Reasonable Accommodations

Jennifer Esposito is just one of the ever-growing list of celebrities diagnosed with celiac and/or living a gluten-free lifestyle.  Diagnosed with celiac in 2009 after an apparently long struggle with the illness, she has become a vocal advocate for celiac awareness.  She has a blog and has started a foundation -- called the JW Foundation-- to fund research, advocacy and awareness.  And apparently she was recently effectively fired for having the disease.

F&*K*#&$!!!

Damn you people on the train, with your germs and your sneezing and your failure to cover your mouth!  Ok, so maybe its not the best idea to lick the poles on the metro (my toddler, not me).  Lesson learned.  Thank you.  Again, my household has been struck down.

For the first day, I thought it was allergies.  Really, really bad allergies.  But no.  Is it just me or do celiacs get sick all the time?  I guess it makes sense, right? Compromised immune system and all?  I actually thought that once you were on the diet and no longer testing positive, you were "normal".  This does not seem to be the case.  I think, in the last three months, I've been sick--with a cold, flu, etc.--at least three times.  That's a LOT!  And I'm not a good sick person.  I'm whiny, pathetic, irritable, cranky.  (When I'm sick!)

The icing on the cake is that, while food is increasingly labelled gluten-free, medication is not.  Apparently, there are proprietary issues; pharmaceutical companies have resisted any attempts to require allergen labeling because they fear that their super-secret formulas will be stolen.  Somehow.  From the indication that it has wheat in it.  Because the presence of wheat is clearly the missing link.  Anyway.  Suffice it to say, it can be tricky to determine whether a medication has gluten in it.

Take Zyrtec, for example (I thought I had allergies).  Google it.  Some sites say "zyrtec has gluten."  Others claim that calls to the company have assured them that the medication is safe.  Still others suggest that some dosages are fine, while others are dangerous.  Calls to the company--typically the go-to measure of last resort--were, frankly, no more helpful. I got transferred around.

I don't have a great suggestion here.  I'm worn down.  Really, I don't understand the logic behind not mandating the drug companies label the presence of common allergens.  I'm sure I'm overly cynical, but I have a fair certainty that effective lobbying has played a role.  What can you do to fight that?

Meanwhile, it's late.  I'm sick.  I need to go to bed.

Magnesium Deficiency in Celiacs

I was reading this month's Oprah -- yes, I'm a little embarrased to admit it, but I read it for the articles! ahem--and noticed a tiny little reference to the glutens.  In a question and answer article on medical issues, someone wrote asking about magnesium and copper deficiencies.  The author of the question had been told by a dietitian that he had a severe magnesium and copper deficiency.  The expert responding to the question was skeptical, stating that it is rare to see the symptoms of a severe deficiency in these minerals in anyone not suffering from "Chron's disease or a gluten sensitivity".  Interesting.  Magnesium deficiency can cause serious symptoms, like frequent migraines, personality changes, depression and exhaustion.  Worth checking into, for sure. 

The Economic Benefits of a Celiac Diagnosis

I got a medical bill yesterday.  You know those notices you get from your insurance company that say how much the doctor's office charged for a service, how much you paid, and how much they are willing to pay? Before I was diagnosed with celiac, I used to get at least one a week.  I was going to the doctor so often, I was convinced that they had a little note on the chart saying: "This one's crazy--disregard all complaints."  I had gotten to that crisis point that apparently happens frequently for celiacs--my system was essentially shutting down.  In many ways, my life and health have improved exponentially following the diagnosis, yet I have health issues that remain because it took so long to find out what was wrong.  So I continue to get those medical bills.  Luckily, as I've said here before, I have pretty great health insurance.

Just based on my own experiences, I could have told you that undiagnosed celiac causes an enormous economic burden both for individuals and for the health insurance industry.  However, you do not have to take my word for it; the Journal of Insurance Medicine published a study back in March discussing this very phenomenon.  Dr. Peter Green of the Celiac Disease Center at Columbia University joined forces with CIGNA HealthCare and, using anonymous data collected from 1999 through 2003, compared more than 10 million managed care patients in the U.S.  They divided patients into four sub-groups: (1) newly diagnosed with celiac disease, (2) one symptom of celiac disease but no official diagnosis, (3) two symptoms of celiac disease but no official diagnosis, and (4) three celiac disease symptoms but no official diagnosis. After analyzing the medical resources utilized by each of the four groups, including amount and cost, they found that, after the first few months following diagnosis, the first group had consistently lower resource use and overall costs than the other groups. 

Clearly, the study is not perfect.  But how could this not make sense? Before diagnosis, those suffering with untreated celiac are sick.  The list of symptoms is ridiculous.  You have migraines, stomach problems (to put it mildly), extreme fatigue, skin issues, mental health problems.  It goes on and on.  Of course you are going to see the doctor, if you can.  And the longer you go with untreated celiac, the sicker you become.  It is an autoimmune disease; eventually it will wear your body out.  It has been associated with other autoimmune diseases, cancer, osteoperosis, chronic fatigue.  When you get to the point of other illness involvement, the medical costs are not going to go down.  And those costs are pervasive. 

The conclusion of this study was that early diagnosis would be economically beneficial to the health insurance industry.  Yes! An important point! The blood test that ultimately was responsible for my diagnosis cost them about $100 versus the many, many thousands that they had put out previously just looking for what was wrong.  But I would take it a step further.  Early diagnosis is economically beneficial to just about everyone.  Besides the pure health costs, imagine the work time that would not be lost for pointless medical tests, unnecessary hospital stays, care for family members who cannot be cared for by the patient.  When you get right down to it, considering that an estimated 1 in 133 people have celiac but only a tiny percentage of those are currently diagnosed, the costs of performing the test on everyone are probably lower than the costs associated with undiagnosed celiac.  (That might be an exaggeration.  I clearly have not done those calculations.) 

While health care is on everyone's minds, its a great time to suggest that your loved ones get tested.  A simple blood test might save more than your friend's life... it might just save everyone a ton of cash.