It’s disappointing to see even Reuters dancing around the topic of the fully justified and wildly popular outrage against corporate America. They’re trying so hard to whitewash this and paint support for Luigi as “disturbing” while painstakingly tip-toeing around the actual issues. I expected better of Reuters than contributing to the bootlicking editorializing that’s going on in this article.

Thankfully, I do meet criteria for medical necessity, it’s just a matter of getting it done in the middle of medical school instead of when I’m done with everything and actually have a substantial amount of time off for full recovery.

This is why I’m accelerating my plans for a hysterectomy by a year even though it will complicate quite a few things for me.

This is entirely unsurprising. Hopefully they can wrangle something functional out of the insurance at some point.

Also check out www.pirateship.com

In my family medicine rotation a couple months ago, we got it approved for someone with pre-diabetes, high blood pressure, and stage 2/3 kidney disease (which is not very advanced. A lot of people over the age of 35-40 can technically fall into stage 1/2.)

I don’t think the poor people have empathy for rich people, rather I think it’s a jealousy problem or a self-serving attitude. They’re convinced that they’ll hit it big one day and they don’t want to pay a bunch of taxes when they’re the billionaire. It’s this perversion of the American dream in which people think of themselves as “temporarily disgraced m/billionaires” and of course they’re going to become fabulously wealthy…somehow…any day now…

If they have cardiovascular disease or kidney disease, those are getting added as indications for the GLP-1’s so they might be able to resubmit the authorization/claim with those diagnosis codes added to get it covered.

I do recall having done the prior authorization for a medically necessary breast reduction that was not covered by the patient’s plan. Apparently, she worked for a religious organization and they opted out of coverage for ALL breast surgeries that were not mastectomies for breast cancer. So, yes, I am unfortunately familiar with the carve-out plans.

In line with what you are saying, I believe that it should be a centerpiece of the current conversation to address the “just world theory”, especially in the context of corporate-managed healthcare. For Luigi, and for any human walking around in America today, we’re one bad/unlucky injury away from ending up in the “discard pile”, especially if our insurance drags their heels and uses the Deny, Delay, Defend playbook. In the “just world theory”, there’s some unconscious belief that people are disabled or damaged or broken or wrong (in the eyes of a heavily discriminatory society) deserved it somehow, and if one is virtuous enough, eats a good diet, gets exercise, etc etc…that won’t happen to them.

This is a perfect case study. Luigi was probably pretty comfortable and pretty insulated from the hell that is the corporate healthcare system in America…until he had an unlucky injury that changed his life forever. You don’t even have to be doing something vaguely risky like surfing. You can end up with a severe injury that will leave you in chronic, unbearable pain for the rest of your life if some drunk driver runs a red light and slams into your car. There are some absolutely revolting people who will then spout some nonsense about your misery and pain being “part of God’s plan”, but they’d probably change their tune once it’s their spine being bolted back together.

Empathy is a scarce commodity these days, and we’re going to need to foster the growth of a whole hell of a lot more of it if we want to keep this spark alive.

Here’s a link to the most credible version of the manifesto we have: https://www.kenklippenstein.com/p/luigis-manifesto

Ken Klippenstein is a very reliable journalist and this version contains the snippets that have been released by law enforcement. Also, considering the thing was hand-written, that very long version involving his mom is dubious. (And there’s not any good evidence that his mom is in anything besides decent/good health)

Sorry for the very late reply (I just found this community). Disclaimer: I am a medical student and my recommendations here are things to discuss with your primary care provider and are not a replacement for care and consultation from a provider that you see directly and is familiar with your full medical history.

Shingles is hella awful and I’m sorry you’re dealing with it (I hope you haven’t had a recurrence since you posted this). It is more likely to show up at sites of previous injury because it is a virus that hangs out in nerve endings that gets reactivated, usually when you are stressed out or your immune system loses control of it. If you had traumatic injuries to an area, the nerve endings there are going to be more susceptible to the viral reactivation.

You could/should ask about getting the Shingles vaccine, especially if you have other conditions that put you at higher risk for immune problems as it can still be at least partially effective in reducing the frequency, severity, and duration of future recurrences.

For pain management, heat is a good way to help improve circulation to the area to increase the number of white blood cells in the area to help with healing, and cold is a good way to numb the discomfort for a while. Over the counter pain medications are variably helpful, and if the pain is really bad, you can alternate Tylenol and ibuprofen on a schedule. Staying on top of pain is always more effective than trying to catch up to it. The OTC pain med alternation schedule I recommended when I was an assistant at a surgery clinic (based on the instruction/direction of the surgeons) is as follows: Example: Tylenol (Acetaminophen is the American generic name, Paracetamol is the European generic name) Ibuprofen (Motrin and Advil are the brand names)

• 8:00AM: 650mg to 1000mg Tylenol
• 12:00PM: 600mg to 800mg Ibuprofen
• 4:00PM: 650mg to 1000mg Tylenol
• 8:00PM: 600mg to 800mg Ibuprofen

(if it’s extremely bad pain, set alarms to take meds in the middle of the night)

• 12:00AM: 650mg to 1000mg Tylenol
• 4:00AM: 600mg to 800mg Ibuprofen

You can go down to 500mg of Tylenol and 400mg of Ibuprofen for each dose if it’s less severe pain that is still constant

WARNING!! DO NOT EXCEED 3000MG OF TYLENOL IN A 24H PERIOD. Tylenol overdose can lead to serious liver damage and life-threatening complications if it gets bad enough. Warning: Take Ibuprofen with food and limit regular dosing of Ibuprofen to 3 days if possible as excessive use of NSAIDs like

Ibuprofen can cause stomach ulcers, and long term use can cause kidney damage. Do not combine Ibuprofen with other NSAIDs including Aspirin, and do not take Ibuprofen if you have kidney disease and have been instructed to avoid it.

These medications are safe if taken as directed and as minimally as possible, but be sure to read the labels of ALL medications that you take as some over the counter products contain Tylenol or Ibuprofen without listing it clearly on the box. (It will be listed in the “Active Ingredients” section on the back of the box) Common products that have these as part of a cocktail are things like Midol or Dayquil.

For me, it’s not the professional reputation, but the second that kind of thing gets tagged onto a patient’s chart, it becomes extremely hard to expunge. There are a lot of patients with mental illnesses (some which are misdiagnoses) that face significant problems because of that diagnosis. If a chart gets flagged with “homicidal ideation” at any point, that patient will forever be flagged as dangerous and people will be suspicious of them immediately.

FIP Warriors is who we went through, but it progressed too quickly because the fluid accumulation was in his lungs, not his abdomen.

That medication is quite new to the market and wasn’t available when this happened about 4 years ago, but I will mention this to our current vet so that she knows about it.

Careful with that one. Big pharma killed my cat once.

My cat came down with Feline Infectious Peritonitis which is a coronavirus that is lethal to cats when the virus mutates and becomes FIP. FIP is 100% fatal without treatment, and there is now a treatment (originally developed at UC Davis) that is now owned by a big pharma company. They shut down the feline clinical trials in 2020 because they also make Remdesivir, and there was a concern that if there were any problems with the feline drug trial, the FDA might not approve Remdesivir for COVID. You can buy the drug on the internet from China, but it’s a 12 week course of twice daily injections, and you’re gambling on whether you got a good batch every time you get a shipment.

By the time we found this out, it was too late to save our kitty, so he crossed the rainbow bridge.

You have to make a report if the patient expresses homicidal ideation, intent, and a plan with a specific target or targets in mind. If the target is a particular person (like a partner or friend) you are supposed to notify that person directly or ensure that the police notify them.

Establishing any kind of precedent that chronic pain = homicidal ideation and intent is an extremely bad idea, and not something I’m even willing to joke about.

Unfortunately, the swing to the right and the rise of shit like “Blue Lives Matter” has changed this in some places. When I was in the western part of Virginia for school, there was a local car dealership called “Pinkerton” and I saw their dealership license plate frames and emblem on a LOT of cars in the area. Many of those cars also had the Gadsden vanity plates and a bunch of blue lives matter, trump, etc. stickers on them.

Unfortunately, that would end up under the Tarasoff precedent and we would be required by law to report it to police and the intended target. There’s better ways to weasel around this when filing insurance paperwork, but we’ll have to have a designated person in the clinic whose job it is to fight with the insurance companies.

I just want to clarify that these stories are about patients I have cared for. I have had my own personal fights with insurance regarding coverage for life-preserving medications and diagnostic testing for damage caused by incorrect medications that I used to be on, but what I discussed here are other people whose medical care I was involved in.

Pain makes people desperate. Desperate people are not known for being particularly calm about things, and it is entirely unreasonable to expect calm and decorum from someone in constant pain (that can be improved if not eliminated by certain treatments that are unfortunately usually quite expensive).