Airway clearance

Thank you Scoop. I can't use Albuterol because it make me trimble . Have been using Levalbuterol for a few years but I have to stop every now and then because of thrush. Recently I started using
Ipratropium Bromide 1 X a day. but has to stop that yesterday due to thrush...I have found that Nystatin oral rince works best for me to cure the thrush .
Also recently learned from a CT scan that there is a vertabtas out of alignment and a spur from it is pressing on my esophagus.
I know now that is the reason for the dysphagia but also wondering if that is the reason it takes so long to get the mucus up. I have not found out yet if the esophagus is compressing the trach.

Rick, you said "The Medicare part d inconsistencies drives me crazy. How about the same plan for all?..." and @bamaqueen said her Advantage Plan doesn't cover Arikayce either.

Please, please, pleas bombard your Representative and Senators with these examples of inequity in Medicare, which was supposed to protect us all in our senior years. Ask them to clamp down on the insurance industry with all of its fancy-named plans to enrich them, not serve us.

Specifically, Advantage Plans came about because the insurance companies complained about needing a cheaper way to bring people in - they are paid a certain amount per year by Medicare for each enrollee, and that's all they get. So the more times they say "No" to a procedure or a referral the less money they pay out.

The drug issue is an even bigger issue. "Formularies" are agreed on each year by insurance companies and Pharmacy Benefit Managers (PBM's) - which are often owned by the insurance companies - creating Tiers of drugs with generics being cheapest, the newest patented drugs and biologics the most expensive.
Each insurance company sets the co-pays and "prior authorization" requirements for medications, then turns it all over to a tightly controlled group of people (who may or may not be medically trained) to run the process.

My insurance company changed PBM's this January, and medications my husband and I had been taking for a long time to manage chronic conditions had to be reauthorized - on first submission, both were denied as "not medically necessary" - appeals restored both prescriptions "for one year only." No person signs and can be held accountable for these authorizations. My daughter's PBM wants to authorize her biologic every 3 months, even though it is for a disease she'll have the rest of her life. Her latest kerfuffle with them caused a 4 month delay, forcing her back on high doses of prednisone - which she will probably pay for in her future with osteoporosis. I was just prescribed a new prior approval drug today, after having failed the conservative protocols. I will be watching closely to see how soon approval comes.

If you read around Connect, you will see we all need to lobby for change - with the people who regulate this, and not just amongst ourselves.

Spot on, Sue. Medicare Advantage plans are mostly an advantage to the insurance companies, not patients. My husband and I have Medicare with a supplemental plan through my former employer, and I am constantly surprised at how much more coverage for actual medical expenses we have than relatives with Medicare Advantage plans have and at how seamless our benefits are. Of course, I must admit we didn't get that free gym membership....

Raney. Besides nystatin liquid there are Nystatin tablets and clotrimazole lozenges- might be easier to use. I did not know they exist. Besides rinse mouth with apple cider vinegar( one teaspoon for a glass of water) that helps too or tea tree oil- might help too. By the way I really think nystatin has terrible taste.

Thank you Scoop. I can't use Albuterol because it make me trimble . Have been using Levalbuterol for a few years but I have to stop every now and then because of thrush. Recently I started using
Ipratropium Bromide 1 X a day. but has to stop that yesterday due to thrush...I have found that Nystatin oral rince works best for me to cure the thrush .
Also recently learned from a CT scan that there is a vertabtas out of alignment and a spur from it is pressing on my esophagus.
I know now that is the reason for the dysphagia but also wondering if that is the reason it takes so long to get the mucus up. I have not found out yet if the esophagus is compressing the trach.

raney. After reading your post I wanted to ask you about your experience with levalbuterol causing thrush. I've got an autommune condition (lichen planus) which causes problems with my gums--inflammed, very tender. I never experienced what I thought might be thrush. I've used levalbuterol (puffer) for over 5 years and last year my teeth have begun breaking off at the gumline--six so far. None of the doctors or dentists have any answers and to be honest I don't think they want to take the time of help figure things out. I'm 78 and have been told my bones or gums are not strong enough to have implants or even dentures. They've made a partial for the upper and the inflammation is so bad I can't eat with it or even wear it. They have done numerous "adjustments" but things are unbearably painful. I guess I'm just trying to grab at straws to attempt to find answers before all or most of my teeth are gone. If you prefer to pvt message me, that's fine. @fdixon63

When I had iv amikacin my id doctor arranged it through a research pharmacy so it was paid differently. So there are ways not to pay for it but I think the doctor has to be resourceful and willing to help. My id doctor was like that. On the other hand my pulmonologist is passive and was very surprised I was prescribed a vest during my NJH visit and my insurance paid for it. She still thinks I did not qualify- it’s just good will or lack of it.

raney. After reading your post I wanted to ask you about your experience with levalbuterol causing thrush. I've got an autommune condition (lichen planus) which causes problems with my gums--inflammed, very tender. I never experienced what I thought might be thrush. I've used levalbuterol (puffer) for over 5 years and last year my teeth have begun breaking off at the gumline--six so far. None of the doctors or dentists have any answers and to be honest I don't think they want to take the time of help figure things out. I'm 78 and have been told my bones or gums are not strong enough to have implants or even dentures. They've made a partial for the upper and the inflammation is so bad I can't eat with it or even wear it. They have done numerous "adjustments" but things are unbearably painful. I guess I'm just trying to grab at straws to attempt to find answers before all or most of my teeth are gone. If you prefer to pvt message me, that's fine. @fdixon63

@raney Diligent airway clearance will help with the deep mucus removal. It took time to build up and it will take time to get out. Mucinex 1200mg tablet twice day and 7% saline via nebulizer twice day. Albuterol before nebulizer often helps especially in asthmatics.

Allergic to most antibiotics used for treatment and mucinex. Have any of you had any other expectorant prescribed? Thanks