| | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | OP  Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | I have noticed that my dry mouth has gotten a tad drier during the night for the past couple of weeks. I have not done anything different but it has none the less. So Sunday I wake up to a slightly burning tongue with a coat on it and yesterday my PCP called in a prescrip for Diflucan. When I get to Walgreens to pick it up the pharm guy says my doc ordered 1 a day for 7 days but my ins will only pay for 2 a month and that he had never heard of someone taking Diflucan for 7 days. Anyway I took my one pill and will see. Anyone else told to take that many?
Man it only takes the slightest change in my (our) mouth for thrush to take over!
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: Mar 2008 Posts: 3,082 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Mar 2008 Posts: 3,082 | David
I've had similar issues with insurance over Diflucan. The insurance companies base their restrictions on the assumption that Diflucan is being prescribed for a vaginal infection which does not get a daily dose. Luckily for me, at that time I was getting my prescriptions filled at the hospital pharmacy. The pharmacist knew that your dosage is standard for oral thrush in cancer patients and he called and argued with the insurance company. He had special numbers to call a supervisor since similar issues came up all the time with cancer patients and did get my insurance to pay for it.
Since I'm not going to the hospital daily, when I get thrush, I use Mycelex lozenges (generic name is Clotrimazole 10 mg troches) which dissolve on your tongue and are really effective. Unlike Diflucan which courses through your whole body and can do a number on your kidney and liver, this just hits topically on the thrush on your tongue. You might want to ask your doctor next time.
good luck - I hate it when the thrush comes back
Charm
65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin
Passed away 4-29-13
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | OP Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | That's I just e mailed my PCP about the lozenges.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: May 2002 Posts: 2,152 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: May 2002 Posts: 2,152 | David,
I've had similar problems with the pharmacy and Diflucan. The dosage for a vaginal infection is higher and you only need one. Normally, I take pills for 14 days for thrush. Once the pharmacist orders the lower dosage, the insurance covers it but it usually takes a phone call and an argument. Sorry to hear you have it again. What the heck triggers this?
Take care,
Eileen
----------------------
Aug 1997 unknown primary, Stage III
mets to 1 lymph node in neck; rt ND, 36 XRT rad
Aug 2001 tiny tumor on larynx, Stage I total laryngectomy; left ND
June 5, 2010 dx early stage breast cancer
June 9, 2011 SCC 1.5 cm hypo pharynx, 70% P-16 positive, no mets, Stage I
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | OP Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | So what is the dosage for oral uses?
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: Mar 2002 Posts: 4,918 Likes: 66 OCF Founder Patient Advocate (old timer, 2000 posts) | | OCF Founder Patient Advocate (old timer, 2000 posts)
Joined: Mar 2002 Posts: 4,918 Likes: 66 | David that one pill dose is weird. I have never been on less that 100mg/day for 5-7 days.
Adults: Vaginal Candidiasis: 150mg PO single dose. IV/PO:
Oropharyngeal Candidiasis: 200mg on 1st day, then 100mg qd for at least 2 weeks.
Esophageal Candidiasis: 200mg on 1st day, then 100mg qd for at least 3 weeks and for at least 2 weeks following resolution of symptoms. Max: 400mg/day.
Systemic Candida Infections: Up to 400mg/day.
UTI/Peritonitis: 50-200mg/day.
Cryptococcal Meningitis: 400mg on 1st day, then 200mg qd for 10-12 weeks after negative CSF culture.
Suppression of Cryptococcal Meningitis Relapse in AIDS: 200mg qd.
Prophylaxis in Bone Marrow Transplant: 400mg qd.
Renal Impairment (Multiple Doses) CrCl≤50mL/min (no dialysis): Initial: LD 50-400mg. Maint: Give 50% of recommended dose.
Dialysis: Give 100% of dose after each dialysis.
Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | OP Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | Thanks, I'm going back to the ins company now that I'm armed with this info.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: Jun 2007 Posts: 10,507 Likes: 7 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 10,507 Likes: 7 | I take the same as Charm, the Clotrimazole when I get thrush. You put the wafer in your mouth and even with limited salivia it will dissolve. I think the dose I had was 5 per day.
Brian, you are way too smart!!!! Technical info always goes right over my head.
ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive  | | | | | Joined: Jul 2009 Posts: 1,409 Patient Advocate (1000+ posts) | | Patient Advocate (1000+ posts)
Joined: Jul 2009 Posts: 1,409 | David, I was on 100 mg of Diflucan daily during the entire course of my radiation, and probably for awhile after, can't remember.
You'd think the pharmacist might get a hint that you weren't using it for vaginal purposes by looking at you...
David 2
David 2
SCC of occult origin 1/09 (age 55)| Stage III TXN1M0 | HPV 16+, non-smoker, moderate drinker | Modified radical neck dissection 3/09 | 31 days IMRT finished 6/09 | Hit 15 years all clear in 6/24 | Radiation Fibrosis Syndrome kicked in a few years after treatment and has been progressing since | Prostate cancer diagnosis 10/18
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | OP Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | OK so here's what happened. I called my PCP who called the pharm guy who said the PCP had to call the ins co and complain. PCP called ins co and they said pharm had to fax their denial to PCP who then had to write a letter to ins to appeal their decision by claiming (and you're going to love this) that his prescrip was MEDICALLY NECESSARY!!! WTF, I kinda thought that was the whole purpose of a prescrip in the 1st place. So I guess doctors should have a check off on their prescrip pad; check here is medically necessary and check here if not medically necessary! I would have to pay full price for the pills until the appeal was decided. So I asked my wife to pick up the remaining 5 pills at a cost of $89 and when she got there the pharm said "why don't you renew your Discount Prescrip Card for $20 (annual) and then you will only have to pay $20 for the 5 pills." What's further amusing is that after arguing over this for 3 days, paying $4 a pill with Walgreen's discount card is $10 a pill cheaper than what my ins discount was!!
Anyone calm has been restored in my world and now I can concentrate on getting rid of this burning crap.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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