The Tab 3

All I can say is that my jaw drops from these figures.

Balance forward from Tab 2, through surgery on September 7:
$69,238.23

Miscellaneous charges related to 9/7 surgery and prep:

9/2/2010
Pathology consultation, slides (presumably pathology slides from New York-Roosevelt)
$97.00

9/3/2010
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.
$176.00
Prothrombin time, how long does it take my blood to clot?
$85.00
PTT, Activated, another test to make sure I don’t have blood clotting problems
$120.00
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”
$98.00
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.
$64.84
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.
$60.59
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.
$58.47
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.
$64.84
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.
$64.84
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.
$75.47
ALT (GPT). “Alanine Aminotransferase,” another enzyme produced in the liver, another test of liver function.
$65.91
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.
$58.47
Carbon dioxide. How much CO2 in my blood? CO2 is another electrolyte that is closely tied to kidney and liver function.
$61.65
Digital mammogram on the left side.
$488.00
Chest x-ray
$192.00

Total for pre-op tests:
$1,542.08

RUNNING TOTAL: $70,972.31

9/7/2010
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:
$1,282.00

TC SC LYM PER MCI. Injection of radioactive tracer to see if breast cancer has spread to nearby lymph nodes.
$436.00

10/18/2010
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.
$3,101.00

10/25/2010
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:
$4637.00

Contrast omnipaque 350mg. Contrast agent to make the CAT scan easier to read
$439.50
Blood glucose test strip
$35.00
FDG PET dose. Fludeoxyglucose. An analog of glucose, this is the radioactive tracer detected by the PET scan.
$826.00

Subtotal for PET/CT scan: $5,937.50

RUNNING TOTAL: $81,728.81

10/26/2010
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.
$185.00

Appointment with primary care doc who does the PAP smear.
$230.00

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)
$606.61
and adding:
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
$48.90
Creatinine serum. The urea test is often done with creatinine test. The ratio between the two can identify problems like dehydration
$63.78
Blood draw, routine venopuncture. The charge for the phlebotomist getting the blood samples.
$62.00
Total for blood work:
$781.29

Outpatient visit to the clinic for check up to make sure I’m OK for chemotherapy
$177.00

Infusion Center:
Half a liter of dextrose solution:
$26.00
Half a liter of saline:
$24.00
Setting up the IV:
$44.00
IV push, new drug
$258.00
Chemo infusion, first hour
$810.00
Two addition infusions, up to one hour
$516.00
.33 grams of Herceptin, the monoclonal antibody
$6,402.00
.9 grams of Carboplatin, the old-line chemo drug
$9,522.00
.14 grams of Taxotere, part of Taxol family of chemo druges
$8,208.00
8 mg of Zofran, the anti-nausea drug
$160.00

Subtotal for one visit to the infusion center:
$25,970.00

RUNNING BALANCE:
$109,072.10

11/4/10
Half a liter of saline, in the infusion center
$24.00
Chemotherapy infusion, 1 hour
$810.00
.17 grams of Herceptin, the monoclonal antibody, part of a “loading” weekly dose at the beginning of treatment
$3,298.00

11/11/10
Back for another “loading dose” of Herceptin
Another half liter of saline
$24.00
Chemotherapy infusion, another hour
$810.00
Another .17 gram dose of Herceptin
$3,298.00

11/18/10
Setting up the IV and the pump in the infusion center
$44.00
Three quarters of a liter of saline
$36.00
IV Push in preparation for a new drug
$516.00
Another .49 grams of Herceptin
$9506.00

Charge for another hour of chemo
$810.00
Charge for IV push in preparation for another drug
$516.00

Carboplatin, an old-line chemo drug, .9 grams
$9,522.00

Taxotere, part of the taxol family of chemo drugs, .14 gram
$8,208.00

Decadron, a steroid to mitigate side effects
$11.40
Zofran, an anti-nausea medicine
$160.00

Subtotal for two “loading doses” of Herceptin plus one “full HCT regimen” visit with Herceptin, Carboplatin and Taxotere:
$37,593.00

RUNNING TOTAL:
$146,665.50

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.

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About leftbreast

I have had breast cancer. I was diagnosed at 47, and am now 49. I have finished "active treatment," two surgeries, chemo, radiation, monoclonal antibodies. These days, I only take a drug to suppress my uptake of estrogen, since my tumor was highly reactive to that hormone. I have been married to my husband Pete for 21 years. I have a stepdaughter, Maureen, 30, and a daughter, Erin, 10. I've been a freelance magazine journalist for 20-plus years, covering everything from Chinese foreign policy to Catholic nuns to endangered species. I have had a great life. I have lived in Asia and all over the United States. I have spent nights with tree-sitters in Oregon and with astronomers at the Mauna Kea observatory in Hawaii. I've been to a cocktail party on the poopdeck of a British destroyer docked in Shanghai. I've taken the bus to Tibet, and tramped through the cloud forests of Panama with biologists. A magazine sent me on a raft trip down the Colorado through the Grand Canyon; another sent me to cooking school for a week. I have spent time with celebrities, presidents and heroin dealers. I love my work. I have a loving, supportive family and more friends than I probably deserve. I have had the space and time to camp, ski, cycle, garden, cook and spoil my pets (an Australian shepherd, a German shepherd and a tabby cat). If it all ended tomorrow, I would have to say that it has been a really, really good ride. When I was in thick of treatment, I was simply fighting for more time. Now, I'm trying to connect the experience of cancer with the rest of my life, with the time that's been won. I hope the cancer never comes back, but if it does, I'll be ready. That's what this blog is about.
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One Response to The Tab 3

  1. I love how you thought to look at it this way. It is pretty jaw dropping.

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