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HAD 3 FISH/PCR LABS This year at same location. FISH Postive but stable. Why does Onc insist on still doing PCR? Don't get it?

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#1 pamsouth



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Posted 10 October 2012 - 08:21 PM

Everything about the same.  Have had 3 FISH/PCR, CMP, CBC, this year at the same lab, on site where my oncologist is.

Labs Sept 19, 2012 -  FISH AT 5% AND PCR AT 6.09 %.

June 2012, -  Fish 6.5% and PCR 8.4 %.

March 2012,  - Fish 1.5% and PCR 7.623 %.

CBC, CMP,  good,  glucose was a little high 114, but then it jumps around between 85 to 120.  Probably should have fasted.

Kidneys's about the same, GFR EST MDRD 60,  GFR COCKROFT GAULT EST 57 LOW, Would like for them to be a little higher.  <60 puts me in chronic stage., so I am border line there, sort of jumps up and down a little.

Creatine .86 normal.  Bun 13 normal. Everything else normal. WBC 6.2, RBC 4.05, HGB 12.7 Platelet 415, Differential granulyctes in normal range.

All of the above labs were done at Indiana University Simon Cancer Center.   Indiana University is a school of medicine where they have students from all over the world come to study and do their internship.  The cancer center  is in  busy downtown Indianapolis. I have to pay to park, but it is only 15 miles from my home.   I believe they are the only ones in Indiana that actually do the FISH & PCR in house.  I don't know why he, the oncologist keeps ordering the  PCR since my FISH is positive.  I asked the nurse if the onc would not do the PCR, as it cost the insurance over $3000,00 but I guess he still wanted the PCR.

I mentioned my Medicare would be effective Dec 1, 2012 and I needed to call to find out how that works.  Onc said he doesn't know anything about insurance.  Nurse said we have older people on Medicare that come here.  However I got some literature about Medicare and our UAW benefits.  It looks like if I have my labs done in Dec I would have to pay my deductibles, and then pay them again in January when I go for my oncology appointment.  That's kind of stupid.  So I think I will call Medicare to make sure I understand and push my lab and onc visit both into Jan.  That will probably upset the oncologist, he already lectured me about not coming every two months, I said NO, because of my insurance.   He has sort of got a short fuse.  I took 2 lorazepam before I went to my appointment and didn't say much to him, he did most all the talking.  In fact he asked me if I knew that Gleevec would be generic 2013.   When he got upset about me not coming every two months, I just repeat myself, I don't think insurance will pay for it because my labs have been the same for quite a few years, including here at Indiana University. Yep  every time he goes over the same issue, I just repeat....  and they say women are bad about repeating, I wondering why does he not hear? 

All in All, the appointment really didn't go that bad, he just tells me one thing, and I do another, he is not the one who has to pay the bills, and he could have me do a monthly CBC, but when the nurse suggested I call her for a script to do labs, I assume she meant CBC, he said no, yet he wanted me to come in every two months as I am in a short window, and I said I don't think insurance would like that, I am stable for a number of years,  diagnosed 2005.   I did push the issue, every 3 months, he seemed to be irritable.   Again I don't understand if he is so concerned why he just doesn't have me do a monthly CBC locally.

Anyhow I should call Medicare, since it is effective Dec 1, 2012 and see if I will have to pay deductible for 2012 as I am scheduled for another FISH & PCR in Dec then Onc visit in Jan 2013.  Seem kind of stupid to pay deducible in Dec for 2012 and turn around in and pay them again for Jan 2013.   I will check on it and onc will just have to realize I need to do the practical thing and work with my insurance, if he is worried about me, I can go do a cheap CBC.

Don't know if this makes sense, it is getting late, will proof read it tomorrow.



#2 CallMeLucky


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Posted 11 October 2012 - 10:03 AM


I notice you keep saying you "don't think insurance will like it".  Frankly who the hell gives a damn what the insurance thinks?  I get being responsible and not having frivolous tests but you have a serious illness and you are willing to put yourself at risk to save the insurance company a few dollars?  They had no problem collecting your premiums when you worked and were healthy.  If you want to get pre-approval on everything before hand so you don't get billed that makes sense and go ahead and do that.  If at the end of the day you say "I am too tired to deal with this, come what may I will keep doing what I am doing for as long as it works" then fine, that is your decision.  I just hope you are not making decisions about your care based on your assumptions of what the insurance company may or may not do.

Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%


#3 Sneezy12


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Posted 11 October 2012 - 01:56 PM

If your Oncologist is "worried about me", why do you think a CBC will give him any useful information? Regards, Frank

#4 Trey


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Posted 12 October 2012 - 09:20 AM

When the FISH is  at or near the "false positives" level, doing a PCR is a good idea.

#5 pamsouth



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Posted 12 October 2012 - 01:25 PM


I was just thinking the Oncologist said I have a small window, I am assuming he meant if something went wrong, as he has been on me to see him and have labs every two month instead of three month.  I have been going to an onc every three months for a few years and my FISH have always been between undetectable to 8%.

Kind of a confusing story, but before I changed oncologist and went to Indiana University Cancer Center, my previous oncologist, sent my labs FISH/PCR to Bio Ref Gen Path in N.J.   I was PCRU for a few years, but sometimes they would retest PCR because my FISH would be positive.  When I switched onc to Indiana University, I gave him quite a few copies of my labs, from Gen Path (i think they have changed names) and he said I couldn't have been PCRU with positive FISH, so he did some other labs and all were negative.  Also the lab in N.J. had changed over to IS and the PCR was jumping up and down all over the place, I mean as high as 50% increase, then a week later down to 12%, so go figure.  I know it makes no sense and no one understands it.  However FISH have always remained stable the past several years.

OH, back to the question,  I just thought if oncologist at Ind Univ ( I'v had my last 3 labs with him at Ind Univ)  was worried about me being in a small window, that if I did a monthly CBC it would indicate if there was something not right and then I could get another FISH/PCR.  Plus the insurance would warrant paying for another FISH/LAB.  Otherwise just leave the FISH / PCR LABS at every three months.

I know Lucky says don't worry about insurance, but my experience of disputing claims with them has not been pleasant.  However this year at Indiana University my claims have went thru pretty smoothly.  For the first time in seven years I have not had to dispute a claim.  However I will be Medicare age 12/01/12, even though my birthday is New Years, New years birthday are always effective 1 month early.  Must have something to do with money.  Anyhow I am suppose to have labs in Dec and Onc appointment in Jan.  But when I got my medicare benefit statement, I do believe they will charge me dedcutible for 2012 and then again for 2013.  So am thinking about moving labs to January, Onc will think I am being difficult again.  But he keeps saying he doesn't know anything about insurance.  I do need to work with in the realms of my insurance, I don't want thousands of dollars, of debt that are not necessary.  I really don't think I am in eminent peril, as long as I get labs every 3 months and perhaps I should pressure onc for CBC every month, can't figure out why he didn't want the monthly or bi-monthly CBC.  But then he didn't seem to being having a good day.  I did try to be professional and listen and was nice to him. I didn't think I gave him a hard time.  Onc didn't say anything about Sprycel this time, but other two visit we sort of had strong disagreement about changing drugs.  Maybe that is why he always seems frustrated.  He did snap at the nurse when she told me to call her and she would give me a script to go to my local pharmacy.  I think maybe I will go to him one more time, then I will have 4 FISH/PCR from Ind Unive.  However I do think they are the only ones who do FISH/PCR in the state of Indiana and they are only 15 miles from my home.  I think all the other cancer hospitals and oncologist sen theirs PCR/FISH LABS out of state.



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