The Life Insurance Questionnaire

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So tonight I had to answer some medical questions over the phone to some poor sap probably not making much more than minimum wage. From the way she read the questions, I could tell she was relatively knew at this. The questionnaire was for a new life insurance policy my wife and I are applying for. I had to answer questions about doctors, medical history and diagnoses.  I knew this was going to get interesting when the first question was about medication.

Luckily, this is coming now and not at the time a few months ago when my pill intake was over 40 pills a day.

So I rattled off my list:  Imuran, 100 mg.  Prednisone, 10 mg.  Flagyl, 250 mg three times a day.  Prevacid, 30 mg.

She then asked me the diagnosis that the medicine is treating.

"Crohn's," I replied.

"When were you diagnosed with Crohn's disease?"

"In 2000."

"What symptoms did you have to prompt that diagnosis?"

"I had some pain," I replied.

"Just pain?  Anything else?"

I paused.  I wasn't sure just how much information I was to give.  How detailed should I be?  Did I need to tell her about mucous poops?  Or the times the toilet bowel looked like something from one of those Saw movies?  I decided to go easy on her.  "And frequent elimination," I added.

"Frequent elimination?"  She was quiet for a moment, as if looking for something on a computer screen.  "Did you say elimination?"

"Yeah."  It was silent on the other end.  I could hear the keys tapping.  She was trying to find the box to check off on the form, undoubtedly.

I decided to help her out.  "I shit a lot," I explained.

"Oh," she said with surprise.  I heard some keys tapping and imagined with a slight chuckle a box on a computer screen somewhere in a dark room with the phrase "shits a lot" suddenly checked off.

Then she asked about diagnostic tests.  Oh, boy.  Where to start?  I listed off colonoscopies.  One in 2010.  2008.  And every two years before that.  Sigmoidoscopy in 2012.  Endoscopy in 2012. Exploratory surgery in 2012.  A CT scan in 2012 for a suspected fistula.  That was negative, I quickly added.  Three CT scans in 2010.  Stress test in 2010.  Another one in 2012.

"What were the stress tests for?" she asked.

"Costochondritis," I replied.

She paused, looking for a list on her screen.  "Can you spell that?"

I did and then explained that it is inflammation of the cartilage in the rib cage.  Back in May of 2010, I experienced severe chest pain and was brought to the hospital in an ambulance (I didn't mention that part.)   The CT scans revealed nothing abnormal.  And it was decided that the inflammation was probably related to the general inflammation I had as a result of Crohn's.  Nothing wrong with my heart, I assured her.

"What was the stress test for in 2012 then?" she asked.

"Oh, that.  I was experiencing pain and palpitations."

"Costo...whatever it was?"

"No.  It was the result of the large dose of prednisone that I was on at the time.  And the stress, most likely, during a particularly bad flare up."

"How often do you experience flare-ups?"  she asked.

I paused and thought about it. And the truth was, I really wasn't sure. The worst flare up I had was a year ago. I missed a couple of weeks of work as the Crohn's moved to my lower colon. That was when they had to go in and look at the inflammation and ulceration in the lower colon. I haven't had a severe flare since, but I have been on numerous medications since then, including a whole regimen Chinese herbs and ointments that I have since stopped.

I rarely get flares in the summer.  Probably because I am off from school.

I flare up in the Fall, usually. The Spring. The severity varies. Sometimes food can be a trigger, of course, but I didn't want to go into that whole history.

"About once a year," I said.

After answering some more questions about doctors and family history, the interview ended.  Now some stranger who I will never, ever meet knows a hell of a lot about me.  More than most people, actually.  And all of that data about tests, doctors, medicine and symptoms are now part of another large database.  My personal experience will soon be categorized and quantified; my weight, height and medication transformed into numbers that will be added to spreadsheets and risk assessments.  Everything I am will be reduced to a formula and that formula will determine how much I will have to spend on life insurance so that my family can be secure in case something happens to me in the near future.  Or if medical bills need to be paid.

How much risk is a Crohn's patient worth?  That is what someone, somewhere sitting in a cubicle staring at those numbers will determine.

Generally, I am pretty healthy.  Except for the Crohn's, of course.  But that doesn't matter to a number cruncher.  Life insurance companies are in the business to make money, plain and simple.  My experience---rattled off through a phone interview and a physical examination next week---will be reduced to a single number that represents my worth to someone who really has never met me.

But they have met Crohn's.

And to them, that is all that matters.

Fistula, In-Grown Hair or Staph?

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This is the sore a couple of days after draining;
it is about the size of a dime.

As I mentioned earlier, I took Imuran for two weeks and then stopped due to some pain that had returned in my right side. Blood tests turned out okay, yet the pain was still there.

And then the sore appeared.  It was relatively small, located just underneath my navel.  I hadn't seen it before due to two things:  1) it was located right at my waistline and covered most of the time under the band of my undies and 2) the flab of my gut covered it.

I didn't think anything of it.  Probably an ingrown hair or something, I told myself.  By the time I noticed it, the pain was rather high, however, and it resembled a volcano that was about to blow.  So I did what any person would do in such a situation:  I drained it and cleaned it with alcohol and went on with my life.

When talking with my I doctor, I mentioned the sore and she became concerned.  Although I assured her that it was nothing but a topical skin infection, she said that it could also be a fistula.  These noxious ailments are often mistaken for ingrown hairs or boils.  They are small, but painful infections that tunnel through the walls of the colon, through soft tissue until they reach the outside.  Fistulas can happen anywhere and for someone like me, any such external infection located on the abdomen is cause for worry.

So she ordered a CT scan^* and I was convinced that I now had a fistula.  I looked up fistulas on the internet. I compared pictures of fistulas to the sore on my abdomen.  Self-diagnosis is something we crohnies always do--and almost always assume the worst.  It's not that we are negative about our ailment, just realistic and prone to being prepared for the worst.

I had my CT scan on Friday evening and by Sunday I had the results.  My doctor phoned me to explain that it was not a fistula, but that I did have moderate swelling in my lower colon. Other than that, everything looked okay.  Nothing on the CT scan could explain the sore.

The sore was troubling to her, however.  Imuran is an immunosuppressant and could leave the body open to various infections.  This is the reason why I had to go through additional tuberculosis testing before starting the drug.  Among other things, immunosuppressants have the tendency to awaken latent tuberculosis in the body.

This is the sore today.

I saw my general practitioner today in order to get a look at the sore.  It's still there, but very much smaller.  He too was concerned that, after draining and applying alcohol, it was still red and swollen.  So, he gave me an antibiotic particular to skin infections.  And he told me that if it comes to a head, not to drain it.  I need to come back in so that he can take a culture and determine what type of infection it is.  Staph, he said, is something that has been coming back with a vengeance.

My GI wants to continue with the Imuran.  I am up for that, but have to wait until this sore is gone.  I have a week on this new antibiotic and then we will go from there.  What is strange, however, and most likely the reason for such caution, is that I have been on Flagyl for the last 9 months.

Flagyl is an antibiotic.

So, whatever it was that gave me that little, yet painful pustule, was strong enough to evade the Flagyl.

This new antibiotic is called Keflex.  Amazingly, it is not one that I have every had before.

Let's see if it works.

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^* You know you're a crohnie when a skin infection requires a CT scan