The Tab 6

Balance forward from The Tab 5: $240,120.48

1/26/11
Chest x-ray, 2 views, checking out my heart and whether it’s coping with the Herceptin infusions
$251.00

Office visit, level 3
$139.00

2/10/11
Bills finally in from the last infusion:

Three-quarters of a liter of saline solution
$36.00

Another liter of saline, (a quarter of a liter more than last time, I must have been dehydrated)
$13.00

Set IV pump, 1 port
$40.00

Chemo administration, first hour
$810.00

Chemo administration, second hour, with a price break
$258.00

Two “IV pushes” after the first drug
$516.00

8 mg. of Zofran, the anti-nausea drug
$160.00

10 mg of Decadron, the steroid that combats the effects of chemo. I forgot to take the pills beforehand!
$11.40

.49 grams of Herceptin, the monoclonal antibody
$9,506.00

.9 grams of Carboplatin, Last time, the price was down$1,298.00, to $8,464.00, more than 10 percent below. Now it’s back up to the old price of $9,522.00. Why remains a mystery, as outlined in my post “Carboplatin, Why are you so pricey?”
$9,522.00

.14 grams of Taxotere, a member of the Taxol family
$8,208.00

Subtotal for the last poison party:
$29,069.00

2/23/11
Complete transthoracic echocardiogram with doppler. This test is performed by sending high-pitched sound waves through a transducer pushed against different locations in your chest wall, to see how blood is flowing through your heart. Unfortunately, the heart is on the left, and this means the tech has to push rather hard under my left breast. Ouch. Luckily, the result comes back on the low end of normal. So apparently, the Herceptin isn’t damaging my heart overmuch. Cost for this peace of mind:
$3,101.00

3/4/11
Pre-surgery blood work:
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.” This price was up last time, now it’s back down to:
$98.00

3/7/11
Another transthoracic echocardiogram, to make sure that my heart’s really, really not being overly damaged by the Herceptin
$945.00, why this is more than $2,000 less than the last echo, I’m not sure.

3/8/11
Complete blood work-up before surgery.
Many of these are the same as last time:

Prothrombin time, how long does it take my blood to clot?
$85.00

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

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

But, for some reason, Dr. Hwang or somebody, has added a few more tests:

Glucose, fast serum, How much glucose, or sugar, in my blood after an 8-hour fast? This is often used as a test for diabetes.
$48.90

HDL Cholesterol, direct measure, a new, more accurate way to find out my level of “good cholesterol.”
$102.05

Cholesterol, serum total, Are they worried I’ve got heart disease, too?
$54.21

PSA, Total diagnostic, This is “prostate-specific antigen,” a test used to identify very early stage prostate cancer. Huh? I don’t even have a prostate gland!
$229.61

Testosterone, total, OK, are you sure my orders didn’t get mixed up with a guy’s, or maybe a guy with diabetes?
$322.15

Hemoglobin a1c. This is a standard test to measure glucose levels in diabetes patients. I think there’s a mistake here.
$121.18

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

Triglycerides, a measure of fat in my blood
$71.22

Vitamin D-25-hydroxy. How much Vitamin D in my blood? Not sure why this is relevant.
$104.17

Lumbar spine x-ray. Huh? I’m having surgery on my breast!
$271.00

Preventative – Established FPC
Can’t figure out what this is, the only “FPC” acronym that seems vaguely medical is “family planning clinic.”
Anyway, it cost:
$178.00

Total for pre-operative tests, including the ones that don’t seem to be indicated for a breast cancer patient:
$2,423.19

3/8/11
Back into surgery to get clean margins, i.e. a safe border of disease-free tissue around the place where they found cancerous tissue.

Pre-operative service. This consists of lots of nurses taking my blood pressure and asking me if I’m allergic to any medicines, starting an IV etc.
$510.00

Basic Minor Surgery Pack: I can’t seem to find the exact contents of this particular pack, but from surfing around the net, I gather it contains the same stuff they used last time: Blade No. 101, Blade No. 151, Cautery pencil (This a handle ending in a thin, electrically charged platinum wire used to burn tissue to close off small bleeding vessels.) Medicine cup, drapes, gauze, gowns, lap sponges (laparatomy sponges, rayon and polypropylene sandwiched between two layers of gauze, for mopping up blood), cover needle, needle container, skin scrub tray, ruler for skin marker, skin marker, syringe, cautery tip (tip for the cautery pencil I guess), OR towels (these are cotton, designed for “maximum absorbency” according to one website, Yankauer without vent, (this is a suctioning tool, kind of like the suction tube used at the dentist but this is for blood, and other “fluids.”) and so on.

While clicking around, I also come across this cool/gross website, “Limbs and Things” which apparently markets bits of synthetic body parts for med students to practice upon. You can buy a sebaceous cyst pad or a wound closure pad, and more. Cool, but slightly weird, too.
$352.00

Anesthesia, first 30 minutes
$787.00, or $26.23/minute, same price as last time.

Anesthesia, 54 additional minutes, for a total of 1 hour and 24 minutes in the OR
$1,458.00

Level 2 surgery, first 30 minutes
$3,140.00, or $104.66/minute, nearly double the price of last time: $53/minute

Level 2 surgery, 54 additional minutes
$2,862.00

OR Base Level B, This is the basic charge for the use of the operating room
$2,094.00, same price as last time

Bupivacain, 30 units, a local anesthetic.
$14.51

Fentanyl, 3 units, a narcotic analgesic (see Vicodin post)
$13.13

Hydromorphone, 1 mg, another narcotic analgesic, more commonly known by the brand names Palladone, Dilaudid
$13.66

Vicodin, I remember asking for this in post-op. How many opioids can a girl take in one day? A lot, it seems.
$0.77

Prochlorperazine, 5 mg, more commonly known as Compazine, an anti-nausea drug. We’re old friends from chemo days.
$23.66

Ondansetron, 4 mg, better known as Zofran, another pal from chemo days.
$4.46

Post-anesthesia care unit, 1st hour
$1,751.00, $29.18/minute

Post-anesthesia care unit, 117 additional minutes. Yay! This is the part where I get cranberry juice and graham crackers. Husband Pete and daughter Erin come in to sit with me and they bring COFFEE.
$1,755.00, or $15/minute. Why do we get such a bargain on the minutes after the first hour?

Path exam, Level IV, examining my breast tissue
$460.00

Path exam, Level V, examining another piece of breast tissue, apparently a more difficult piece.
$786.00

Path exam, Level V, yet another sample of breast tissue.
$786.00

Subtotal for entire re-excision adventure: $16,811.30, about half of what the original lumpectomy surgery cost.

RUNNING TOTAL: $292,947.97

God help us, the radiation bills haven’t even come in yet…

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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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