, including eye problems (I get mine checked every year and I have no difficulties there), neuropathy (nerve damage in the extremities) (I have no feeling in the front half of both feet), and others. This and the following issue are the primary discussion items when I meet with my primary care physician every three months.

(D) High Triglycerides – Most of my blood test results (other than glucose) are right where they should be. My cholesterol in particular is quite good. But the exception is that my triglycerides are off the chart. Without treatment they have been over 900 (the normal range is <200).

(E)  Arthritic buildup in the joint behind my right toe – this causes a bulge in the joint and puts all the weight on it when walking. When the callus that had built up broke loose, I eventually had nearly two years of treatment and had two bouts of sepsis (blood poisoning) that put me in the hospital for a week each time (*4). So, to prevent any further issues. I meet with my podiatrist every two months for a checkup to prevent ongoing complications.

Besides the cost of visits with various physicians, there are a number of ongoing costs for various medications and other medical implements.

[Pills]



Pictured here are my daily pills. The top row I take each morning, the bottom row I take in the evening. From left to right (the order I take them), their names and costs are:

(1)   Farxiga – diabetes treatment (C) – $360 (90 days)
(2)   Ezetimibe – cholesterol lowering (D) (even though mine is ok, this will help keep in under control while we work on my triglycerides – $76 (90 days)
(3)   Niacinamide – vitamin supplement, non-prescription – $5 (90 days)
(4)   Metformin – diabetes treatment (C) – $3 (90 days)
(5)   Metoprolol Tartrate – to keep blood pressure from getting elevated which could cause heart damage (B) – $3 (90 days)
(6)   Allopurinol – keep urine from getting too acidic (A) – $8 (90 days)
(7)   Lisinopril – ACE inhibitor to prevent further heart attacks (B) – $2.50 (90 days)
(8)   Low dose Aspirin – general heart (B) – $10 (90 days)

The first and last in the bottom row are repeats of (4) and (5) as I take them twice daily. The other one is:

(9)   Simvastatin – cholesterol lowering (D) (even though mine is ok, this will help keep in under control while we work on my triglycerides – $5 (90 days)

In total, that’s about $2000/year for medications, with Farxiga accounting for ¾ of the total.

[Fish oil]



In addition to the medications taken in pill form, one of the best things that helps lower my triglycerides (D) is fish oil. Because my triglyceride level is so high, taking fish oil in the usual capsule form would be a handful each day and pretty unmanageable. So, I have found a source of pure liquid fish oil that is much easier to manage. I take 4 teaspoons a day, so a bottle like the one shown here lasts about a month. Cost – $42 (30 days) or $500/year.



[Glucose Monitor]



In order to monitor my blood sugars (C), I do a daily finger stick. This is especially important anytime there is a change in my medications to make sure that I’m heading in the right direction. It can also give me any feedback on how I’m doing and whether I need to pay more attention to my diet. The only ongoing cost is for the lancets and test strips, but both of those are totally covered by Medicare so there is no cost to me.





[Trulicity]


 Even with the above medications, my blood sugar levels (C) were slowly creeping higher. So, a month ago my primary care physician prescribed a weekly injectable medication. These types of medications are Tier 3, so the cost is not covered to the extent that most of the others are. With a list price of nearly $800/month for 4 once-a-week injectors, the cost to me is $214/four weeks or $2800/year. Not cheap, but I’ve seen my blood glucose levels drop nearly 40 points so far!



[Shoes]



In order to prevent future incidents of a callus buildup on my right foot (E), I need to wear shoes that have a thicker cushion on the bottom and prevent the pressure that causes the callus in the first place. These are the ONLY shoes that I wear, so I need a new pair every year or so.

While I could have Medicare cover the cost of these shoes because of my neuropathy, that’s not the reason I really need them, so I choose to cover the cost myself. $145/year


[CPAP]



I’ve saved the most interesting picture for last. During my last visit with my cardiologist (done via telemedicine), he noted that he has become convinced that there is a definite connection between sleep problems and heart complications. At his advice, I completed a 3-day sleep study – all done at home by following the directions. This included a finger cuff for measuring blood oxygen levels, a chest strap to measure breathing, and a strap around my head with inputs near my nose to measure breathing, sound levels, and any stoppages. After mailing it back and getting it analyzed, the cardiologist noted that my snoring was slight (and confirmed by my wife as it used to be much worse), but that I had breathing stoppages quite often. Thus, he recommended using a CPAP. I’ve only had this a short time.

In the picture here, I have first a chin strap to keep my mouth closed (I am normally a mouth breather so this forces me to breath through my nose), as well as the CPAP that keeps positive air pressure and stops my air passages from closing down and eliminating the breathing stoppages. I’ve only just begun using it and am building up the amount of time that I wear it each evening. While having the connection on the top of my head allows me to turn from one side to the other, it still requires me to take it all off if I need to go to the bathroom – which, like many people my age, I often need to do in the middle of the night. But the hardest adjustment is learning to breath only through my nose – however I know that this is best, as mouth-breathing is also a contributing factor to my poor oral/gum health.

Cost – unknown at this time as I have just gotten started and am using the supplies that came with it. But I know that it will eventually include small air filters, distilled water, and perhaps other items.


Summary

The above add up to about $5500/year, most of which is just the Farxiga and Trulicity which total $4300/year. As some have noted, getting older is not for sissies. I’m glad that I’m in a spot financially that these costs are manageable.


Notes:




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