Mom & Me Four Archive

...despite Mom complaining of unusual stiffness and body aches both morning and night. Some of the detail is at The Dailies post for yesterday. Besides what's reported there, Mom was very animated, helped me bake what looks to be some luscious banana bread almost exactly from a Joy of Cooking recipe that does not include any liquid other than bananas (a lot) or eggs. Mom mashed the bananas. Her napping time was shortened, as well, and we spent a lot of time just talking, watching more episodes of Northern Exposure, only one informal exercise session but she did well (she doesn't really realize we're doing exercises when we do these and I leave her in her rocker). It was a great rainy day for both of us.
    I continued my research on alternate sources for Niferex-150 after she went to bed. Much to my surprise, one of the links buried a couple of pages back brought up a TriCare Pharmacy listing for Niferex-150 Forte, which, if prescribed for her, we'd be able to get for an astoundingly reduced price. The problem is that it also includes megadoses of Folic Acid and Vitamin B-12, neither of which Mom needs. I decided to fax the doctor today with the following discussion of the possibility of him prescribing this supplement for her:

Possible Prescription for Niferex-150 Forte:
    Currently my mother is taking two Niferex-150 capsules a day to keep her anemia in relative check. This iron supplement is strictly OTC and not covered by her Medicare/TriCare prescription coverage. We are paying about $80.00 per 100 capsules for this supplement. I've just discovered that Medicare/TriCare does cover Niferex-150 under prescription if it is prescribed as "Niferex-150 Forte". The cost to us would be $27.00 for a 90 day supply (180 capsules).
    There is, however, a problem. Each Niferex-150 Forte capsule contains 1 mg Folic Acid and 25 mg Vitamin B12. My mother always runs high on B12 on her blood tests and frequently runs high on Folate. Her last blood tests for these were taken on 9/02/04 (you should have copies of these from your previous office):
Folate: 24 ng/ml which was nominally high for Prescott elevation (reference range 6.0-23.0) and fairly high for Mesa elevation (reference range 3.0-17.0).
B12: 1092 pg/ml which was fairly high for both Prescott elevation (referene range 220-960) and Mesa elevation (192-982). She has, in the past, run as high as 1200 pg/ml.
    There are a couple of adjustments I could make in her supplements to alleviate some of the problem:

• I can stop her extra 400 mcg Folic Acid Supplement and see if I can find a multi-vitamin with a lower dose of Folic Acid (her current multi-vitamin contains 400 mcg, so she's getting a total of 800 mcg a day at present). If I can't find an adequate multi-vitamin with a lower dose (or no dose) of Folic Acid, continue her current multi-vitamin and stop her extra Folic Acid supplement, with two Niferex-150 Forte capsules a day she'd be receiving a total of 2400 mcg Folic Acid daily, 200% more than she currently receives.
• I can try to find a multi-vitamin with a lower lower dose of B12 (her current multi-vitamin contains 30 mcg). If I can't find a lower dose in an adequate multi-vitamin and switch her to Niferex-150 Forte, she'd be receiving 167% more B12 than she is now.

    We can afford to continue to buy the OTC Niferex-150 without added Folic Acid and B12. Although it would be nice to be able to save a substantial amount of money by getting this iron supplement by prescription, I'm also leery of the necessity to also raise her B12 and Folic Acid, in the bargain, by the amount required by the prescription iron supplement. In your opinion, would it be best to stay with the non-additive OTC supplement and bite the bullet regarding cost or will she be okay on the prescription supplement with the substantial increase in B12 and Folic Acid? I understand that you may want to run some inclusive iron TIBC, B12, Folate and possibly other tests before deciding.

    Later on, before her appointment next week, I'll probably do some research on the long term effects of high levels of folate and B12, if any exist.
    In my search I also found an article that addresses iron supplementation for people with Chronic Kidney Failure, chiefly those who are on dialysis, published by the National Kidney Foundation. It addresses supplementation by injection, as well as maintaining adequate levels of Erythropoietin. Although interesting, I'm not sure the article applies to Mom. First of all, she's not on dialysis and appears to be quite a ways away from that possibility. Second, there has been, up to 9/02/04, no indication that her erythropoiesis is challenged. Third, everything except her direct anemia indicators run fine to high. It's possible that I'm misunderstanding, from Mom's perspective, some of what the article talks about. And, of course, it wouldn't hurt to run new tests on all those items related in any way to iron deficiency anemia. Third, she rarely reaches a hemoglobin count of 11 or above, but her doctor is satisfied with her range and I can't help but think it's because everything else indicates that her body is doing the best it can and all other indicators suggest that further types of therapy (except for blood transfusions if she runs too low) would not help. I'm not sure that I'm even going to mention the article and its recommendations to her PCP on Tuesday. I'll probably just wait and see what he says about the possibility of prescribing the enhanced Niferex-150.
    When I peaked in on her at 1030 her eyes were open but she asked me to let her continue to sleep. As I close this post it is noon. I'll check on her again but if she wants an extra hour or so, I'll let her go. We're experiencing the tail end of one low and the advance feelers of another which promises rain tomorrow, make that Saturday (I'm a day ahead of myself).
    Later.