Welcome to Lydy Land III (TMI Re My Brain)

[lydy]

I admit, I'd totally been hoping that ECT would be the magic pill. I'm tired of all the time trying to figure out if I'm unhappy or being lazy. Also, I'm tired all the time of being unhappy, or being on the verge of being unhappy, or just coming out of being unhappy. Having no sense of shame, and having been born without modesty, I've been polling friends for information on ECT, if they know anyone who's had it, what they think about it, etc. I was at porphyria's baby shower last Saturday. One of her friends is a pediatric neurologist, who I know slightly and like more than that. When she heard me asking about ECT, she asked me if I had ever heard about VNS. Nope.

VNS stands for Vagus Nerve Stimulator. It's this queer thing rather like a pacemaker only different. They cut a little hole in your chest, and another in your neck, and wrap a wire around your left vagus nerve. The power supply fits into the incision in the chest. I think the wire is inserted in the other incision, wrapped around the nerve, and attached to the power supply. I'm not real clear on the whole geographical thing. It stimulates the nerve every so often, which in turn stimulates both the parasympathetic and limbic systems, and if I knew what those were, I'd be a wiser person today. They affect things that help control your mood and your neurotransmitters and for all I know your psychic presence on Alpha Centauri. One of the things they do very, very, very well is they control seizures. The other thing it has spectacular success with is depression. The device has been FDA approved for both uses since something like 1985. Safe as houses. Well understood, at least, as well as anything involving the brain can said to be well understood. Incredibly non-invasive. The pediatric neurologist I was talking to was excited about it. Entranced with it. It had committed miracles as far as she was concerned. She was so enthused that she unconsciously reached out and rested her hand on the place where the power generator would go and said, "Call. Let me write down the name of the nurse I work with. She's great."

I poked around the web site which was, of course, VNS for dummies. That's ok, I was a dummy. Some nice stuff, some useful stuff, some stuff I wouldn't bother telling a two year old. One of the most interesting things is that, although it is an adjunctive therapy like ECT, it may allow the doctor to wean the patient off drugs, or at least reduce the amount of drugs the patient is on, over time.

To my knowledge, no one has ever found any relationship between bi-polar and epilepsy or any other seizure disorders. However, most of the bi-polar disorder drugs were originally developed as seizure drugs. Now, let's have a review. The VNS is effective on depression and class? class? Let's not see the same hands all the time. Yes, you at the back. Epilepsy! Most mood levelers are also classes of anti-seizure drugs also known as anti-epileptic drugs. Very good.

I did call, on Monday. The nurse's name was Ellen Smith, and she was fun and smart. She referred me to her case manager, and I said that I would call her case manager on Tuesday. Tuesday -- I remember Tuesday, now. I didn't sleep through it, I only thought I did. I actually went to Pat's and did some work. I couldn't call because I was working. I don't remember when I went to bed. Wednesday I slept. Possibly because I was afraid to deal with the VNS. I don't know why I do things anymore. Thursday, I slept. Same song, second verse.
Friday, I got up. Very late. I forced myself to make the call. The nurse was discouraging, in that anyone who has graduated from nursing school really ought to be able to explain the limbic system better than, "Well, we did have this back in nursing school, but I really don't think I could explain it to you now..." She will, however, send me many DVDs and pieces of literature on pretty, shiny pieces of paper, and talk to my psychiatrist, and talk to my insurance company, SCREECH.

"What state do you live in?"

"Minnesota."

"Minnesota insurance companies don't approve VNS for depression. They only pay for it for epilepsy." Double heart beat. Sudden perky voice of despair, "We'll instantly appeal it, of course. We'll go with you as far as you want to go in the appeals process."

"You've done this in Minnesota before."

"Several times."

"Ever won?"

"Um, no."

"Right."

"What's rack rate on the procedure?"

"Huh?"

"What does it cost, start to end, out of pocket? Assume I have a rich uncle who just died."

"Oh," she said in an even more perkily apologetic voice than before. "Well, including everything, the device, the surgery, the follow-up, it'd be $25,000."

"Twenty-five thousand dollars?" I started to cry.

"Yes. I'm sorry."

Ok. It was looking like the magic pill. Two magic pills, one of which looks poison and one of which is a mirage all in a week is a bit much. I don't think that it entirely explains why I slept for two and a half days and have been crying for two, though. I think my new-ish anti-depressant isn't working.

I mean, I called up my mother and cried at her for a half an hour, and when she suggested I go home for a while, I actually considered it. I'm still considering it.


Meanwhile, anyone who hasn't heard Jonathan Coultan's Re Your Brain should go and listen to it right now. It is way funnier than Code Monkey and if I had any energy, I'd go find the URL, but I'm sure you can manage just fine.

Comments

[lydy.livejournal.com]

Were they giving her the insulin shock therapy at the same time? (I can't actually think of words vile enough to describe insulin shock therapy.) I ought to look into acupuncture, but I don't believe in actupuncture, which makes it more difficult.

The difference between the vagus nerve stimulator and the lap band is that obesity is the new hot disease. Moreover, it makes hundreds of thousands of dollars for the surgeons and hospitals. Having recently worked in the Department of Surgery at the University of Minnesota, I actually know some real numbers and some real bariatric surgeons. At the time, bariatric surgery was the fastest growing area in the department. It was totally raking in the bucks. There's a complicated relationship between the cost of a surgery and whether or not it's covered by an insurance company partly impacted by what the federal government will cover through Medicare, Medicaid, and whatall ever else it is that they do. Since the government is incredibly het up about fat people, getting a lap band covered by insurance is easy-peasy.

Depression coverage is largely driven by drug companies recouping their R&D money by selling drugs at spectacularly high costs. (Last time I calculated it, my drugs w/no insurance were running about $1500 per month.) The government does cover depression, but it doesn't really have any particular dogs in that fight, unlike obesity.

My guess is that a VNS just isn't very profitable. Let's face it, $25,000 is basically peanuts for a serious medical procedure. Compare it to a Roux-n-y (complicated lap band) which will run, um, I dunno, quarter of a million? On a Roux-n-y, it's probably worth the insurance company's time and energy to dicker. Mostly everybody charges between 40% and 60% more than the insurance company is going to pay because the insurance company and they have a service agreement to provide services at a lower "cost."

What that means, to me, is that my psychiatrist charges my insurance company $190 for a 15 min. med check up. If I'm between insurance companies and I'm "self pay", she charges me $70, because what she actually gets from the insurance company after the house discount is applied is something like $85 dollars.

So, I dunno, maybe I could dicker it down. Or not. Or, I don't know. At the moment, I'm too tired to think about it, you know.

I do know that if you are between insurance companies and find yourself paying out of pocket, ask if you can pay what they'd get if you were insured, not what they'd charge if you were insured.