Heatlh matters--part deux.  One more entry on the ups and downs of the daily routine.  When I last posted, it was Sunday morning.  I had gotten up at 6 to make an emergency trip to the bathroom, and then a few minutes later, I had vomited--luckily, before I had taken all my morning pills.  By the time I finished writing, I had to go running back to the toilet.  Friends were coming in from Kansas City at noon, but as I sat waiting for them, I kept falling asleep--short naps, but enough to worry me that I wouldn't be up for the visit.  The short bursts of sleep seem to have helped, however, and when Mark and Noel arrived, I was feeling peppy.  They had just returned from Paris and brought us TEN boites/bocaux of confit, terrines, and rillettes--an extremely generous gift and one that I know will give me an appetite and variety in what I eat.  We went out for brunch, and everything was fine till we were in the car driving home.  I made it home in time, but it's embarrassing to have to keep leaving the guests.  Three hours after they arrived, we had said good-bye, and I was in bed, deeply asleep.  That's what a typical day is like these days: quick successions of ups and downs.  I don't remember what I tried to eat Sunday evening, but it wasn't much.

Monday morning was worse.  I think I jinxed myself by what I wrote on Sunday because this time, awakened by my stomach's gurgling, I tried to rush to the bathroom, but I didn't quite make it.  So much for laughing at jokes about Al Roker.  It's not fun at 5 a.m. to deal with this, but nothing is potentially more humiliating and frightening--and discouraging--than the thought of public incontinence.  Ir's embarrassing even to write about, and I debated whether to include it in a blog that seems to comprise an inordinate amount of discussing bed and bath, but I want to be as honest as possible.  My intake for the day consisted of a bowl of cereal, two pieces of toast with rillettes of pork, and another bowl of cereal for dinner.  I dozed off several times and didn't have enough energy to do anything except stare mindlessly at the TV.  The tincture of opium--no matter how much I had hoped for different results (and from enjoying being able to ask for my opium at Walgreens)--doesn't seem to be having any positive effects.  It's also much less convenient than pills, which I carry with me when we leave the house and the dosage of which I can juggle as circumstances change.

And then, after two miserable days, yesterday was much better.  Yes, the day was bookended by trips to the bathroom and punctuated by a 2½ hour nap in the afternoon.  But for the rest of the day I had a good appetite and lots of energy.  Food actually looked and tasted good.  I had a plateful of sushi for lunch, followed by a sticky bun (no joking) for dessert.  And I finished off a jar of rillettes of pork on a croissant for dinner. 

These three days may have more extreme than most, but they illustrate the wild variability of how I feel, the unpredictability of one hour or one day from the next.  Today has started well, but the frustration is in not knowing how long that will last while knowing that no amount of will can change the day's trajectory.

One of the consequences I had forgotten about of entering the new year, is that Medicare Part D begins its accounting from scratch.  I get to the "catastrophic" phase, where I pay 5% for drugs, quite quickily, but now that it's January, I'm back in stage one.  Yesterday I picked up some prescriptions, including 24 needles for the morning anti-coagulant shot.  A 24-day supply costs over $3,000, so my share was nearly $800.  (How these figures are calculated is beyond me; I just accept whatever I'm told, since in the long run, I'll pay a certain fixed amount as I move through stage one, the doughnut hole, and into the last phase.)  The total bill was nearly $1,000.  I also phoned the special pharmacy for the chemotherapy.  The pills for a month cost over $6,000, my share in phase one coming to $2,300.  My first reaction to shelling out $3,200+ in one day was to wish my debit card was racking up more enjoyable purchases.  My second thought, however, was once again how insane our system is.  What if I weren't old enough for Medicare or had been feeling good and didn't want to spend the extra money on Part D coverage?  Each morning shot costs over $100.  The small package of one small bottle of pills that will last a month that UPS delivers today is worth $6,000.  Although Medicare Part D is far from perfect, what choices do people without insurance have to make?  Entitlement (how the name already prejudices the discussion) reforms have to be on the table at some point, but not hurriedly as part of the current Washington politicking.  Social security is healthy for many years to come.  Medicare is more efficient than private insurance policies and still has another decade of health, and the Affordable Care Act should bring reductions in Medicare costs.  This isn't the time for panicked (and panic-inducing) debate.  This is one can that deserves to be kicked down the road (I don't watch all those TV debates without picking up the clichés) until reasoned and reasonable discussion can take place.