Let’s Say You Get Six Days

I saw a new doctor last month. She prescribed two new medicines for my headaches, which visit me with faithful regularity. One is a preventive, and time will tell if it prevents anything. I am, as they say, titrating up, taking a bit more every week until I’m at the full-bore dose.

The other is called an abortive, something to stop an incipient headache in its tracks. Ever hopeful, I’ve tried many, but have yet to find one that works and has no alarming side effects. The best one yet was given to me, in some desperation, while I was hospitalized in a special head-pain unit in Michigan. When I asked the name of this wonder drug, a wise nurse smiled as she told me, adding, “It’s a narcotic, and you can’t have it again.” Now I think it might be illegal. So much for that miracle worker.

The new one prescribed by the neurologist at the Cleveland Clinic is neither as dangerous nor as effective as that. But it works better than any others I’ve tried, so I’m glad to have it in my arsenal. But there’s a catch. Of course there’s a catch. If there’s one thing a person in chronic pain learns to expect, it’s the fickleness of anything that works.

In this case, though, it’s not the drug that’s the problem. It’s not addictive, like narcotics, and it doesn’t seem to cause rebound pain, the scourge of many analgesics that work so well, the body begs for more by sending out nearly constant pain signals. I’m good, anyway, at avoiding the rebound merry-go-round by following the rules, which state You Can’t Take This Marvelous Stuff Every Day, Even If You Need It That Often. No sir, not me. I take it only as directed, which means not often enough.

On the other days, I take drugs that don’t work so well, or, more often, nothing at all. My sisters in arms – a friend I met in the hospital, a grown child who inherited my head genes – send each other messages in code on those drug-free, pain-full days: “Going back to bed.” “Turn off the sun!” “Just shoot me.” Been there; said that.

The thing is, I think I could safely take two of these new pills every day. I’ve read articles in medical journals attesting to the efficacy of taking two of these triptans, as this class of drug is called, every single day, thus turning the abortive into a preventive for those with my diagnosis, which features – delivered fresh to your head! – daily headaches.

So the problem isn’t the drug, which works. It isn’t the doctor, who prescribed it. No, it’s the insurance company that, in its wisdom, limits coverage for this drug to twelve – not even a baker’s dozen! – pills a month. Since it really does take two to make a dent in a headache of moderate to screamingly high severity, that gives me six days a month when I can, if the stars are somewhat aligned, be relatively pain-free.

I know I’m not the only one with pain, or some other health burden of woe. Maybe you have cancer, or a father with Alzheimer’s. Maybe your 12-year-old son is struggling with Crohn’s Disease, or your wife’s heart is failing. The older you get, and the more people you care about, the more likely it is that you, or they, suffer from something Every. Single. Day.

My question is, what would you do if you had something, some handful of magic beans, that would allay that pain and suffering for 24 hours, but only six days a month? Which days would you choose to take a dose, knowing that would leave only five, and then four, three, two, and finally just one more day to function almost normally?

When my son was preparing to marry the woman of his dreams, I asked a big favor of my doctor. Not the big-shot specialist in Cleveland, but the kind, intelligent generalist I see at home. Could I please, I asked, have a prescription of X, the wonder drug I know I’m not supposed to take because it’s evil because it causes rebound headaches if you take it even twice a week? (It’s a barbiturate, and, for your own protection, I’m not telling you what it is.)

It’s so evil, it’s been banned in Germany. For once, I’m applauding our FDA’s tardiness. I find it interesting that my insurance has no problem covering thirty of those pills per month, evidently because it’s not a new, designer drug.

My first delivery of the new triptan arrived by the time I got home, and so far I’ve taken six. That leaves six more to cover the three weeks until I can get a refill. (If not limited by insurance, they would cost $15 a pill.) So that means three days. Three out of the next twenty-one days.

Which days should I save it for? The weekend we spend out-of-town with my son and his wife, or here with my visiting daughter? Two weekends would take all twelve pills. What about an anniversary dinner out with my husband? A presentation at work? Four Sundays to go to church, four Saturdays at the Farmers Market and Hy-Vee? What about Mondays at work, which can be challenging enough without headaches, or Fridays when everyone is calling out, “TGIF”? What if we’re having company? What if I want to read a book? What about, I ask you, the day the series finale of Mad Men airs?

But no. The insurance company, it its infinite wisdom, grants me only six days free of pain. I must grit my teeth – or not, since that can lead to headaches – and carry on.