All I can say is that my jaw drops from these figures.
Balance forward from Tab 2, through surgery on September 7:
Miscellaneous charges related to 9/7 surgery and prep:
Pathology consultation, slides (presumably pathology slides from New York-Roosevelt)
Blood tests, mammogram, EKG, tests to establish my “baseline normal” before surgery:
EKG tracing only, the familiar “heart beat” scrawl on paper to show that my heart rhythm is normal.
Prothrombin time, how long does it take my blood to clot?
PTT, Activated, another test to make sure I don’t have blood clotting problems
CBC Auto, with platelet count
An automated count of various kinds of blood cells, red, white, platelets etc. This is considered more precise than “manual-counting”
Bilirubin, total, This is a measure of liver and kidney function. When hemoglobin is broken down into smaller pieces, bilirubin is one of the major components. It is usually excreted in bile and urine. An elevated bilirubin count can tip off problems in the liver and kidneys.
Sodium serum. How much sodium in my blood? Sodium is needed to regulate blood and body fluids, transmit nerve signals, keep the heart pumping and other vital things. As we all hear endlessly, of course, too much sodium isn’t a good thing.
Potassium serum. How much potassium in my blood? Potassium also helps transmit nerve signals. It’s also key to kidney, muscle, and the digestive system function.
AST (GOT) Aspartate Aminotransferase/Glutamic-Oxalacetic Transaminase, an enzyme found in the mitochondria (power source), and the “cytoplasm” (all the stuff in the cell that’s not an “organelle,” a membrane or a nucleus) of all cells. Elevated levels may signal liver disease or muscle disorders.
Alkaline phosphatase. Elevated levels of this enzyme can signal liver disease, bone tumors (the most common metastasis of breast cancer) or other bone disorders such as Paget’s disease.
LDH Total. “Lactic acid dehydrogenase” is found in almost all cells of the body. It plays a role in cell “respiration,” in which sugar (glucose) is converted into energy the cell can use. When tissues are damaged or diseased, they release extra LDH into the bloodstream.
ALT (GPT). “Alanine Aminotransferase,” another enzyme produced in the liver, another test of liver function.
Chloride serum. How much chloride in my blood? Chloride is a type of electrolyte, substances that help transmit nerve signals. Chloride works with other electrolytes such as potassium, sodium, and carbon dioxide (CO2) to help keep the proper balance of body fluids and maintain the body’s acid-base balance. An imbalance of chloride can be a tip off to sodium imbalances or kidney problems.
Carbon dioxide. How much CO2 in my blood? CO2 is another electrolyte that is closely tied to kidney and liver function.
Digital mammogram on the left side.
Total for pre-op tests:
RUNNING TOTAL: $70,972.31
FISH: Her2Neu. “Fluorescence In Situ Hybridization,” this test uses fluorescent probes to determine the number of copies of the Her2 gene, human epidermal growth factor 2. This gene is present in some breast cancers and can be effectively treated with Herceptin. The test, of course, is pricey:
TC SC LYM PER MCI. Injection of radioactive tracer to see if breast cancer has spread to nearby lymph nodes.
Complete echocardiogram with doppler. My cancer is borderline positive for Her2. Herceptin, which can treat this sort of cancer, can also damage heart valves, so they do an echocardiogram to get a baseline of how efficiently my heart pushes blood in and out.
PET with CAT scan from skull base to mid thigh. I’m having shoulder pain, so the oncologist wants to rule out any metastases, plus I’ve also agreed to be part of a clinical study of cognitive function, which requires a PET scan. By measuring gamma rays emitted by a radioactive tracer, PET scans can produce a three-dimensional image of body functions. It’s even more fine-grained imagery than an MRI, and it costs a fortune:
Contrast omnipaque 350mg. Contrast agent to make the CAT scan easier to read
Blood glucose test strip
FDG PET dose. Fludeoxyglucose. An analog of glucose, this is the radioactive tracer detected by the PET scan.
Subtotal for PET/CT scan: $5,937.50
RUNNING TOTAL: $81,728.81
Thin prep PAP test with imaging. Chemotherapy often can create abnormal PAP smear results, so it’s a good idea to get one before starting chemo.
Appointment with primary care doc who does the PAP smear.
10/28/2010 First day of chemotherapy
Complete blood panel of everything they measured before the lumpectomy, minus the clotting tests (I’m not having surgery)
Urea Nitrogen Serum. How much nitrogen in the form of the waste produce urea is in my blood? An indication of how well my kidneys are working
Creatinine serum. The urea test is often done with creatinine test. The ratio between the two can identify problems like dehydration
Blood draw, routine venopuncture. The charge for the phlebotomist getting the blood samples.
Total for blood work:
Outpatient visit to the clinic for check up to make sure I’m OK for chemotherapy
Half a liter of dextrose solution:
Half a liter of saline:
Setting up the IV:
IV push, new drug
Chemo infusion, first hour
Two addition infusions, up to one hour
.33 grams of Herceptin, the monoclonal antibody
.9 grams of Carboplatin, the old-line chemo drug
.14 grams of Taxotere, part of Taxol family of chemo druges
8 mg of Zofran, the anti-nausea drug
Subtotal for one visit to the infusion center:
Half a liter of saline, in the infusion center
Chemotherapy infusion, 1 hour
.17 grams of Herceptin, the monoclonal antibody, part of a “loading” weekly dose at the beginning of treatment
Back for another “loading dose” of Herceptin
Another half liter of saline
Chemotherapy infusion, another hour
Another .17 gram dose of Herceptin
Setting up the IV and the pump in the infusion center
Three quarters of a liter of saline
IV Push in preparation for a new drug
Another .49 grams of Herceptin
Charge for another hour of chemo
Charge for IV push in preparation for another drug
Carboplatin, an old-line chemo drug, .9 grams
Taxotere, part of the taxol family of chemo drugs, .14 gram
Decadron, a steroid to mitigate side effects
Zofran, an anti-nausea medicine
Subtotal for two “loading doses” of Herceptin plus one “full HCT regimen” visit with Herceptin, Carboplatin and Taxotere:
I knew these numbers were going to be big, but I am floored. This is only the bill through infusion number 2. I’ve had three infusions since then. With poison parties costing about $25,000 each, that probably brings my bill to more than $200,000. I’ve still got one more infusion to go, plus another surgery, radiation and Herceptin every three weeks through October.
How can anyone look at these bills and not conclude that our healthcare system is out of whack? Certainly, pharmaceutical companies should be rewarded for their efforts, but why are chemotherapy drugs so absurdly expensive? Shouldn’t some of the older ones, like Carboplatin, cost less than $9,000 a dose? Why are the visits with nurses—the clinic visits where the rubber meets the road—so undervalued? Surely the internist and the nurse practitioner who are my front-line caregivers deserve more than $170/$200 per visit? Surgeons get $53/minute! Well, at least the hospital gets $53 per surgeon-minute.
Obviously, minds greater than mine have, and continue, to wrestle with these issues. But next time you get an itemized medical bill, try looking at it line-by-line. I bet it will blow your mind.