Praise then darkness, and creation unfinished

I talked to Carmen this afternoon. This was originally my quarterly appointment for the Ritalin prescription. That only took a couple of minutes, long enough to confirm that the meds are still working reasonably well, and ask if she could write the next prescription for 87 days after I filled the previous 90-day prescription.

Then we talked about my gut. I was hoping to be able to tell her that it had been (just) over 4 days since the last episode of diarrhea, but alas, I had one today, not quite four full days since the previous.

It turns out that when they said the symptoms might last for a while after finishing the antibiotics for C. diff, "a while" means a couple of months.

So:

I will continue to track tbe symptoms/how often I need to take Imodium.
Get another package of the probiotic, because it might help and won't hurt.
Carmen isn't going to put me in touch with the infectious disease specialist unless I'm still having symptoms at the end of February.
If I need another antibiotic, Carmen may look into fecal transplant to reset my microbiome, ditto if the symptoms go away soon, but I have a recurrence at some point in the future.

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I had a frustrating time getting through to the customer service department for my Visa card: the number printed on my card, and as "lost/stolen and general inquiries" on last month's bill, connected me to the collections department. I eventually got someone in that department to connect me to customer service, where it turned out that they hadn't issued a new card to replace the one that expires at the end of this week. The agent ordered me a new card, and predicted it would get here in 3-5 business days. She suggested calling on Monday to check, if I don't get it before then. I asked her for the number to call, and she gave me a number that might work. It's not the one printed on the card, and it's not the one I got from the first collections agent, which was out of service.

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I went out for a brief walk this afternoon, because I've spent too much time sitting indoors, and I wanted a little exercise that isn't just my PT exercises.

This is via MyChart, with the usual "has not been reviewed by care team" note:

Negative for Campylobacter Species antigen.

This result is listed as "normal," but I don't think it was high on the list of possibilities.

Second result just showed up,

Negative for Shiga toxins, EIA w/RFL to E. Coli O157 culture.

Also listed as normal. That top line means "with reflex to," meaning run an E. coli test using the same sample if the first was inconclusive. Thanks for the correction/explanation, gatheringrivers

1) I finished the Dificid (antibiotic) Friday morning, but am still having occasional bouts of diarrhea. ( numbers )

So I called the dentist to reschedule, since I can't count on being able to sit still in the dental chair for long enough, and then called my doctor's office.

Carmen just called me back, and I told her what's going on. She took notes and said she is going to send a message to someone who knows more about C. diff. We were talking at 6 p.m., so Carmen didn't expect an answer today, and said she will call tomorrow if they don't respond, and that she'll call me back tomorrow or Wednesday. In the meantime, I am continuing the probiotics.

2) I got email from CVS Caremark at about 3:00, saying they had my prescription and would "begin processing it shortly. If we run into any issues while filling your prescriptions, we will contact you or your prescriber." Having heard nothing for a couple of hours, I used the chat on their website to ask for status. In reply, the agent told me what the copay would be. I asked how to pay that, but when I tried to follow those instructions, it showed a zero balance. Back to chat, where the agent told me that the way to add a payment method was via "set up automatic payment." I have done this, but that took long enough that it now says I will get the Kesimpta on Wednesday.

Given how healthcare works in the US, I didn't expect it to be that hard to find out how to pay them.

I just finished my video call with Carmen. She said the Dificid usually takes 3-7 days before there's noticeable improvement, so it could be as early as tonight, but Friday is also plausible. Based on that, if I'm not feeling somewhat better by next Monday, which would be ten days, I will call her office again. (I was feeling better yesterday than the day before, but worse this morning, so that was probably random variation.) That had been the main thing I wanted to ask about.

Carmen also called in a prescription for a two-week supply of a probiotic. Wnile Dificid isn't as hard on the gut microbiome as some antibiotics, the probiotic still might help and won't hurt. If I start taking that today or tomorrow, I'll be taking it until a few days after I finish the Dificid.

Dr. McGonigle, who I talked to on Friday, said she wanted to redo some of the testing once I'm recovered, because the test that came back as "consistent with Crohn's and ulcerative colitis" tends to produce false positives if there's an active infection. Carmen agrees that retesting (rather than assuming a false positive) makes sense. While we were talking, she checked when to retest for C. diff. after the patient recovers, and the answers were "wait six weeks" and "don't even bother" (because even healthy people have enough of the bacteria in their system that it might show up on a test).

Carmen was shocked at how expensive the Dificid was, and I asked her to pass that information along to Dr. Morgan. Dr. Morgan might still have prescribed the Dificid, but if she'd known how expensive it was, I think she'd have asked whether I wanted to try something less expensive.