Katz Patient Advocate Inc.

Health Tips by Myra:
Saying Good-Bye Isn’t Easy
As I sit here with Ms. X in her hospice room as her death doula, I think about how difficult it is to die. She is unusual because she has been here for more than two weeks. In fact, this is my third visit. When I first came 13 days ago, she was semi-conscious, occasionally crying out, but mostly comfortable. I watched her aide lovingly bathe her, covering her private parts and moisturizing her skin. Lastly, she plucked the little white hairs on her chin so she would look beautiful as she prepared to die.

When I visited last week, she was still with us but had slipped into a coma. I was sure she was able to hear me. Studies have shown that hearing is one of the last senses to go. I talked about the balloons in her room, the cards from her family members, and how much they love her. But it is nearly impossible for them to be here all the time. She is here in a beautiful facility, cared for by nurses, nursing aides, doctors, and death doulas.

When a loved one is near death, perhaps in a coma or heavily sedated because of pain, it’s vitally important to be present for them. Be aware not to have negative conversations with other family members or discuss their condition with the medical staff in their presence. Hold their hand, speak to them, and reminisce even when they can’t participate in the conversation. Let them know they are loved. Let them know they will be missed but never forgotten. Help them let go.

And I am back six days later, and Ms. X is still with us. She is lying peacefully in her bed, with her arm wrapped around her stuffed bear, in a clean, crisp pink patterned hospital gown. She looks very comfortable. Who knows what she is waiting for, why she is clinging to a life slipping away? Once again, I am reminded of how much work it is to die and how blessed I am to be a part of this process. Perhaps she will be here next week when I return, or maybe she will have passed over. I talk to her again today, wishing her an easy passing, and I remind her she is loved.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra
More on First Aid Kits
Recently, we discussed the necessity of a first aid kit and to know where it is at all times.

A friend recently moved, and while the delivery men were bringing in the washer and dryer, one cut his finger badly, enough that it bled on the stairs and the carpet. The new homeowners couldn’t locate the first aid kit, but fortunately, one was in the delivery truck.
As I reviewed the previous blog, I realized there are things I missed that need to be available, especially during summer. And things that we need in our homes.

1-chewable aspirin, 81 mg. You NEVER want to take this without a physician’s ( or PA/NP) advice, but if you think you may be having a heart attack, you are often advised to chew aspirin. Keep a small bottle in your home, first aid kit, or purse, and ensure it isn’t expired.
2-Many first aid kits (including the day hiker one I pictured) include some medications, including acetaminophen, antihistamine, and perhaps chewable aspirin. Check the expiration dates (I just realized that our envelope of aspirin EXPIRED in 2017), and keep them current.
3-butterfly bandages.
4-perhaps aloe Vera, if you have a bad sunburn

As I have said, you can buy a First Aid Kit pre-made or make your own. Either way, be sure to have one accessible at all times. You never know when you will need it.

Health Tips by Myra:
Thirst—The Healthful Benefits of Water
We all hear the importance of drinking plenty of water to avoid heat stroke, especially during yet another heat wave. The “magic” number is 64 oz daily, but we don’t know if that is correct. But it doesn’t matter. The key is to drink regularly and not wait until we feel thirsty. By the time you are thirsty, you are probably somewhat dehydrated. In addition, as we age, we tend to feel less thirsty, so we must be reminded to drink.

My grandson knows that if his “pee” smells or is dark, he needs to drink more, something we all need to adhere to. When you are well hydrated, your urine should be straw-colored.

Six years ago next month, I had a heart attack and required two stents. I had two blockages, (80 % in my main artery, the LAD, also known as the “widowmaker” and 64% in another). While I will never know for sure, dehydration most likely precipitated the event. I was at the beach for the weekend with friends. It was hot, I had cocktails (2), we took walks in the heat, and I know I did not drink enough water. Alcohol doesn’t count in the “64 ounces”. Dehydration makes your heart work harder as the blood in your body becomes viscous (thicker), which can lead to an increased heart rate, palpitations, and possibly clots in your heart. As I said, I will never know for sure, but now I work very hard to drink plenty of water daily, especially when I exercise and in the heat. Dehydration can also cause urinary tract infections, (particularly in the elderly,) and kidney stones as well as dizziness, fatigue, and balance issues.

My nurse practitioner suggested I place a 16-ounce water bottle next to my bed and drink the entire amount when I wake up. I have now had 25 % of what I need.

FYI, caffeinated beverages and alcoholic drinks don’t count as part of your fluid intake. The other question is: do you need to consume electrolyte-balanced drinks? Most people don’t; however, one bottle daily (Gatorade, Liquid IV, etc.) is probably adequate and should be incorporated into your intake if you exercise and sweat. Just don’t overdo it.

If you are older or don’t experience thirst, set a timer on your watch or phone to drink every 15 minutes.

Carry a water bottle with you, especially in this heat. Buy a fun water bottle; whatever it takes, drink your water.

Do you have any other suggestions on how to get adequate water intake? Please share.

See you at the water cooler.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Advocacy at its Best: Prevent, Don’t Sue
I recently had a telephone call from a fellow Physician Assistant who looked at my resume and saw that I had worked for a lawyer as an investigator, determining when medical standards were breached and if there was potential to sue the doctor (or hospital.)
As I listened to her, it took me back to many years ago when I believed that I could change the system, that if there were “bad” doctors out there who made life-changing mistakes, not only would the patient be compensated, but the doctors would no longer be able to practice.

I quickly learned that in Maryland, at least, it doesn’t matter. I had one doctor who was found guilty of malpractice four times and was still practicing when he missed a lacerated liver on an 18-year-old child who died.

As I was listening to this woman speak to me about what happened to her mother, I realized that trying to stop the doctors was a long and arduous task. Instead, we must work to prevent these incidences. We need to advocate for ourselves, our loved ones, our clients. Why wait until the mistakes happen?

No amount of money will make up for a dead child or a parent who had been independent, now living in assisted living, unable to toilet themselves.

Unfortunately, we live in a time when the healthcare system is broken. More and more people are leaving medicine (upwards of 50% of people graduating from medical school will not practice as physicians). The cost of drugs is at an all-time high, and we need to protect ourselves and work with our providers.

Having an advocate will help you navigate the “broken” medical system and make your visits more meaningful and productive. We know what questions to ask, when a second opinion is necessary, and the risks to consider when pursuing tests and treatments. We can review your medication list and work with your providers to be sure you are taking what you need, no more, no less.

Don’t forget your yearly physical. Keep track of your preventive health visits, i.e., mammograms, prostate scanning, dermatologist screening, and any other specialists you see. Don’t count on the doctors reminding you.

Be your own advocate! If you need help, call or email me. It may save your life or the life of someone you love.
410.978.3763 or [email protected]

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Advance Directives are not: “One and Done”

Recently, I had the opportunity to give a “lunch and learn” to my financial planning group. It was a fundamental overview of how we all must be prepared with our Advance Directives and have the “conversation.” While talking, we realized that one of the women there had lost her mother a few weeks ago. In speaking to her, we discovered all the “mistakes” and how they could have gone sideways.

Her mother did have an Advance Directive and had had many conversations with her husband, daughters, and doctors about all of her wishes. She had dementia and three days earlier had been diagnosed with inoperable pancreatic cancer but was in no pain. The family was to meet with the doctor to determine if and how she would be treated. That morning, her husband woke and realized that she wasn’t breathing. Her daughter recommended that 911 be called; they didn’t know what else to do but knew that she was a DNR (do not resuscitate and no heroic measures.). However, she was dead, and there was nothing that 911 could do.
What the family did not realize was that EMTs have an obligation to save a life. I have seen times when the EMT does everything in their power to attempt to “bring someone back,” even if they have a DNR tattoo on their chest.

The family needed a MOLST form (Medical Order for Life-Sustaining Treatment), in which case they would do nothing. EMTs look for a MOLST order to know what they should do immediately before transporting. What was “routine” could have become a nightmare for the family. The lesson here is not to call 911 if the person/family doesn’t want them to have CPR or any other aggressive treatment.

In talking with the daughter yesterday, it occurred to all of us that her mother had an Advance Directive, and her father was in charge of making the decisions. But now that her mother had died, the form her father had in place listed his wife to make decisions, so he is now without any Advance Directive.

Everyone needs a MOLST form for EMTs and an Advance Directive. We must review and redo all our forms annually and with any life change, i.e., death, marriage, or new medical problems. Things change. Be prepared.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Advance Directives are not: “One and Done”

Recently, I had the opportunity to give a “lunch and learn” to my financial planning group. It was a fundamental overview of how we all must be prepared with our Advance Directives and have the “conversation.” While talking, we realized that one of the women there had lost her mother a few weeks ago. In speaking to her, we discovered all the “mistakes” and how they could have gone sideways.

Her mother did have an Advance Directive and had had many conversations with her husband, daughters, and doctors about all of her wishes. She had dementia and three days earlier had been diagnosed with inoperable pancreatic cancer but was in no pain. The family was to meet with the doctor to determine if and how she would be treated. That morning, her husband woke and realized that she wasn’t breathing. Her daughter recommended that 911 be called; they didn’t know what else to do but knew that she was a DNR (do not resuscitate and no heroic measures.). However, she was dead, and there was nothing that 911 could do.
What the family did not realize was that EMTs have an obligation to save a life. I have seen times when the EMT does everything in their power to attempt to “bring someone back,” even if they have a DNR tattoo on their chest.

The family needed a MOLST form (Medical Order for Life-Sustaining Treatment), in which case they would do nothing. EMTs look for a MOLST order to know what they should do immediately before transporting. What was “routine” could have become a nightmare for the family. The lesson here is not to call 911 if the person/family doesn’t want them to have CPR or any other aggressive treatment.

In talking with the daughter yesterday, it occurred to all of us that her mother had an Advance Directive, and her father was in charge of making the decisions. But now that her mother had died, the form her father had in place listed his wife to make decisions, so he is now without any Advance Directive.

Everyone needs a MOLST form for EMTs and an Advance Directive. We must review and redo all our forms annually and with any life change, i.e., death, marriage, or new medical problems. Things change. Be prepared.

Health Tips by Myra:
Need a Medical Procedure in June or July?

This is a blog from last year, but it is important enough to review it annually (like we review our Advance Directives) as it is one constant in the health care system.

If we talk with our friends and tell them of an impending elective surgery or medical procedure, often we are met with, "Don't go in July. The new "doctors" are there, and they don't know
anything." And June isn't much better, as the fellows typically have one foot out the door, and some people often complain that the care is lacking.

Is it true? Are we more vulnerable at the end of June and in July, when many of our doctors went from Mr., Ms. Mrs. to "Dr. Smith" overnight? It may be, but it reminds us of the need to continue to do our due diligence and not assume that things will "flow" perfectly" and there will be no glitches in our care. So, how do we do that? For More: https://www.katzadvocate.com/blog/2024/6/6/need-a-medical-procedure-in-june-or-july

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra
First Aid Kits for Home and Travel

Help!!!! The cry comes from your child who has been playing on the swing set. Or from your husband who is slicing bagels. Or from your daughter who was playing on the deck and has a foot full of splinters.

Are you prepared? Do you have a first aid kit in your house? Do you have one in the car? Do you know where it is, and has it been checked recently?

If you don’t have one, it is easy (and necessary) to either buy one ready -made (Amazon, REI, drugstore) or put your own together. And, if you use up an item, be sure to replace it. In fact, check your first aid twice yearly when you change the batteries in your smoke alarm.

Here are the basics that you should have in your home kit:
Adhesive tape
Elastic wrap bandages (in various sizes)
Band-aids and butterfly bandages in various sizes
Liquid Band-aids
Nonstick sterile bandages
Eye shield or pad
Instant cold packs
Duct tape (it is also waterproof. When my son lacerated his arm on a canoe trip,
And was unable to get stitches, which he needed, the counselor used butterfly
Bandages and duct tape. It stayed dry in the river and healed well.
Disposable non latex gloves
Scissors and twisters
Hand sanitizer
Antibiotic ointment
Antiseptic solution and towelettes
Eyewash solution
Hydrogen peroxide
Thermometer
Covid tests (Covid has not gone away!)
Masks

Medications:
Aloe Vera gel
Antihistamine, i.e. diphenhydramine
Hydrocortisone cream
Pain relievers, i.e. acetaminophen, Ibuprofen, CHEWABLE ASPIRIN, 81 mg (to be
Used if any possibility of a heart attack)
Auto-injector of epinephrine, if prescribed by your health care provider.

Emergency Items:

Phone numbers for doctors, family members
Flashlight
Fire extinguisher

Remember, first aid kits should not be limited to your home, put one in your car, and if hiking, or bicycling, one in your backpack. Carry a small one with you when you are out with the family, just bandaids, wipes, Tylenol, chewable aspirin. Be prepared.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Get Your Affairs in Order

It’s one of the most frightening phrases you may hear from your healthcare provider. It means we are facing our death soon.
Why wait until you get that heads up, if indeed you have that time. You don’t want to waste the end of your days doing this. Do it now, for those you love the most or for your own piece of mind!

We know that tomorrow is not guaranteed for any of us. We could have a medical emergency (heart attack), car accident, or illness, and there may not be a tomorrow.

What does it mean to “have your affairs in order?” There are a lot of parts to this, so let’s go through them one by one.
1-Have an updated will. Review it annually and change it if need be.
2-Be sure the will is in a place that your loved ones know where to find it, not in a Safety Deposit box. The bank can seal Safety Deposit boxes as soon as they are notified of a death. Look into getting a safe box in your home; they are not expensive, and you can put all your important papers there.
3-Prepare your Advance Directives, including a living will, medical health care proxy, and a MOLST (or POLST) form.
4-Be sure your family has your passwords to get into your computer and passwords to pay bills you pay online.
5-Make a list of your monthly, bimonthly, and annual bills, the amounts, and when they are due. If you pay annually, your heirs may be entitled to a refund depending on when you pass.
6-Discuss funeral plans with your loved ones, arrange them, and possibly pre-pay it. This will make life much easier for everyone. Don’t let them guess as to what you want, or worse have family members argue about it.
7-If you have been living in your house for decades, declutter. Please do not leave it to your spouse or children.
8-Be sure your heirs have a list of all your assets, financial advisers, and insurance (life, long-term care).
We all know the rawness of grief when a loved one passes. Make decisions ahead of time. If you have difficulty with some of the suggestions here, ask an advocate for help. Preparing for the inevitable is the best gift you can give the ones you love.
Call or email me for a free consultation on how I can help you do this. [email protected] or 410.978.3763

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Death Doula
I am a volunteer Death Doula for my local hospice. What is a Death Doula? I assist patients and their loved ones as they are near passing away. It is a very humbling experience and makes the family feel better. I believe people can still hear as they get ready to die, and I try to comfort them and let them know they are not alone.

Usually, I am a Death Doula at the facility, and patients at this point no longer receive anything by mouth, food, or water, but they are very comfortable, and nature takes its course. Today, I am at a nursing home, and I am both sad and appalled. The patient is an 83- year-old who had a stroke, and I was told: “actively dying.” However, she is still getting fluids by IV, being fed through a feeding tube, and presently is breathing at 52 breaths a minute! The average person takes approximately 15 breaths a minute. This woman is using every bit of strength to breathe. It’s exhausting! And this is where morphine has a role. It helps with pain and controls breathing.

And Medicare continues to pay. Why? Did anyone discuss her prognosis with the family? Do they understand that she is struggling to breathe? Did she have an Advance Directive? I don’t know if she is a full code, meaning, if (when) her heart stops, will they administer CPR?

We need to prepare for death as we prepare for childbirth, and my being here today is yet another example of the importance of this. When my father-in-law (post-stroke, in chronic pain, demented) was failing, my sister-in-law wanted him to have a feeding tube, among other life-preserving measures. I am “just the daughter-in-law”, but I asked my mother-in-law, “If Dad had had a crystal ball?” (this was 30 years ago, and Advance Directives were not the standard). I didn’t need to say anything else. My mother-in-law said, “We are done; we will let nature take its course.” Two weeks later, she called me from Florida to tell me he was in bed, she couldn’t wake him, and his breathing had changed. She never called 911; my husband flew down, and he died the next day peacefully.

Make plans and have a conversation. Maintain control. When it is my time, I don’t plan to be kept alive any longer than my body wants with intravenous fluids and tube feedings. And embrace and accept death as we embrace and accept birth. I have an Advance Directive, which I have discussed with my loved ones. We all need to be prepared.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
When is the Best Time for Seniors to Move

My husband and I have lived in our home for 36 years, raised our sons here, made lifelong friends, and celebrated holidays, family events, good times, and challenging times. And I LOVE my backyard. It is my little slice of paradise, private with birds of all varieties, flowers, vegetables, and deer (on the outside, thanks to the addition of our fence.) We belong to a wonderful synagogue, really a second home. How can any of this be replaced?

Our home is big enough to host dinners, holidays, family visits, grandchildren playing with old toys, and dirt and water. It's always a big hit. So why would we leave? And how or why do we decide to leave?

Because, at some point, decisions have to be made. Our oldest son is moving to Philadelphia, and our youngest son, his wife, and our wonderful grandchildren live in Long Island. My brothers and two nephews live in New Jersey, where I was raised. "All" left in Baltimore are our friends (more like family), memories, and everything familiar to us. We know our doctors, hospitals, and food stores, how to get places, who to call if we need something done, etc.

But we are now both 70 and need to think of the future. And as my son puts it, not "if" something happens, but "when." We must move while still independent, can drive, make new friends, and make a new life. But it won't be easy. Something many of us are faced with as we age.

Years ago, we all lived near each other and needn't uproot ourselves. Children didn't routinely move away from home. But times have changed. And so must we all.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Beware of Medicare Fraud
Most of us have heard that it exists but don’t pay much attention to it until it happens to us. And then, WOW. How does this happen, and what do we do about it? I don’t always look at my EOB’s (explanation of benefits) from Medicare. These tell what they pay out, and since I am not responsible, I don’t pay them much mind. But I realize now that it is imperative to look.

Medicare fraud and the amount we pay monthly for our premiums is growing. My husband and I are now paying $50 apiece more each month than we did a year ago. And it will only get worse. I opened my EOBs today for my Medicare Part B, and the first line was, “This is not a bill.” I learned that someone in Baltimore has been billing monthly “intermittent urinary catheterization” to my account, to the tune of $20,000 that Medicare has paid.

According to a recent article in The Washington Post, nearly 2 billion dollars were billed for these fraudulent catheters last year alone! Just think how that money could have been used! Perhaps cheaper costs for life-saving medications, i.e., Eliquis or inhalers, to name a few.

The only way to protect myself is to get a new Medicare number, but then I have to change it everywhere I have used Medicare. I chose not to change it now, but I will check my EOBs every month to be sure it doesn’t happen again. Now, it is up to Medicare to get their money back.

How do we stop it? I don’t have the answer, but I ask all of you to review your EOBs monthly and if incorrect, report it to Medicare. Maybe then we can stem the flow of fraud.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
A Vital Question
Today, I spoke with old friends who are awaiting the imminent death of another friend and hospice placement. The news came as a surprise; she didn’t want anyone to know which was her right and privilege. However, the family had not prepared for the next steps. She is currently in the hospital before going to hospice. I asked the family a simple question that needs to be discussed in every situation when facing the death of a loved one. And too often, it isn’t. They were preparing to leave for the night, and I asked them, “Are you okay if she dies and nobody is with her?” The question gave them pause, and the response was “Wow”! We discussed this, and they were okay if they were not with her.

There is no right or wrong answer here. Some people choose to die alone, even in a coma. My mother-in-law was in a coma, but when we left her in hospice for dinner (the first time in 5 days), she was still breathing well, was comfortable, and did not appear to be “close.” We promised we would all be back after dinner. As soon as we finished eating, we got the call. We think she realized we were all together and spared us being with her when she took her last breath. She had made the decision. And we were okay.

Some people don’t want to be alone and want a loved one to hold their hand; others prefer to be alone. Talk about it with your loved ones. Be at peace.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
Prescription Follow-Up

Last week, I wrote about the problem of getting an inhaler for my asthma. What was interesting was the disparity in prices. I finally found one through Good Rx, but you must price-check again. Costco through Good Rx was $190, and $49 at CVS!! Both prices were through Good Rx. How does this happen, and why?

The saga doesn't end. I never got a call that the prescription was ready; CVS didn't answer the phone (pharmacies are frequently understaffed), so I drove there. The prescription was never filled, and then they realized they didn't have it in stock.

We can't quit. Not if we want to take care of our health. Is it fair? No, but it is reality. I have had great difficulty filling this prescription and getting it at the best possible price to begin using it. This is only one of the many challenges in caring for our health. If you don't have the time to do it yourself, hire an advocate. It will end up being cheaper in the end.
. .

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
The Cost of Medication
For the first time in my adult life, I wavered about going to the pharmacy and picking up a prescription medication for myself. And I really understood what so many Americans are going through, and the realization hit me hard.

My doctor prescribed an inhaler for asthma, one that I will be using for quite some time, and my Medicare insurance didn't cover it. They don't really "cover" the majority of inhalers, and it shocked me. I’ve heard about this, but until it hit home, I didn’t pay it much mind. I have made many phone calls, substitute it for a different one, but even using Good Rx, (or a similar pharmacy) it is still ridiculously expensive. I will get it tomorrow, but not before agonizing about it and wondering if I "really need it" or "can I take it half the time."

We can afford it, but the price of prescription medications adds up, and along with the ever-increasing cost of our monthly Medicare Part B and supplemental insurance, it gives us sticker shock. Our retirement budget for health care did not account for the ever-increasing cost of monthly payments nor necessary medications that we took for granted before.

Fortunately, we can adjust our budget, but how many millions of people can do this? How many people go through their days and nights having difficulty breathing, chest discomfort, migraine headaches, uncontrolled blood pressure, and can't get to their doctor or pay for the needed medications?

Many people with asthma are poor and live in homes and neighborhoods where living conditions exacerbate asthma they can't control. Something must be done.

In the meantime, I found the lowest price I could for my medication (not the first or even second choice of my physician), but good enough, and I will get better. As an advocate for myself and others I know how to make the system work. But there has to be a better way.

Katz Patient Advocate Inc. When someone is diagnosed with cancer or a chronic, life altering disease, it can be terrifying. Man

Health Tips by Myra:
The Cost of Medication
For the first time in my adult life, I wavered about going to the pharmacy and picking up a prescription medication for myself. And I really understood what so many Americans are going through, and the realization hit me hard.

My doctor prescribed an inhaler for asthma, one that I will be using for quite some time, and my Medicare insurance didn't cover it. They don't really "cover" the majority of inhalers, and it shocked me. I’ve heard about this, but until it hit home, I didn’t pay it much mind. I have made many phone calls, substitute it for a different one, but even using Good Rx, (or a similar pharmacy) it is still ridiculously expensive. I will get it tomorrow, but not before agonizing about it and wondering if I "really need it" or "can I take it half the time."

We can afford it, but the price of prescription medications adds up, and along with the ever-increasing cost of our monthly Medicare Part B and supplemental insurance, it gives us sticker shock. Our retirement budget for health care did not account for the ever -increasing cost of monthly payments nor necessary medications that we took for granted before.

Fortunately, we can adjust our budget, but how many millions of people can do this? How many people go through their days and nights having difficulty breathing, chest discomfort, migraine headaches, uncontrolled blood pressure, and can't get to their doctor or pay for the needed medications?

Many people with asthma are poor and live in homes and neighborhoods where living conditions exacerbate asthma they can't control. Something must be done.

In the meantime, I found the lowest price I could for my medication (not the first or even second choice of my physician), but good enough, and I will get better. As an advocate for myself and others I know how to make the system work. But there has to be a better way.