First Day In The Canadian Health Care System

July 19, 2011

So I finally went to the doctor today - my first foray into the Canadian Health Care System, or as American Republicans would call it:  the Socialist Medical Gulag.

For those who are unaware of my medical background, let me give you a quick summary:

In 2005, I was diagnosed with Common Variable Immuno Deficiency (CVID) , a genetic auto-immune disorder that is extremely rare in adults, that keeps my body from being able to produce red and white blood cells properly.  The CVID also causes an exacerbated and severe atopic dermatitis, a painful skin condition that leaves me itchy from head to toe 24/7.  There are currently over 20 different prescriptions that I need and use, the two most important being methadone (to control chronic pain) and interferon-gamma 1b (a transplant rejection drug that keeps me from itching), both being very hard to get medications.  I also need to monitor my blood levels to make sure they do not drop too low, causing me to need a transfusion.  There is no cure for either, simply management.

Kelowna is a town of only 130,000 people, 4 hours away from Vancouver and 6 hours away from Calgary.  This is going to make finding the right doctors a challenge.

So I went to the walk-in clinic today, the first step in getting set-up with a primary care physician.  When I arrived, the waiting room was completely empty.  After informing the girl at the front desk that I was still a few weeks away from getting my Canadian Health Care card, she told me it was going to be an expensive visit, out of pocket.  I panicked.  I was told on the phone the day before that it was only going to be $60.  "Oh, yes, it is $60," she told me, "I'm sorry it's so much."  Again, I laughed at the notion.  Some people have $60 co-pays for an insurance-covered doctors visit in the States.

I wasn't even done punching in my pin on the debit machine when I was called back.  Never in my life have I been called back to see the doctor that fast.  No need for the solitaire game on the iPod in my pocket.  I was put in a room like any other doctor's exam room in the States, but instead of taking my blood pressure, temperature, height & weight, I was only asked what the purpose of my visit was.  I told her I needed some prescription refills and referrals to see specialists.  And with that, she nodded absently and walked out of the room.  Literally 15 seconds later, the doctor came in.

I told him what I was there for.  When I told him why, giving him my diagnosis, he stopped up short, his eyes widened a little.

"You have a rare auto-immune disease?"

"Yes"

"So why did you come to Kelowna?"

"My wife got a job here with Disney."

"And you still came here knowing you have what you have?"

"Yes.  I knew finding doctors might be a challenge..."

"Oh, you ain't kidding!"

He took my list of medications, his eyes growing wider, his head shaking more and more.

"You're on methadone?"

"Yes.  For chronic pain management."

"THAT is going to be your biggest problem."  It seems that you need a very special license in Canada to prescribe methadone, it not being as readily available as it is in the States.  "I think I know of a doctor in town that has a methadone license, and from what I remember, he has a keen interest in unusual diagnoses."

There is but ONE hematologist in Kelowna.  The doctor was going to try and get me in as a new patient without having to wait a year to see him based on the rarity and uniqueness of my situation.  It was my hope when moving here that the very nature of my disorder, it's rarity (especially in adults) would pique the interest of the few qualified doctors to treat CVID in the area.  There is only one clinical dermatologist in Kelowna as well, but the hope is that my dermatological drugs could be prescribed, for now, by the hematologist (as the interferon is used by hematologists, making them familiar with it).  The wait to see this dermatologist is a year long as well, if not longer, based on the fact that she only holds hours 2 days a week (why?).

The doctor I saw today, Doctor Hopman, a dead ringer for Liev Schrieber, admitted this was the strangest set of circumstances he had seen in years.  He was flabbergasted that someone with as serious a condition that I have would move to such a small town in the middle of the wilderness.  Currently, my condition is pretty much under control, needing only regular blood tests to monitor my hematocrit, hemoglobin, and ferritin (iron) levels, plus my regular regimen of pharmaceuticals.  But even something as "simple" as that is already proving to be a challenge.  The big thing will be getting refills of methadone.  The problem with methadone is that once you start taking it, you cannot stop, you cannot miss a single dose.  The withdrawal symptoms of methadone are called worse than withdrawal from heroin.  You cannot quit cold turkey.  I once tried to ween myself off of it (I am on a relatively low dose), going from one pill in the morning and one at night, to one in the morning and a half a pill at night.  After being sicker than I have ever been in my life (and I do NOT exaggerate that) for 5 days, I caved and went right back to my regular dose.  It is imperative that I get my prescription refilled.

I'm to stop by and see Dr Hopman tomorrow to see if he was able to persuade his colleague who has a methadone license (and a curiosity in rare conditions) to take me on as a patient.

My whole appointment lasted 15 minutes, from walking in to walking out.

I was sent to the lab to get my blood levels checked.

Again, not having my health care card yet, I was told this was going to cost me.  Twenty one dollars.

This was the part of my day that showed the ugly side of the Canadian Health Care System:  the phlebotomists are evil. 

I've had my fair share of needle pokes, and I've had some bad phlebotomists, but this girl today was just brutal.  She jabbed that needle in my arm like she was John Travolta bringing Uma Thurman back to life after over-dosing in "Pulp Fiction".  I nearly involuntarily punched her in the face.  It was as if I was being mugged and stabbed by some LA Crip.  And they don't give you a band-aid.  No, they give you a cotton ball not big enough for a Smurf and tell you to hold it until you stop bleeding.  After 5 minutes, I asked if she could just tape the cotton ball to my arm.  She said if I didn't wait, it might bruise.  It was all I could do not to say "it's gonna bruise anyway after the way you raped me with that needle, She-Ra."  As I was leaving, I gave the frail old octogenarian coming in a sad, sympathetic look.

Because I will need to get my blood drawn every month, they gave me a card to carry with me that allows me to go into any lab in Kelowna and get my orders whenever I want.  And once I get my health care card, I can send my receipts in from today and get a partial reimbursement of the cost of my visits.

Needless to say, I will be visiting a different lab the next time I go.

So hopefully I will know more tomorrow after checking back in to see if I can get an appointment with a methadone doc.  Dr Hofman said I might have to keep coming back until he could get all my doctors set up and confirmed.  But then, if I can just "drop-by" and check on how he's coming along, then it's a small price to get into the right doctors.  "This is going to be a big challenge, but I will do everything I can to make sure you get the right doctors," he told me.  He gave me a free sample of a needed refill, saving me a trip to the pharmacy, then he welcomed me to Kelowna, to Canada, and asked that I give his congratulations to my wife on her new job.

Back tomorrow to see where the system takes me next.  Stay tuned!


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