B & O: it's not a railroad in a board game.
Well, it is that too, just not in this blog. But there's a back story first.
Last Saturday Paul drove his grandfather to the ER. We thought his catheter was plugged again. He wasn't passing anything, his bladder was backing up, and his discomfort level was approaching extreme pain. Since it was Saturday, we didn't call Randy to come out, but loaded him up in the car. We were hoping for some kind of information that would tell us there was more than just a short-term fix. These had been coming more and more frequently, and this was the third in a week. The usual fix was a back-flush to rid the catheter of whatever was plugging it, then letting it drain. It works fine, just isn't permanent. Not even long term, lately. And it needs skilled medical help. But hey, it was Saturday. Randy has a life too.
While they were gone, I did call her, just to fill her in on what was going on. We brainstormed about more long-term fixes, like increasing his catheter size from 14 to 16, thinking maybe that wouldn't plug so easily. She was willing to chat for a while, until her grandson started waking up. Then he needed her full attention. I promised to keep her informed, both as Daddy's healthcare team supervisor and as a friend.
When they left the hospital, Paul called me. Was there a close pharmacy that we had used that would have Daddy's insurance information? Because the hospital is 8 miles east of us, and his regular pharmacy is 17 miles west. Since we had stuck strictly with Target for him, he brought Daddy back home and drove off again. He had a prescription for B & O.
By now Daddy was feeling comfortable again. When he was in so much pain earlier, I'd given him an extra dose of what are usually his bedtime pills: hydromorphone and lorazepam. One kills pain, the other relaxes him. They had done the job - incidentally - of treating his problem, had we but known it. He wasn't having blockages, but bladder spasms. The medications relaxed the smooth muscle of the bladder enough for him to empty it, mostly during transport. An ultrasound in the ER showed an empty bladder. The B & O was prescribed in suppository form for the next times it happened.
So what's B & O? Belladonna and opium! Yikes! Not only does it sound dangerous, there quickly developed other issues with the prescription. First, Medicare won't cover it. They think it's a quality-of-life versus a medical necessity drug. More voluntary than necessary is how I heard it. However, if your bladder is backing up to the point you're in extreme pain and risking a rupture, it's not a necessity? The full price of the 15 pills that were prescribed is a mere $300. It could be covered if absolutely necessary, but....
As a suppository, it's just more difficult to administer, starting with getting him standing up to relocate to a place - like bed - where he can lie full out so we can get to the proper area. Mouth is so much easier.
It's so unusual a drug that Target couldn't get ahold of any until Monday. (Later they called back and pushed that date back to Friday.) Since he'd been having increasingly frequent spasming episodes, Friday might be too long a wait.
The prescribing doctor wrote the prescription out with out specifying the strength of the dosage. It is available in two. And since it's a Schedule II narcotic, every single "i" must be dotted and "t" crossed. So if we were determined to get this particular prescription filled, we'd have to get another, properly filled out written prescription and physically bring it in. We're used to hard copy prescriptions for his Schedule I drugs. It just meant that we'd have to contact his regular doctor, get him to agree this was necessary, have him write out what he thought was appropriate, and have me pick it up. During his office hours. Regardless of where work thought they wanted to send me at that time. With his regular drugs, we call in the refills with a week of dosages left so there's time to play with.
All of that might have been worth the effort except for one thing. The combination of opium and belladonna might very well depress his breathing, something he can't spare these days. If we were trying to hurry him out the door and underground, it might be just the trick. However....
Surely there were newer, better, safer drugs on the market these days to help with bladder spasms.
I told the pharmacist to tear up the prescription for B & O. I'd need to call his doctor on Monday anyway, now that we knew what we were dealing with, and ask for some kind of more realistic drug for his conditions. Worst case, we could retreat him with the same bedtime meds we'd used earlier. We wound up with something called oxybutynin, regularly prescribed for bladder spasms, though usually the kind that cause incontinence. 3 pills a day with meals. $3. A very slight risk of sleepiness so he shouldn't operate heavy machinery.
On Tuesday a doctor from the ER called us to let us know he had a UTI. Technically, 2 UTIs. The cipro, his latest antibiotic he took for respiratory issues, wouldn't touch either of these, but he prescribed something that would work on both the pesky bugs infecting his bladder this time. So Tuesday night I went back to Target pharmacy yet one more time to pick this one up. Another $3. 3 pills a day with meals.
And the little coupon they gave us with the register receipt this purchase gives us a $15 Target gift card with our next new prescription we bring to them. I got a new one at the beginning of this month. Daddy got 2 new ones this week. And now they give us the coupon?